Psoriatic Arthritis Care Priorities Differ Between Patient and Clinicians

Philip Mease, MD

Credit: Rheumatology Education Group

New research has highlighted differences between patient and clinician perspectives in aspects of psoriatic arthritis (PsA) care.¹

“To contribute to our understanding of “what matters” in PsA and compare patient and clinician perspectives, the current study aimed to assemble an extensive list of PsA concerns relevant to patients and clinicians in the United States and then use this list to assess priorities for these groups. This is the first multicenter US-focused study, to our knowledge, that allowed for de novo generation of individual issues affecting patients, extensive expert-led assessment to add new domains to previously identified domains of importance, and direct comparison of priorities between patients and physicians,” lead investigator Philip Mease, MD, Clinical Professor, University of Washington School of Medicine and Director, Rheumatology Research, Swedish Medical Center, and colleagues wrote.¹

Mease and colleagues conducted 4 focus groups of patients with PsA across 3 US rheumatology practices using mixed methods to identify attributes of PsA important to patients. They combined these attributes with extant attributes identified by a steering committee to create a comprehensive list. In separate patient and physician Delphi exercises, participants distributed 100 points across items on the list according to importance in relation to PsA.¹

In their paper, Mease and colleagues emphasized the importance of the study, as current treatment recommendations highlight the importance of shared decision-making between patient and clinicians but before this can be achieved, a greater understanding of what matters to each party must be achieved.²

Altogether, 51 items were generated describing PsA. The last Delphi rating exercise was completed by 38 patients and 13 clinicians. The investigators found that patients distributed points across a wider range of items than physicians. When comparing prioritization between groups using group mean score per item, they found that items with the top 10 mean scores for both groups included arthritis, disease activity, pain, fatigue, physical function, and spine symptoms. Disparity was seen across other prioritized domains including access to care, daily activities, stiffness, future health uncertainty, and sleep quality for patients compared with specific disease skin and joint manifestations, comorbidities, structural damage, and disease management goals for clinicians.¹

“In conclusion, our study revealed opportunities to improve disease assessment and shared decision-making by better understanding how PsA affects patients. The data revealed patient concerns about the future and life limitations as well as current challenges and impact on almost all aspects of daily life; because of the personalized nature of some of these areas, they could not be the focus in broader consensus projects and more research is needed,” Mease and colleagues concluded.¹ “Our study highlights the need for clinicians to ask and address “what matters” with patients to increase clinician empathy and empower patients to articulate their concerns, with the goal of improving communications, understanding, and patient-centered outcomes.

REFERENCES

1. Mease PJ, Husni ME, Siegel E, et al. What Matters in Psoriatic Arthritis: A Comparison of Patient and Clinician Perspectives. ACR Open Rheumatol. Published online January 12, 2025. doi: 10.1002/acr2.11781

2. Coates LC, Soriano ER, Corp N, et al; GRAPPA Treatment Recommendations domain subcommittees. Group for Research and Assessment of Psoriasis and Psoriatic Arthritis (GRAPPA): updated treatment recommendations for psoriatic arthritis 2021. Nat Rev Rheumatol. 2022; 18(8): 465–479.