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5/15/2015
1
Psoriasis and PsA Clinical Features, Associated Conditions,
Screening, and Assessment
Amit Garg, MDAssociate Professor and Founding Chair
Department of DermatologyHofstra NSLIJ School of Medicine
North Shore LIJ Health SystemManhasset, New York
Kristina Callis Duffin, MD, MSAssociate Professor
Department of DermatologyUniversity of Utah
Salt Lake City, Utah
Laura Coates, MBChB, MRCP, PhDNIHR Clinical Lecturer in Rheumatology
Leeds Institute of Rheumatic and Musculoskeletal MedicineUniversity of Leeds and the
Leeds Musculoskeletal Biological Research UnitLeeds Teaching Hospitals NHS Trust
Leeds, England
Content Developers
Kristina Callis-Duffin, MD, MSAssociate Professor
Department of DermatologyUniversity of Utah
Salt Lake City, Utah
Philip Mease, MDDirector, Rheumatology Research
Swedish Medical CenterClinical Professor
University of Washington School of MedicineSeattle, Washington
Speakers
Pre-Activity Question 1
How confident are you in your ability to establish a clinical framework to diagnose and screen the psoriasis patient for psoriatic arthritis?
1. Very confident
2. Confident
3. Somewhat confident
4. Not confident
Pre-Activity Question 2
PASI includes a component for patient-reported outcomes.
1. True
2. False
Pre-Activity Question 3
For what percentage of psoriasis patients do you currently perform an annual assessment for PsA?
1. 0-25%
2. 26-50%
3. 51-75%
4. 76-100%
5/15/2015
2
Objective:
• After this presentation, the attendee will be able to:
– Establish a clinical framework to diagnose and screen the patient with psoriasis and psoriatic arthritis
Psoriasis Phenotypes
• Plaque
• Inverse
• Guttate
• Erythrodermic
• Pustular (generalized, localized)
• Palmoplantar
• Nail disease
• Overlap
6p4 16 17
Photos courtesy of Kristina Callis Duffin
Plaque Type Psoriasis
Photo courtesy of Kristina Callis Duffin
Photo courtesy of Kristina Callis Duffin
Photo courtesy of Kristina Callis Duffin
Plaque Type Psoriasis
• Most common morphology (80%)
• Well demarcated plaques with varying degrees of
– Erythema (pink to red)
– Scale (desquamation)
– Induration (thickness)
Inverse Psoriasis
• Involves skin folds
• Smooth, well-demarcated red patches
• Scale is minimal or entirely absent
• Sometimes eroded, moist
• Often mistaken for a dermatophyte or candidalinfection
Photos courtesy of Kristina Callis Duffin& Amit Garg
Guttate Psoriasis
• Eruptive
• Red erythematous, scaly papules and small plaques
• May follow streptococcal pharyngitis
Photo courtesy of Kristina Callis Duffin
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Erythrodermic Psoriasis
• Means “red skin”
– Warm, red, scaly patches covering almost entire body surface
• Disrupted barrier function: temperature, fluids, electrolytes
• Differential diagnosis includes drug reaction, cutaneous T cell lymphoma, atopic dermatitis
Photos courtesy of Kristina Callis Duffin
Pustular Psoriasis
• Localized
– PPP
– steroid withdrawal
• Generalized (von Zumbusch)
– Mimics include other pustular dermatoses(pustular drug eruption/ AGEP)
Photos courtesy of Kristina Callis Duffin
Palmar Plantar Psoriasis (PPP):Pustular and non-Pustular
• Spectrum:
– Non-pustular: hyperkeratotic plaques
– Pustular: predominance of pustules
• Pustular variant: (palmoplantar pustulosis)
– Regarded as a distinct entity by some
• Not associated with HLA-Cw62
– Associated with smoking
– Treatment poses a challenge
– Associated with plaque psoriasis in ~20%
1. Farley E, Masrour S, McKey J, Menter A. Palmoplantar psoriasis: A phenotypical and clinical review with introduction of a new quality-of-life assessment tool. J Am AcadDermatol. 2009;60:1024-31. 2. Asumalahti K, Ameen M, Suomela S, et al. Genetic analysis of PSORS1 distinguishes guttate psoriasis and palmoplantar pustulosis. J Invest Dermatol. 2003;120:627-32.
Photos courtesy of Kristina Callis Duffin and Amit Garg
Palmar Psoriasis
Photos courtesy of Amit Garg
Plantar Psoriasis
Plantar Psoriasis
• Keratoderma over weight bearing areas of the foot
Photo courtesy of Amit Garg
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Psoriatic Nail Disease
• Affects 50% - 85% of psoriasis pts
• Difficult to treat
• May be associated with joint involvement
Jiaravuthisan, et al. Psoriasis of the nail: anatomy, pathology, clinical presentation,and a review of the literature on therapy. J Am Acad Dermatol, 2007;57:1-27. Zaias N: Psoriasis of the nail. A clinical-pathology study. Arch Dermatol. 1969;99:567-579.Samman PD: The Nails in Disease, ed 3. London, William Heinemann Medical, 1978.
Photos courtesy of Kristina Callis Duffin
pitting
crumbling
oil spot
Clues to the Diagnosis of Psoriasis
• Phenotypes
• Demarcation
• Type of Scale
• Distribution
• Hidden places
Photo courtesy of Amit Garg
Places Psoriasis Likes to Hide
Photos courtesy of Kristina Callis Duffin and Amit Garg
Silver colored scale
Margination along hairline
Photos courtesy of Amit Garg
Is the Distinction Clear?
Dx: Psoriasis
Photo courtesy of Amit Garg
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Dx: Atopic Dermatitis
Photo courtesy of Amit Garg
Dx: Dyshidosis
Photo courtesy of Amit Garg
Dx: Nummular Eczema
Photo courtesy of Amit Garg
Dx: Psoriasis
Dx: Contact Dermatitis
Photo courtesy of Amit Garg
Dx: Contact Dermatitis
Photo courtesy of Amit Garg
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Dx: Contact Dermatitis
Photo courtesy of Amit Garg
Dx: Lichen Planus
Photo courtesy of Amit Garg
Dx: Tinea Corporis
Photo courtesy of Amit Garg
Dx: Lichen Simplex Chronicus
Photo courtesy of Amit Garg
Dx: CTCL
Photo courtesy of Amit Garg
Cutaneous T-cell Lymphoma/Mycosis Fungoides
Increased risk of CTCL: biologic vs misdiagnosed?
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Differential Dx
• Some conditions which may be difficult to distinguish from Psoriasis
– Seborrheic dermatitis
– Nummular eczema
– Atopic Dermatitis
– Contact dermatitis
– Hand Dermatitis
– Balanitis
– Dermatophyte or Candidal infection
– Palmoplantar keratodermas
– Cutaneous T Cell Lymphoma
– Onychodystrophy related to a number of etiologies including Dermatophyteinfection and trauma
Assessment of Psoriasis: PASI
• Most commonly utilized disease severity measure in clinical trials
• Quantify severity based on:
– Erythema, Induration, and Scale
– Body parts and surface area involved
• Separate calculation for head, trunk, upper extremities, and lower extremities
PASI Strengths
• Assesses both lesion quality and extent of involvement
• Validated instrument – Low intra-observer variability
– Moderate inter-observer variability
– Reproducible when performed by trained individuals
• Allows some historical comparison across several treatments
PASI Limitations
• Erythema, induration, and scaling are equally weighted
• Interpretation not so intuitive
– Nonlinear
– Composite score has no clinical frame of reference
• Lacks sensitivity to change at lower ranges
• No component for patient input
Seeking Out Your Dermatology Colleague
• When diagnosis of psoriasis is not certain
• Optimization of topical therapies and regimens
• When use of oral retinoid may be appropriate
• When phototherapy may be useful
– Guttate psoriasis, or with diffuse thin plaques
– Adjunctive to systemic therapy
– Poor candidacy for systemic therapy
• When Psoriasis is flaring or unstable
• “Undifferentiated” or seronegative inflammatory disease and a rash
Diagnosis/Presentation of PsA
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Features of PsA
• An inflammatory arthritis that occurs in 6%-42% of patients with psoriasis1
• Psoriasis typically precedes development of the arthritic component of PsA
– In 70% of patients with PsA, psoriasis is the first symptom to present2,3
– 20% have PsA before psoriasis2,3
– 10%-15% report simultaneous onset of skin and joint disease2,3
• Severity of psoriasis is not predictive of severity of PsA3
1. Gladman D, et al. Ann Rheum Dis. 2005; 64 (Suppl II): ii14-7. 2. Leung Y, et al. J Postgrad Med. 2007; 53: 63-71. 3. Cohen M, et al. J Rheumatol. 1999; 26: 1752-6.
Assessing the Psoriasis Patient
• Annual assessment for PsA to people with any type of psoriasis. Especially important within the first 10 years of onset of psoriasis.
• Use a validated tool to assess adults for psoriatic arthritis in primary care and specialist settings, such as the Psoriasis Epidemiological Screening Tool (PEST).
– PEST does not detect axial arthritis or inflammatory back pain
• As soon as psoriatic arthritis is suspected, refer to a rheumatologist for assessment and advice about planning their care.
NICE clinical guideline 153 ‘The assessment and management of psoriasis’. 2012. Available at: http://www.nice.org.uk/nicemedia/live/13938/61190/61190.pdf. Date accessed: November 2013.
Psoriatic Disease
Arthritis
Skin and nails
Enthesitis
Dactylitis
Axial Disease
Metabolic Syndrome
Inflammatory bowel
disease
Uveitis
Identifying PsA
• Dermatology
– Recognize relevant MSKL sxs among Pso pts
– CASPAR may not yet be applicable without a definition of inflammatory arthritis
• Rheumatology
– Distinguish inflammatory and non-inflammatory disease
– Identify PsA within inflammatory arthritis
– CASPAR criteria applicable to all patients
Clinical Presentation of PsA
Peripheral Arthritis
Arthritis
Present
Absent
Helliwell, et al. ARD. 2007;66:113-7.
5/15/2015
9
Mease P, van der Heijde D. Int J Adv Rheumatol. 2006;4:38-48.
PsA: Radiographic Features
• Juxta-articular periostitis and ankylosis
• Joint osteolysis(pencil-in-cup)
PM3
Other Radiological Features of PsA
Tuft Resorption
Periostitis
Mease P, van der Heijde D. Int J Adv Rheumatol. 2006;4:38-48.
PsA vs RA
Psoriatic Arthritis Rheumatoid Arthritis
RF and anti-CCP seronegative1 RF and anti-CCP seropositive1
Inflammatory markers often normal Inflammatory markers usually raised
Absence of rheumatoid nodules1 Rheumatoid nodules present over bony prominences1
Asymmetric oligoarticular manifestations1 Symmetric polyarticular manifestations1
Predilection for the distal interphalangeal(DIP) joints2
Typically affects the metacarpophalangealand proximal interphalangeal (PIP) joints2
Radiological damage commonly involves periostitis, ‘pencil-in-cup’ changes and
ankylosis2Radiological changes include osteopenia2
50% of patients have spinal manifestations2 Spine is largely unaffected2
Skin manifestations (psoriasis) Skin manifestations are atypical
1. Gladman D, et al. Ann Rheum Dis. 2005;64 (Suppl II):ii14-7. 2. Gladman D. Ann Rheum Dis. 2006;5 (Suppl III):iii22-4.
Enthesitis
Enthesitis
Present
Absent
Helliwell, et al. ARD. 2007;66:113-7.
Inflammation at the site of insertion of muscle/tendon into bone
PM5
How to Spot PsA – Enthesitis
• Common sites
– Achilles tendon
– Plantar fascia
– Elbows
– Costochondral joints
– Patellar
MRI of 3rd MCP
Namey TC. Arthritis Rheum. 1976;19(3):607. Offidani A, et al. ActaDerm Venereol. 1998;78:463. Gisondi, et al. Ann Rheum Dis. 2008;67:26-30.
T2W
US of AT
Scintigraphy
Sub-clinical Bone and EnthesealInflammation in Psoriasis Patients
Slide 53
PM3 Reference I have added to this slide and next is a general review article on radiologic features of PsA and is not specific to the specific imagesadmin, 10/29/2014
Slide 58
PM5 remove build pleaseadmin, 10/29/2014
5/15/2015
10
Lower Limb Enthesopathy in Psoriasis Patients without PsA
• Ultrasound evaluation of Achilles, quadriceps, patellar entheses and plantar aponeurosis according to Glasgow Ultrasound EnthesitisScoring System (GUESS)
– 30 psoriasis patients
– 30 controls
• The mean thickness of all tendons was higher in psoriasis patients than controls
• Mean GUESS score was significantly higher with 7.9 in psoriasis patients vs. 2.9 in controls
enthesophyte
Bursitis
Gisondi, et al. Ann Rheum Dis. 2008;67:26-30.*Girolomoni, et al. JEADV. 2009;23(Suppl. 1):3-8.
“10% of patients with psoriasisprogressed to PsA over 2 yrs”*
Dactylitis
Dactylitis
Present
Absent
Helliwell, et al. ARD. 2007;66:113-7.
uniform/fusiformswelling of a digit
PM6
Spinal Involvement
Spinal pain/stiffness
Present
Absent
Helliwell, et al. ARD. 2007;66:113-7.
How to Spot PsA – Axial Disease
Inflammatory back pain
• Chronic back pain >3 months
• Onset at age <40 yrs
• Pain eased by exercise, worse at rest
• Early morning stiffness
• Waking in second half of the night
PsA in Dermatology Clinics
OA, 24
No MSK diagnosis,
28
SeverePsA,7
MildPsA,10
Other, 17
Husni. JAAD. 2007;57(4):581-7.
Referral to Rheumatology
• Arthralgia that doesn’t settle
• Inflammatory features
– Early morning stiffness
– Better with exercise
– Swollen joints
– Enthesitis
– Low back / buttock pain
Slide 62
PM6 remove build pleaseadmin, 10/29/2014
5/15/2015
11
Screening Tools for PsA
• Most people have psoriasis before joint symptoms
• Is there a simple screening test for PsA?– Quick and easy
– Patient completed
– Sensitive
– Reasonably specific
• Patient-completed questionnaires– PAQ (1997) and modified PAQ (2002)
– PASE (2007)
– ToPAS (2008)
– PEST (2008)
– PASQ (2009)
PAQ = Psoriasis and Arthritis Questionnaire; PASE = Psoriatic Arthritis Screening and Evaluation. ToPAS = Toronto Psoriatic Arthritis Screen; PEST = Psoriasis Epidemiology Screening Tool. PASQ =Psoriatic Arthritis Screening Questionnaire.
PASE – Symptoms
• I feel tired for most of the day
• My joints hurt
• My back hurts
• My joints become swollen
• My joints feel ‘hot’
• Occasionally, my entire finger or toe becomes swollen, making it look like a ‘sausage’
• I have noticed that the pain in my joints moves from one joint to another, for example, my wrist will hurt for a few days, then my knee will hurt, and so on
Husni M, et al. J Am Acad Dermatol. 2007;57:581-7.
ToPAS 1 and 2
Features:
• Pictures
• Questions on
– joint symptoms
– back pain
– dactylitis
Gladman D, et al. Ann Rheum Dis. 2009;68:497-501.
PEST
• Have you ever had a swollen joint (or joints)?
• Has a doctor ever told you that you have arthritis?
• Do your finger nails or toe nails have holes or pits?
• Have you had pain in your heel?
• Have you had a finger or toe that was completely swollen and painful for no apparent reason?
Ibrahim G, et al. Clin Exp Rheumatol. 2009;27:469-74.
In the drawing below, please tick the joints that have
caused you discomfort (i.e stiff, swollen or painful joints)
Identifying PsA in Early Arthritis Clinics
• Presence of psoriasis!
• Psoriatic nail disease
• Negative immunology
• Features of SpA
• Use CASPAR features...
PsA Disease – Complex and Variable
Images supplied by Laura Coates, University of Leeds, UK.
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Current Practice
• Poor documentation of outcome measures
• UK – DAS28 used in 25% of biologic assessments
• 68/66 joint count used for most
• Some assessment of skin disease
• Poor documentation of enthesitis/dactylitis/axial disease activity
• Generally composite measure of arthritis (RA) used
Assessment of PsA
Assessment of Psoriatic Arthritis in Clinical Trials
Domains Instruments
Joint assessment 68/66 T/S joint count, ACR, DAS, PsARC
Axial assessment BASDAI, BASFI, BASMI
Skin assessment PASI, Target lesion, Global
Pain VAS
Patient global VAS (global, skin + joints)
Physician global VAS (global, skin + joints)
Function/QOL HAQ, SF-36, PsAQoL, DLQI
Fatigue FACIT, Krupp, MFI, VAS
Enthesitis assessment Mander, MASES, Leeds, Berlin, SPARCC, 4-point
Dactylitis assessment Leeds, present/absent, acute/chronic
Acute phase reactant ESR, CRP
Imaging Xray (modified Sharp or van der Heijde-Sharp), MRI, US
Mease P. Arth Care & Research. 2011;63:64-85. Mease P, et al. Ann Rheum Dis. 2005;64:ii49-ii54. Mease P, van der Heijde D. Int J Adv Rheum. 2006;4:38-48.
Arthritis
• 68/66 (tenderness/swelling) joint count recommended
Mease P. Arth Care & Research. 2011;63:64-85.
• BSA
• PASI (often only if BSA>3)
• Target Lesion score
• Lattice System PGA (very severe – clear)
• Copenhagen Psoriasis Severity Index (CoPSI)
• NPF Psoriasis Score
Coates, et al. J Rheum. 2011 Jul;38(7):1496-501.
Skin Disease
1% BSA
Assessing Enthesitis - LEI
• Lateral epicondyle of elbow
• Medial condyle of femur
• Achilles tendon insertion
Healy PJ and Helliwell PS. Arthritis Rheum. 2008;59(5):686-691.
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Assessing Enthesitis - SPARCC
• Supraspinatus
• Med/lat epicondyles
• Greater trochanter
• Patellar insertion
• Quads insertion
• Tibial tuberosity
• Achilles tendons
• Plantar fascia
Dactylitis
• Simple count (tender/swollen)1
• Count + grade 0-3 score2
• Leeds Dactylitis Instrument (LDI)3
Images supplied by Laura Coates, University of Leeds, UK
1. Kyle S, et al. Rheumatology. 2005;44:390-7. 2. Antoni CE, et al. [erratum appears in Arthritis Rheum. 2005 Sep;52(9):2951] Arthritis & Rheumatism. 52(4):1227-1236. 3. Helliwell PS, et al. Journal of Rheumatology. 2005;32(9):1745-1750.
Axial Disease
• BASDAI – doesn’t differentiate axial activity
• BASFI – doesn’t differentiate axial activity
• BASMI
• ASDAS
Image supplied by Laura C
oates, University
of Leeds, UK
Coates, et al. J Rheum. 2011 Jul;38(7):1496-501.
IMPART: Arthritis and Dactylitis
MeasureOverall
ICC (95% CI)Rheumatologist
ICC (95% CI)Dermatologist ICC
(95% CI)
Tender joint count
0.78 (0.65, 0.89) 0.81 (0.68, 0.91) 0.73 (0.56, 0.86)
Swollenjoint count
0.24 (0.12, 0.45) 0.42 (0.23, 0.65) 0.31 (0.12, 0.57)
Dactylitis 0.29 (0.15, 0.51) 0.69 (0.52, 0.84) 0.08 (-0.07, 0.32)
PGA-PsA 0.39 (0.23, 0.60) 0.29 (0.11, 0.54) 0.50 (0.29, 0.72)
PGA = physician’s global assessment; ICC = intraclass correlation coefficients. Chandran V, et al. Arthritis Rheum. 2009;27;61:1235-1242.
PM7
Quality of Life and Function
• SF-36
• EQ5D
• DLQI
• PsAQOL
• HAQ-DI
– MID 0.35
• HAQ-S
Mease P. Arth Care & Research. 2011;63:64-85. Mease P, et al. J Rheum. 2011;38:2461-5.
Composite Measures ofPsoriatic Disease
ENB1049a Date of Preparation November 2012
Slide 89
PM7 ICC for swollen joint count for "Overall" is 0.24? Yet ICC for rheum is 0.42 and derm is 0.31 so theoretically the Overall should be in between those two numbers. Please check manuscript. admin, 10/29/2014
5/15/2015
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Composite Assessment of PsA
• Composite Measures of Arthritis
– DAS
– ACR responses
– PsARC
– DAPSA
– PsAJAI
– CDAI
– SDAI
• Composite Measures of PsA
– MDA
– CPDAI
– PASDAS
– AMDF
Mease P. Arth Care & Research. 2011;63:64-85.
A Disease State Measure
• Minimal disease activity is ideal concept
– “a state which is deemed a useful target of treatment by both physician and patient, given current treatment possibilities and limitations”
• Can act as a target for treatment
• Developed for PsA including 7 key outcome measures covering arthritis, enthesitis, skin disease, patient reported outcomes and functional ability
Wells GA, et al. J Rheumatol. 2005;32:2016-24; Coates LC, et al. Ann Rheum Dis. 2010;69(1):48-53.
MDA Criteria for PsA
• A patient is classified as in MDA when they meet 5 of 7 of the following criteria:
– tender joint count ≤1
– swollen joint count ≤1
– PASI ≤1 or BSA ≤3
– patient pain VAS ≤15
– patient global activity VAS ≤20
– HAQ ≤0.5
– tender entheseal points ≤1
Coates LC, et al. Ann Rheum Dis. 2010;69(1):48-53.
Observational Database - Toronto
• n=344
• 59% male, mean age 43 years
Coates LC, et al. Arthritis Care and Res. 2010;62(7):970-6.
Patients Achieving MDA
>1 year
<1 year
never
0
0.5
1
1.5
2
2.5
3
MDA not MDA
Progression of Joint Damage per year
Increasedamaged JC
P=.0005
Interventional Trial Cohort
• Achieving MDA in IMPACT and IMPACT2 studies
Coates LC, et al. Arthritis Care and Res. 2010;62(7):965-9.
0
5
10
15
20
25
30
35
40
45
50
55
Week 16 Week 52
Percentage of patients achieving M
DA
Infliximab
Placebo
Week 16 P<.0001
0
5
10
15
20
25
30
35
40
45
50
55
Week 24 Week 52
Percentage of patients achieving M
DA
Infliximab
Placebo
Week 24 P<.001
MDA
• Validated measure of disease state
• Doesn’t measure disease activity
• Now being reported as outcome in RCTs
• Being used in clinical trials as target
Coates LC, et al. Arthritis Care and Res. 2010;62(7):965-9 and 970-6. Coates, et al. BMC Musculoskelet Disord. 2013 Mar 21;14:101.
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Composite Psoriatic Disease Activity Index (0 -15)
None (0) Mild (1) Moderate (2) Severe (3)
Peripheral Arthritis NONE≤ 4 joints; normal function (HAQ ≤0.5)
≤ 4 joints but function impaired; or > 4 joints, normal function
> 4 joints and function impaired
Skin Disease NONE PASI ≤ 10 and DLQI ≤ 10PASI ≤ 10 but DLQI >10; or PASI > 10 but DLQI ≤ 10
PASI > 10 and DLQI > 10
Enthesitis NONE≤ 3 sites; normal function (HAQ ≤0.5)
≤ 3 sites but function impaired; or >3 sites but normal function
>3 sites and function impaired
Dactylitis NONE≤ 3 digits; normal function (HAQ ≤0.5))
≤ 3 digits but function impaired; or >3 digits but normal function
>3 digits and has function impaired
Spinal Disease NONEBASDAI ≤4; normal function (ASQol ≤ 6)
BASDAI >4 but normal function; BASDAI ≤4 but function impaired
BASDAI >4 and function impaired
HAQ only counted for most severe domain involved (enthesitis/dactylitis/peripheral arthritis)
Mumtaz, A. Ann Rheum Dis. 2011;70:272-7.
GRACE Project (GRAPPA)
• Longitudinal international cohort
• High disease activity identified by increase in therapy
• 2 different methods for development
– PASDAS
• following methodology of RA DAS or ASDAS
• Logistic regression to develop weighting
– AMDF
• Each component translated to 0-1 desirability function
• Simple addition of each component
PASDAS
• 0.18 x √physician global
• + 0.159 x √patient global
• - 0.253 x √SF36-PCS
• + 0.101 x ln (SJC+1)
• + 0.048 x ln (TJC+1)
• + 0.23 x ln (LEI+1)
• + 0.37 x ln (tender dactylitis count+1)
• + 0.102 x ln (CRP+1)
Helliwell PS, et al. Ann Rheum Dis. 2013;72:986-991.
AMDF
• Sum of
– TJC
– SJC
– HAQ
– Patient VAS global
– Patient VAS joints
– Patient VAS skin
– PASI
– PsAQOL
Helliwell PS, et al. Ann Rheum Dis. 2013;72:986-991.
Optimizing Rolesof Dermatologist and Rheumatologist
Screening for PsA in at-risk population
Confirm presence of inflammatory arthritis in pt with psoriasis
Post-Activity Question 1
How confident are you in your ability to establish a clinical framework to diagnose and screen the psoriasis patient for psoriatic arthritis?
1. Very confident
2. Confident
3. Somewhat confident
4. Not confident
5/15/2015
16
Post-Activity Question 2
PASI includes a component for patient reported outcomes.
1. True
2. False
Post-Activity Question 3
For what percentage of psoriasis patients do you intend to perform an annual assessment for PsA?
1. 0-25%
2. 26-50%
3. 51-75%
4. 76-100%
Questions & Answers