A national survey on the management of psoriatic arthritis using the Delphi method.
OBJECTIVE
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.


METHODS
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.


RESULTS
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.


CONCLUSIONS
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.
Rheumatology Unit, Department of Medicine and Health Science "Vincenzo Tiberio", University of Molise, Campobasso, Italy. enniolubrano@hotmail.com.
Ennio
E
Lubrano
Division of Rheumatology, Hospital of Prato, Italy.
Fabrizio
F
Cantini
Rheumatology Unit, Department of Medical Sciences, University of Cagliari, Italy.
Alessandro
A
Mathieu
Rheumatology Department of Lucania, San Carlo Hospital of Potenza and Madonna delle Grazie Hospital of Matera, Potenza and Matera, Italy.
Ignazio
I
Olivieri
Rheumatology Unit, Department of Internal Medicine, Azienda Ospedaliera ASMN, Istituto di Ricovero e Cura a Carattere Scientifico, Reggio Emilia, Italy.
Carlo
C
Salvarani
Rheumatology Unit, Department of Clinical Medicine and Surgery, University Federico II, Naples, Italy.
Raffaele
R
Scarpa
Rheumatology Unit, ASST Orthopaedic Traumatologic Centre Institute G. Pini-CTO, Milan, Italy.
Antonio
A
Marchesoni
D015535:Arthritis, Psoriatic / Q000175:diagnosis* / Q000188:drug therapy* / Q000276:immunology; D001688:Biological Products / Q000009:adverse effects / Q000627:therapeutic use*; D002983:Clinical Competence; D032921:Consensus; D003697:Delphi Technique; D042241:Early Diagnosis; D019538:Health Care Surveys; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D007558:Italy; D010641:Phenotype; D010818:Practice Patterns, Physicians' / Q000592:standards; D011237:Predictive Value of Tests; D012074:Remission Induction; D000072140:Rheumatologists / Q000523:psychology / Q000592:standards; D016896:Treatment Outcome; D014409:Tumor Necrosis Factor-alpha / Q000037:antagonists & inhibitors / Q000276:immunology
D001688:Biological Products; D014409:Tumor Necrosis Factor-alpha