Regional review of patients with psoriatic arthritis in secondary care in the West Midlands: Prevalence, disease activity and eligibility for anti-tumour necrosis factor therapy

Objective: Tumour necrosis factor α-blockers (TNF-α) are licensed for the treatment of psoriatic arthritis (PsA) and their use has been approved by the National Institute for Health and Clinical Excellence (NICE) for use in the United Kingdom under a set of defined clinical criteria. Methods: In this out-patient study we evaluated PsA in rheumatology secondary care clinics in units across the West Midlands over a 2-week period, assessing prevalence, disease activity and eligibility for anti TNF-α treatment as defined by the NICE criteria. Results: Of the 1718 forms returned from the 2000 sent (86% response rate), 175 patients had PsA (10.2%). Of those, 22 (12.6%) were already on anti TNF-α treatment. 12 patients were noted to have purely axial disease and as per the NICE guidelines should not be assessed under the PsA criteria. A further 5 patients fulfilled the criteria for treatment with anti TNF-α with no contraindications. In the region 22 out of 27 patients (81%) with active disease were correctly on Anti TNF therapy. In total 27 (15.4%) patients with PsA met the NICE criteria for treatment of PsA with anti TNF-α therapy. 3 patients had previously failed anti TNF-α treatment. No patient fulfilling criteria for treatment were found to have any contraindications to treatment. Conclusion: We note the relatively high proportion of PsA patients eligible for treatment with anti TNF-α blockers in the region (15.4%) compared to the NICE estimate (2.4%). This may be in part explained by a selection bias. However, the results may have significant implications for healthcare provision given the relatively high cost of anti-TNF-α agents. We comment on the limitations of such criteria and the effective use of regional collaboration for both training and audit purposes.