Monitoring
An ideal monitoring approach is a comprehensive 'total care programme'.[131] The 'total care programme' for psoriatic disease is inclusive of care of the skin and joints, and social and mental care, along with the management of PsA-associated comorbidities.[54] It is not possible to provide this full spectrum of services in a single rheumatology appointment. An effective multidisciplinary approach involving other appropriate sub-specialists along with a dietary/lifestyle modification programme should be initiated with the help of the primary care physician.
While some patients may spontaneously go into remission, the majority of cases persist and potentially progress, leading to impaired function. Therefore, disease and drug monitoring are recommended on a regular basis.
C-reactive protein and physical examination, including joint, dactylitis, and enthesitis counts, and psoriasis extent (body surface area [BSA]), should be performed at each follow-up visit.
Patient global assessment and pain scores, as well as physician global assessment, should be documented at every visit using visual analogue scales.[39][Figure caption and citation for the preceding image starts]: Example of visual analogue pain scaleAdapted from Gould D, et al. Visual analogue scale (VAS). J Clin Nurs. 2001;10:706 [Citation ends].
The recommended frequency of the Health Assessment questionnaire (HAQ) or Short Form-36 (SF-36) survey functional review has not been determined, as these measures may not be sensitive to short-term change in synovitis burden.[40] The PsA Impact of Disease (PsAID) questionnaire, and the Patient-Reported Outcomes Measurement Information System-Physical Function (PROMIS-PF), are validated measures to assess disease activity and impact on the quality of life for patients with psoriatic arthritis, which may be performed at each follow-up visit.[42][132]
Radiographic monitoring for erosions and osteolysis in the hands and feet should be considered annually.
Full blood count and comprehensive metabolic panel (CMP) should be performed for those patients on disease-modifying anti-rheumatic drug (DMARD) therapy (particularly methotrexate, leflunomide, and sulfasalazine).
Patients on ciclosporin should have their blood pressure and creatinine monitored on a regular basis.
TNF-alpha inhibitor therapy requires critical assessment of an adequate short-term response (3 months) using an accepted disease activity score, such as the Psoriatic Arthritis Response Criteria (PsARC), the Minimal Disease Activity for Psoriatic Arthritis (MPA), or the Disease Activity index for PSoriatic Arthritis (DAPSA).[62][133] If patients fail to demonstrate acceptable response, treatment should be discontinued.
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