患者报告的结局指标如何影响银屑病关节炎管理中的治疗强化和患者满意度？一项对503名患者的横断面研究。

How do patient-reported outcome measures affect treatment intensification and patient satisfaction in the management of psoriatic arthritis? A cross sectional study of 503 patients.

作者信息

Coyle Conor, Watson Lily, Whately-Smith Caroline, Brooke Mel, Kiltz Uta, Lubrano Ennio, Queiro Ruben, Trigos David, Brandt-Juergens Jan, Choy Ernest, D'Angelo Salvatore, Delle Sedie Andrea, Dernis Emmanuelle, Wirth Théo, Guis Sandrine, Helliwell Philip, Ho Pauline, Hueber Axel, Joven Beatriz, Koehm Michaela, Morales Carlos Montilla, Packham Jon, Pinto Tasende Jose Antonio, Ramírez Julio, Ruyssen-Witrand Adeline, Scrivo Rossana, Twigg Sarah, Welcker Martin, Soubrier Martin, Gossec Laure, Coates Laura C

机构信息

Oxford University, John Radcliffe Hospital, Oxford University Hospitals, Oxford, UK.

Department of Cellular and Molecular Medicine, University of Bristol, Bristol, UK.

出版信息

Rheumatology (Oxford). 2025 Jan 1;64(1):242-251. doi: 10.1093/rheumatology/kead679.

DOI:10.1093/rheumatology/kead679

PMID:38191998

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC11701309/

Abstract

OBJECTIVES

The AsseSSing Impact in pSoriatic Treatment (ASSIST) study investigated prescribing in routine PsA care and whether the patient-reported outcome-PsA Impact of Disease questionnaire (PsAID-12)-impacted treatment. This study also assessed a range of patient and clinician factors and their relationship to PsAID-12 scoring and treatment modification.

METHODS

Patients with PsA were selected across the UK and Europe between July 2021 and March 2022. Patients completed the PsAID questionnaire and the results were shared with their physician. Patient characteristics, disease activity, current treatment methods, treatment strategies, medication changes and patient satisfaction scores were recorded.

RESULTS

A total of 503 patients were recruited. Some 36.2% had changes made to treatment, and 88.8% of these had treatment escalation. Overall, the mean PsAID-12 score was higher for patients with treatment escalation; increase in PSAID-12 score is associated with increased odds of treatment escalation (odds ratio 1.58; P < 0.0001). However, most clinicians reported that PsAID-12 did not impact their decision to escalate treatment, instead supporting treatment reduction decisions. Physician's assessment of disease activity had the most statistically significant effect on likelihood of treatment escalation (odds ratio 2.68, per 1-point score increase). Escalation was more likely in patients not treated with biologic therapies. Additional factors associated with treatment escalation included: patient characteristics, physician characteristics, disease activity and disease impact.

CONCLUSION

This study highlights multiple factors impacting treatment decision-making for individuals with PsA. PsAID-12 scoring correlates with multiple measures of disease severity and odds of treatment escalation. However, most clinicians reported that the PsAID-12 did not influence treatment escalation decisions. Psoriatic Arthritis Impact of Disease (PsAID) scoring could be used to increase confidence in treatment de-escalation.

摘要

目的

银屑病关节炎治疗评估（ASSIST）研究调查了银屑病关节炎常规护理中的处方情况，以及患者报告结局——银屑病关节炎疾病影响问卷（PsAID-12）是否对治疗产生影响。本研究还评估了一系列患者和临床医生因素及其与PsAID-12评分和治疗调整的关系。

方法

2021年7月至2022年3月期间，在英国和欧洲各地选取了银屑病关节炎患者。患者完成了PsAID问卷，并将结果告知其医生。记录患者特征、疾病活动度、当前治疗方法、治疗策略、药物变化和患者满意度评分。

结果

共招募了503名患者。约36.2%的患者治疗方案发生了改变，其中88.8%的患者治疗升级。总体而言，治疗升级患者的PsAID-12平均得分更高；PsAID-12评分增加与治疗升级几率增加相关（优势比1.58；P<0.0001）。然而，大多数临床医生报告称，PsAID-12并未影响他们升级治疗的决定，反而支持减少治疗的决定。医生对疾病活动度的评估对治疗升级可能性的影响在统计学上最为显著（优势比2.68，每增加1分）。未接受生物疗法治疗的患者更有可能升级治疗。与治疗升级相关的其他因素包括：患者特征、医生特征、疾病活动度和疾病影响。