People with psoriatic arthritis (PsA) who were treated according to an aggressive and strict protocol called “treat to target” had better control of their disease than those who received standard care, according to a study presented this week at the American College of Rheumatology’s annual meeting in San Diego.

Psoriatic arthritis is a form of inflammatory arthritis that affects an estimated 30 percent of people with the skin condition psoriasis (marked by red, scaly, painful rashes). PsA can lead to pain, inflammation and, potentially, joint damage.

Previous studies have shown treat-to-target results in better outcomes for patients with other types of inflammatory arthritis, including rheumatoid arthritis.

“The study is the first to evaluate a 'treatment-to-target' strategy in psoriatic arthritis,” notes study author Laura C. Coates, MD, a lecturer at the University of Leeds in the United Kingdom. “The study confirmed that treating to a specific target can improve clinical outcomes for patients with psoriatic arthritis. Tight control led to a significant improvement in outcomes for both arthritis and skin psoriasis.”

Rates of Psoriatic Arthritis Higher Than Previously Thought

The study included 206 patients who had symptoms of PsA for less than two years and had not previously received disease-modifying antirheumatic drugs (DMARDs), such as methotrexate or leflunomide. The group was randomized to “treat to target” (T2T) or standard therapy.

Patients in the T2T group received methotrexate and were assessed every four weeks. Dr. Coates says they were asked about pain, disease activity and ability to perform daily tasks; they were also assessed for tender and swollen joints, tender spots where tendons and ligaments attach to bone, and whether skin psoriasis was active. Those who did not achieve minimal or no disease activity after 12 weeks were stepped up to additional DMARDs (combination therapy). If, after another 12 weeks, they still had not reached the target of minimal or no disease activity, they were either given a biologic drug or switched to another DMARD with methotrexate.

By contrast, patients in the standard care group were put on DMARDs but not treated according to any escalation plan, schedule or target; treatment was up to the individual doctor.