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To define and give priority to standards of care and quality indicators of multidisciplinary care for patients with psoriatic arthritis (PsA). A systematic literature review on PsA standards of care and quality indicators was performed. An expert panel of rheumatologists and dermatologists who provide multidisciplinary care was established. In a consensus meeting group, the experts discussed and developed the standards of care and quality indicators and graded their priority, agreement and also the feasibility (only for quality indicators) following qualitative methodology and a Delphi process. Afterwards, these results were discussed with 2 focus groups, 1 with patients, another with health managers. A descriptive analysis is presented. We obtained 25 standards of care (9 of structure, 9 of process, 7 of results) and 24 quality indicators (2 of structure, 5 of process, 17 of results). Standards of care include relevant aspects in the multidisciplinary care of PsA patients like an appropriate physical infrastructure and technical equipment, the access to nursing care, labs and imaging techniques, other health professionals and treatments, or the development of care plans. Regarding quality indicators, the definition of multidisciplinary care model objectives and referral criteria, the establishment of responsibilities and coordination among professionals and the active evaluation of patients and data collection were given a high priority. Patients considered all of them as important. This set of standards of care and quality indicators for the multidisciplinary care of patients with PsA should help improve quality of care in these patients.

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The aim of the European Journal of Rheumatology is to cover various aspects of rheumatology for its readers, encompassing the spectrum of diseases with arthritis, musculoskeletal conditions, autoinflammatory diseases, connective tissue disorders, osteoporosis, translational research, the latest therapies and treatment programs. European Journal of Rheumatology publishes original articles, invited reviews, case based reviews, letters to the editor and images in rheumatology. The publication language of the journal is English.

BackgroundThe application of the “treat-to-target” strategy in rheumatoid arthritis requires being proactive in the management of the disease to get the better outcomes. The treatment changes in daily practice are directed to improve the efficacy and/or tolerance, and also reduce the toxicity.ObjectivesThe present study aimed to describe the percentage of patients who suffered a change in their synthetic DMARD regimen due to loss of efficacy (LoE), adverse events (AEs), intolerance, and other reasons. Also the therapeutic strategies chosen by rheumatologists for management of synthetic DMARD after treatment failure were evaluated.MethodsThis retrospective, observational and multicenter study included patients diagnosed with RA (fulfillment of the ACR/EULAR 2010 diagnostic criteria) from 2008 to 2012, who have started on at least one synthetic DMARD within this period. Patients were included in a routine clinical visit performed in 2014. Patient clinical characteristics and previous/current medications for RA were retrospectively collected from patients' medical records after the consensus of the participant rheumatologists in the study. Descriptive analysis of the data retrieved at the study visit in 2014 is presented.Results12 sites in Andalucía (Spain) included 301 patients (mean age: 56.6±14.0; female: 71%; RA duration: 3.6±1.5), whose clinical characteristics are shown in the table. 57% of patients have received a single synthetic DMARD, with metothrexate (MTX) (57%), leflunomide (20%) and hydroxychloroquine (9%) as the most commonly DMARDs prescribed as monotherapy. During the study period, 69% of patients suffered ≥1 change in the first- or subsequent-line DMARDs for AEs, intolerance or LoE. Of the 341 changes registered, 42% were due to LoE, 28% due to AEs (31% liver disorders, 19% gastrointestinal symptoms), 14% due to intolerance, and the remaining 16% due to the following reasons: patient preference, lack of adherence, pregnancy plans and loss of follow-up. DMARD was definitely and temporarily interrupted in 35% and 8% of the cases, respectively. Both the addition of and the switch to another conventional DMARD occurred in 11%, and DMARD dosage was adjusted in 28% of the cases.Table 1.Patients' disease characteristicsCharacteristicsAt FAME initiationAt the study visitSwollen joint count, mean ± SD4.4±4.51.2±2.4Tender joint count, mean ± SD5.9±5.22.2±3.4ESR (mm/h), mean ± SD29.0±21.717.2±15.6CRP (mg/l), mean ± SD17.6±27.47.6±14.5DAS28, mean ± SD4.6±1.53.2±1.4CDAI, mean ± SD19.5±12.310.5±10.0ConclusionsIn clinical practice, MTX was the main DMARD prescribed for initial treatment. Most of all changes made in DMARD therapy (84%) were due to lack of efficacy, AEs and intolerance. Definitely interruptions (35%) and dosage adjustments (28%) were the therapeutic strategies mainly chosen by rheumatologists.Disclosure of InterestNone declared