A national survey on the management of psoriatic arthritis using the Delphi method
E. Lubrano1, F. Cantini2, A. Mathieu3, I. Olivieri4, C. Salvarani5, R. Scarpa6, A. Marchesoni7
- Rheumatology Unit, Department of Medicine and Health Science “Vincenzo Tiberio”, University of Molise, Campobasso, Italy. firstname.lastname@example.org
- Division of Rheumatology, Hospital of Prato, Italy.
- Rheumatology Unit, Department of Medical Sciences, University of Cagliari, Italy.
- Rheumatology Department of Lucania, San Carlo Hospital of Potenza and Madonna delle Grazie Hospital of Matera, Potenza and Matera, Italy.
- Rheumatology Unit, Department of Internal Medicine, Azienda Ospedaliera ASMN, Istituto di Ricovero e Cura a Carattere Scientifico, Reggio Emilia, Italy.
- Rheumatology Unit, Department of Clinical Medicine and Surgery, University Federico II, Naples, Italy.
- Rheumatology Unit, ASST Orthopaedic Traumatologic Centre Institute G. Pini-CTO, Milan, Italy.
2017 Vol.35, N°2
PI 0214, PF 0220
PMID: 27607572 [PubMed]
Accepted : 13/06/2016
In Press: 31/08/2016
Accurate diagnosis and appropriate management of psoriatic arthritis (PsA) is essential to avoid unnecessary morbidity. Our aim in this study was to evaluate the current approach to the management of PsA among rheumatologists.
A 16-item online questionnaire, produced using the Delphi method, was submitted to a panel of rheumatologists who anonymously expressed their opinions on a scale from 1 (maximum disagreement) to 5 (maximum agreement). Positive consensus was defined by ≥66% of the respondents scoring an item 3, 4 or 5. Negative consensus was defined by ≥66% of the respondents scoring an item 1 or 2.
The surveyed rheumatologists agreed that in its early stage, PsA is characterised by the involvement of few joints and/or entheses and that psoriasis, although possibly absent, will be present in a patient’s past personal or family history. There was no consensus among the rheumatologists regarding normalisation of C-reactive protein levels and erythrocyte sedimentation rates defining remission. The specialists believed that clinical remission was achieved more frequently and for longer among patients with PsA than rheumatoid arthritis. The participants believed that neutralising antibodies altered the efficacy of anti-tumour necrosis factor agents and that monoclonal antibodies induced greater production of neutralising antibodies than receptor proteins. However, knowledge was somewhat lacking in relation to the prophylaxis of latent tuberculosis.
The data collected showed that the surveyed rheumatologists had a good knowledge of the diagnosis of early-stage PsA and a good understanding of its management in relation to its clinical phenotype, with the exception of the form having predominantly axial involvement.