LAUSR

Psoriatic Arthritis (PsA) is a complex disease with profound physical and psychosocial effects. The core domain set for this condition was updated by the Group for Research and Assessment of Psoriasis and Psoriatic Arthritis (GRAPPA)-Outcome Measures in Rheumatology (OMERACT) PsA working group in 20161and the TICOPA (TIght COntrol of Psoriatic Arthritis) study suggested that adopting a ‘treat-to-target’ approach aiming for Minimal Disease Activity (MDA) could result in better clinical outcomes2.To improve assessment of all the core domains of PsA during clinic appointments and aim to treat these patients using a ‘treat-to-target’ approach to improve clinical outcomes.We were able to confirm through a retrospective baseline audit that all core domains of PsA were not being fully addressed in our general rheumatology clinics. A dedicated weekly PsA clinic was then set up at our district general hospital. Subsequently, iPads incorporated with GRAPPA App were implemented in these clinics to facilitate multi-domain assessments aiming for MDA. This was supported by a Health Education England (Wessex) Quality Improvement Fellowship that involved rheumatology and dermatology team members working in close collaboration. We then carried out a re-audit to assess our performance. Additionally we set up quarterly combined Rheumatology and Dermatology clinics for patients with severe joint and skin involvement. We also conducted a baseline survey by asking patients for their opinion about the ‘setting up of the dedicated PsA service’, the ‘quarterly combined clinics’ and the ‘use of iPad-based assessments’. We asked them to score each of these on a scale of 0 to 10, with 0 being ‘very negative’ and 10 ‘very positive’.We had pragmatically set a standard of 75% for our baseline audit but we found an overall compliance of only 27.4%. There was also a wide variation between different domains with a compliance of even 0% for some. Domains that are not assessed are unlikely to be fully taken into account when deciding about treatment. The re-audit following the implementation of iPad-based assessments in dedicated PsA clinics showed a significant improvement in each of the domains and the overall compliance went up to 97.9% (Table 1). The patient survey findings were also excellent with mean scores of 9.5, 9.0 and 9.5 respectively for the three items (Figure 1).Table. 1Audit(n = 25)Re-audit(n = 29)ComplianceQ1. Documented evidence of joint count being performed?84.0%100.0%Q2. If yes, then was it a 66/68 count for swollen and tender joints?4.7%100.0%Q3. Documented evidence of dactylitis being assessed?8.0%100.0%Q4. Documented evidence of enthesitis being assessed?4.0%100%Q5. Documented evidence of assessment of spinal involvement?8.0%100.0%Q6. Documented evidence of assessment of skin involvement?36.0%100.0%Q7. Documented evidence of assessment of nail involvement?4.0%93.1%Q8. Documented evidence of assessment of fatigue?8.0%96.6%Q9. Documented evidence of assessment of degree of pain?60.0%100.0%Q10. Documented evidence of patient’s global assessment?68.0%96.6%Q11. Documented evidence of assessment of physical function?0.0%96.6%Q12. Documented evidence of assessment of health-related quality of life?0.0%93.1%Q13. Documented evidence of assessment of systemic inflammation?72.0%96.6%Overall Compliance27.4%97.9%Dedicated PsA clinics using the GRAPPA App on iPads could facilitate comprehensive multi-domain assessments of patients with PsA and potentially lead to better outcomes as well as greater patient satisfaction.[1]Orbai AMet al., (2017) Updating the psoriatic arthritis (PsA) core domain set: a report from the PsA workshop at OMERACT 2016. J Rheumatol 44(10):1522–1528[2]Coates LCet al., Effect of tight control of inflammation in early psoriatic arthritis (TICOPA): a UK multicentre, open-label, randomised controlled trial. Lancet. 2015; 386(10012):2489–2498Disclosure of Interests:None declared