Composite Measures in Psoriatic Arthritis: a report from the GRAPPA 2009 annual meeting

A composite measure is one way of incorporating an assessment of all relevant clinical outcomes into one single measure. By definition it incorporates several dimensions of disease status often by combining these different domains into a single score. Such instruments are well established in rheumatoid arthritis (RA), and these RA-specific measures have successfully been adopted for use in clinical trials involving patients with psoriatic arthritis (PsA). However, the need for a more PsA-specific composite measure has led to a number of proposals, which, for the large part, incorporate only peripheral articular disease activity. New indices that combine the diverse clinical manifestations of PsA are now under development. These issues were discussed at the 2009 annual meeting of GRAPPA (Group for Research and Assessment of Psoriasis and Psoriatic Arthritis) in Stockholm, Sweden, and are summarized here.     

Psoriasis and Psoriatic Arthritis Video Project 2010: a report from the GRAPPA annual meeting

Investigators use several physical examination measures to assess clinical features and severity of psoriasis and psoriatic arthritis (PsA) in clinical trials, clinical registries, and clinical practice; however, no relevant training modules are widely available to teach and standardize the performance of these measures. At a GRAPPA (Group for Research and Assessment of Psoriasis and Psoriatic Arthritis) meeting adjacent to the 2009 International Federation of Psoriasis Associations in Stockholm, members were updated on the development status of online training videos of psoriasis and PsA examination measures. Dermatology assessment modules include the Psoriasis Area and Severity Index, the Static Physician Global Assessment, body surface area, the original and modified Nail Psoriasis Severity Index, the Palmar-Plantar Pustular Psoriasis Area and Severity Index, and the Psoriasis Scalp Severity Index. Rheumatology modules include assessment of tender and swollen joint counts used in the American College of Rheumatology criteria, Disease Activity Score, and other composite arthritis scores; enthesitis assessment used in various enthesitis scoring systems; dactylitis; and spine disease. Each module will include background information for each measure, diagrams and photographs to emphasize teaching points, demonstration video of examination where applicable, and an optional examination at the end. Future plans include evaluating the modules for their influence on interrater and intrarater reliability and development of additional modules.     

Prologue: 2009 Group for Research and Assessment of Psoriasis and Psoriatic Arthritis (GRAPPA)

The 2009 Annual Meeting of the Group for Research and Assessment of Psoriasis and Psoriatic Arthritis (GRAPPA) was held in June 2009 in Stockholm, Sweden, and was attended by rheumatologists, dermatologists, biopharmaceutical company representatives, and patient groups. A primary goal of GRAPPA is to foster outreach and interdisciplinary communication between the fields of rheumatology and dermatology. Several members attended an adjacent meeting of the International Federation of Psoriasis Associations; reports were also provided of recent meetings of the American Academy of Dermatology and the Assessment of SpondyloArthritis (ASAS) working group. In a training session of the GRAPPA meeting, members served as faculty while rheumatology fellows and dermatology residents presented original research work. In one module of the meeting, several response measures were discussed. In another module, discussions were held on the need for dermatologists to be able to diagnose psoriatic arthritis (PsA) among their psoriasis patients; several PsA screening questionnaires were presented, and progress was reported on developing online training videos as an aid to educate clinicians in their diagnoses. Other topics for discussion at the GRAPPA meeting included presentations on genetic associations with PsA and on comorbidities in patients with PsA. Current and future research projects also were outlined.     

Prologue: 2010 Group for Research and Assessment of Psoriasis and Psoriatic Arthritis (GRAPPA)

The 2010 Annual Meeting of the Group for Research and Assessment of Psoriasis and Psoriatic Arthritis (GRAPPA) was held in December 2010 in Miami Beach, Florida, USA, with attendance by rheumatologists, dermatologists, and representatives of biopharmaceutical companies and patient groups. In a training session that preceded the GRAPPA meeting, members served as faculty while rheumatology fellows and dermatology residents presented their original research. During the 2-day GRAPPA meeting, presentations included a review of composite measures for psoriatic arthritis (PsA) and psoriasis, updates on imaging in psoriatic disease (ultrasound and magnetic resonance imaging), a 3-part discussion of the definition of inflammatory musculoskeletal disease, a 4-part discussion of the status and path forward in psoriatic disease biomarker research, an update on comorbidities in psoriasis and PsA, and a review of global education and partnering opportunities. Introductions to the discussions at the GRAPPA 2010 meeting are included in this prologue.     

Toronto Psoriatic Arthritis Screening (ToPAS) questionnaire: a report from the GRAPPA 2009 annual meeting

The Toronto Psoriatic Arthritis Screening questionnaire (ToPAS) was developed as a tool to screen for psoriatic arthritis (PsA) in patients with psoriasis as well as in the general population. Thus, it differs from PsA-specific screening tools and may be used to screen for PsA in epidemiologic and family investigations. In a presentation at the 2009 annual meeting of GRAPPA (Group for Research and Assessment of Psoriasis and Psoriatic Arthritis) in Stockholm, Sweden, the authors described the development, testing, and validation of the ToPAS tool. Results of a comparison of the ToPAS questionnaire with the Psoriatic Arthritis Screening and Evaluation (PASE) questionnaire were also presented. Modification and further validation of the ToPAS are under way.     

Definition of Remission and Disease Activity Assessment in Psoriatic Arthritis: Evidence and Expert-Based Recommendations

ObjectiveWe aimed to reach a consensus on the best instruments to monitor disease activity in patients with psoriatic arthritis (PsA) and to develop a consensus definition of remission.MethodsA modified Delphi approach was used. A scientific committee provided statements addressing the definition of remission and the monitoring of PsA in clinical practice. The questionnaire was evaluated in 2 rounds by rheumatologists with experience in managing PsA patients.ResultsA panel of 77 rheumatologists reached agreement on 62 out of the 86 proposed items (72.0%). The most recommended index for monitoring disease activity was DAPSA (cut-off values: ≤4 for remission and >4–14 for low disease activity ([LDA]), MDA (at least 5/7 criteria). In cases with axial involvement, ASDAS was the preferred index (cut-off values: <1.3 for remission and <2.1 for LDA). BASDAI (cut-off values: ≤2 for remission and ≤4 for LDA) may be used as an alternative. PsAID was the preferred tool to assess disease impact.ConclusionWe propose a definition of remission in PsA as the absence of disease activity evaluated by DAPSA or MDA (ASDAS and/or BASDAI in patients with axial involvement), which would imply absence of signs or symptoms of inflammation, physical well-being, lack of disease impact, and absence of inflammation as measured by biological markers.     

不同亚型银屑病关节炎的临床特征和实验室指标

目的分析不同亚型银屑病关节炎(PsA)临床特征、实验室指标的差异,以提高对该疾病的认识,为临床诊疗提供借鉴。方法对中国人民解放军264医院2005年1月至2011年12月住院诊治的PsA患者进行分型,并对不同亚型PsA患者首发症状、受累关节、类风湿因子(RF)、抗环瓜氨酸多肽抗体(抗CCP抗体)、人类白细胞抗原-B27(HLA-B27)进行比较分析。结果 82例PsA患者,皮疹先发于关节炎者60例(73%),皮疹和关节炎症状1个月内同时出现者9例(11%),关节炎先发于皮疹者13例(16%)。PsA临床分型:远端指(趾)间关节炎型10例(12.2%)、残毁型关节炎型6例(7.3%)、对称性多关节炎型19例(23.2%)、非对称性寡关节炎型20例(24.4%)、脊柱关节炎型27例(32.9%)。红细胞沉降率、C反应蛋白在PsA各亚型之间比较,差异无统计学意义(均P>0.05)。对称性多关节炎型RF或抗CCP抗体的阳性率为68%,远高于脊柱关节炎型(P<0.05)。脊柱关节炎型HLA-B27阳性率为37%,远高于远端指(趾)关节炎型、对称性多关节炎型、非对称性寡关节炎型(均P<0.05)。结论 PsA多以皮疹为首发,仍有部分患者以关节炎首发。临床分型以脊柱关节炎型多见。RF阳性或抗CCP抗体阳性PsA患者易出现对称性多关节受累,HLA-B27阳性PsA患者易出现中轴关节受累。     

Update on Biomarkers in Psoriatic Arthritis

Biomarkers in psoriatic arthritis (PsA) may serve as surrogate end points for disease outcome and can provide insights into disease susceptibility and natural history. Biomarkers could relate to diagnosis, pathogenesis, prognosis, therapeutic response, and comorbidities. The “felt need” is, however, in the development of biomarkers for the presence of PsA in patients with psoriasis, as well as that for joint damage. During the past few years, many studies related to PsA biomarkers have been conducted. These studies are reviewed here. C-reactive protein, matrix metalloproteinase-3, and circulating osteoclast precursors show promise. An international goal-directed study to determine biomarkers for joint damage in PsA is now under way through a collaborative effort of GRAPPA (the Group for Research and Assessment of Psoriasis and Psoriatic Arthritis) and OMERACT (Outcome Measures for Rheumatology Clinical Trials).     

Psoriatic Arthritis Screening and Evaluation (PASE) questionnaire and the role of dermatologists: a report from the GRAPPA 2009 annual meeting

Psoriatic arthritis (PsA) is an inflammatory arthritis associated with psoriasis, often with a variable course that ranges from slowly progressive to rapidly destructive. Delay in diagnosis and treatment may lead to an irreversible erosive arthropathy, leading further to physical disability and deformity. The Psoriatic Arthritis Screening and Evaluation (PASE) tool was developed and validated to help dermatologists screen more effectively for PsA; recently, it has been undergoing further validation. An update on the continuing experience with the PASE questionnaire, along with a discussion of why dermatologists have a critical role in screening for PsA, was a major focus of the Group for Research and Assessment of Psoriasis and Psoriatic Arthritis (GRAPPA) annual meeting at Stockholm, Sweden, in June 2009.