Evaluation and Management of Real-World Cases of Psoriatic Arthritis - Episode 5

Goals of Therapy for Psoriatic Arthritis

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Leonard H. Calabrese, DO, shares insight on goals of therapy and factors that guide treatment selection for patients with psoriatic arthritis.

Anthony M. Turkiewicz, MD: We’ll move on to our second part or segment, and this goes into treatment, specifically looking at PsA [psoriatic arthritis] treatment with biologics that are available. Let me start with Len again for the big overview of looking at goals. We know that we want to care for our patients, make good decisions for them. But in essence could you summarize, in your mind, what are some of the goals of therapy, some of the factors that may guide your treatment selections in PsA? Can you talk about therapies and the comorbidities? What’s your 30,000-foot view on that, Len?

Leonard H. Calabrese, DO: This is high level; if I have a patient with psoriatic arthritis in front of me, I want to assess the severity. Is this a patient with rip-roaring arthritis and trivial skin? Or is this a patient with rip-roaring arthritis and terrible skin? Or is it somebody with terrible skin but trivial arthritis? All those lead to therapeutic decisions some way or another down the line. That’s assessing the global picture. Patients’ perspective on that is important, how much does the skin bother them? Is this something that’s interfering with their lifestyle?

Secondly, we want control of the musculoskeletal inflammatory disease, and is that just the Brooklyn hack of, “How is your Achilles tendonitis today? Or how is your overall arthritis?” Or are we going to measure something simple with a RAPID3 [Routine Assessment of Patient Index Data 3] or a tender and swollen joint count, which does not take a long time? I then throw in assessment of comorbidities in these people. Is there intercurrent depression? Is there obesity? Is there cardiovascular risk? Do they have anything that sounds like colitis or uveitis, as Sheetal has already mentioned?

Finally, going back to where we started from, what is their concern? What about this whole shooting match is bothering you the most? Is it the pain? Is it the embarrassment of skin? Is it fatiguability or other factors? I try to make a global assessment before I start my therapy, and then try to lay the money down where the patient is most distressed.

Transcript Edited for Clarity