Journal of Rheumatology最新文献

The Group for Research and Assessment of Psoriasis and Psoriatic Arthritis (GRAPPA) 2024 annual meeting included a lively debate regarding the optimal management of musculoskeletal (MSK) symptoms in patients with psoriasis (PsO) at risk of or with early psoriatic arthritis (PsA). Drs. Fabian Proft and Laura Savage presented comprehensive, evidence-based retrospective arguments from the perspectives of rheumatology and dermatology. Proft advocated for rheumatologists to lead PsA management by highlighting the specialized training that allows rheumatologists to identify inflammatory diseases and use advanced imaging techniques to differentiate PsA from mechanical MSK conditions. In contrast, Savage emphasized the pivotal role of dermatologists, who often serve as the first healthcare providers (HCPs) to encounter emergent PsA in their patients with PsO. Dermatologists are increasingly aware of the importance of early detection and timely intervention, as well as of the new data that support the concept of "treating to intercept" in patients at risk of transition from PsO to PsA. Both experts highlighted systemic barriers hindering collaborative care and underscored the necessity of patient-centered approaches that effectively address skin and joint manifestations. This article summarizes the insightful debate, reinforcing the importance of a multidisciplinary approach to optimize patient outcomes with PsA.

Psoriatic disease (PsD) is a complex, heterogeneous disease with unmet medical needs in terms of its diagnosis, management, and prognosis. The identification of biomarkers could improve the implementation of precision medicine in PsD, but to date, none of these biomarkers have been clinically validated. Biomarkers can support clinical trials in several ways, including (1) diagnostics, (2) drug pharmacodynamics, (3) prognostics for patient selection and monitoring of drug efficacy, and (4) predictive models for clinical outcomes. Biomarkers can sometimes be used for both diagnosis and prognosis. Benefits of biomarkers use may include shorter duration of clinical trials, faster access to new treatments, and a personalized approach to disease management. Several potential biomarkers have recently demonstrated promise for use in PsD, including C1M, a serum biomarker reflecting collagen type I collagen degradation, and C4M, a type IV collagen metabolite, but clinical validation has not yet been completed. Here, and as presented at the Group for Research and Assessment of Psoriasis and Psoriatic Arthritis 2024 annual meeting, we summarize the status of biomarker discovery for PsD and their overlap with other musculoskeletal diseases such as rheumatoid arthritis and axial spondyloarthritis.

The Group for Research and Assessment of Psoriasis and Psoriatic Arthritis (GRAPPA) Patient Research Partner (PRP) Network conducted a survey to identify its key strengths and gaps, with the goal of enhancing its global reach and representation. The survey revealed strong gender parity and high long-term project participation among PRP members. However, it also indicated a need for greater ethnic and geographical diversity among the members. To address this, the PRP Network will expand its membership and specifically recruit partners from underrepresented regions such as Africa, Asia, Australia/New Zealand, South America, and Eastern Europe. Additionally, the network aims to expand its age range to include a more representative selection of research partners, thereby advancing GRAPPA's overarching objectives. The results of the survey were presented at the GRAPPA 2024 annual meeting.

Rheumatologists and other nondermatologists often encounter patients with psoriatic arthritis (PsA) who present with cutaneous diseases that mimic psoriasis (PsO). Cutaneous disorders including tinea, seborrheic dermatitis, eczema, pityriasis rubra pilaris, syphilis, or cutaneous lymphoma are commonly mistaken for PsO. It is crucial for rheumatologists and other nondermatologists to recognize alternative conditions and to consider referral to dermatology when skin disease is not responding to therapy. Correct diagnosis is important when assessing disease severity in clinical practice as well. Although the Psoriasis Area and Severity Index (PASI) and the Dermatology Life Quality Index (DLQI) are gold standards for physician- and patient-reported outcomes in clinical trials, they are not practical to deploy in busy clinical practice. Use of a physician global assessment (PGA), body surface area using a handprint method, and informal patient-reported outcomes can be useful in documenting the burden of disease. A treat-to-target approach using a PGA of clear/almost clear is ideal. At the Group for Research and Assessment of Psoriasis and Psoriatic Arthritis (GRAPPA) 2024 annual meeting, a 2-part workshop was conducted for rheumatologists to first review skin disorders commonly mistaken for PsO, and second, to review outcome measures best suited for clinical practice.

Objective: We aimed to identify and characterize distinct subgroups of patients with psoriatic arthritis (PsA) based on their responses to the Assessment of SpondyloArthritis International Society Health Index (ASAS HI), using latent class analysis (LCA).

Methods: We performed an exploratory LCA on 17 dichotomous ASAS HI items in a cohort of patients with PsA (n: 90). Model adequacy was evaluated by log-likelihood, AIC, BIC, entropy, and average posterior probabilities (AvePP). Clinical measures (PsAID, DAPSA, tender/swollen joint counts, treatment) were compared across classes. Sensitivity analyses with 3-4 classes assessed robustness.

Results: A six-class solution was retained, ordered from Class 0 (lowest impact) to Class 5 (highest impact). Mean ASAS HI ranged from 1.2 in Class 0 to 11.6 in Class 5, with parallel increases in PsAID and DAPSA. Conditional probabilities revealed distinct profiles: Class 0 had minimal impairment, Classes 1-2 showed predominantly physical function limitations of mild to moderate severity, Class 3 combined physical and emotional function burden, Class 4 was characterized by dominant participation and social impact, and Class 5 displayed severe multidimensional impairment. All classes had AvePP >0.86. Sensitivity analyses with K=3 and K=4 reproduced the same gradient of impact but provided less granular separation.

Conclusion: Latent class analysis of the ASAS HI identified six clinically meaningful health impact profiles in PsA. These findings support the use of the ASAS HI as a multidimensional tool capable of capturing diverse patient experiences and may help inform individualized management strategies in PsA.

The International Dermatology Outcome Measures (IDEOM) organization presented updates on its patient-reported outcome measures (PROMs) for psoriasis (PsO), psoriatic arthritis (PsA), and other immune-mediated skin diseases at the Group for Research and Assessment of Psoriasis and Psoriatic Arthritis (GRAPPA) 2024 annual meeting. The Hidradenitis Suppurativa working group reported on the IDEOM Musculoskeletal Questionnaire (MSK-Q), a PROM for MSK manifestations of psoriatic disease. Advances in PsA screening included integrating the Psoriasis Epidemiology Screening Tool (PEST) and 12-item Psoriatic Arthritis Impact of Disease (PsAID-12) questionnaires into the Epic electronic health record system to streamline detection and management of emerging PsA cases. The Connective Tissue Disease working group discussed upcoming trials and tools for addressing significant unmet needs in cutaneous lupus erythematosus. Finally, the Patient Satisfaction working group provided updates on the 7-item Dermatology Treatment Satisfaction Instrument (DermSat-7) and DermSat-11 for clinical trials and real-world studies. The DermSat-7 has been validated in a multicenter study of patients with PsO, whereas the DermSat-11 is currently undergoing validation. IDEOM continues to work to significantly improve patient outcomes and satisfaction in dermatology.

The Group for Research and Assessment of Psoriasis and Psoriatic Arthritis (GRAPPA) 2024 annual meeting was held from July 11 to July 13, 2024, in Seattle, Washington, USA, and was attended by 256 rheumatologists, dermatologists, trainees, patient research partners, patient organization representatives, industry partners, and others. The meeting featured several workshops on various topics including epidemiology, new educational initiatives, use of artificial intelligence for both education and clinical management of disease, use of magnetic resonance imaging in the diagnosis and management of psoriatic disease (PsD), and many more. Young-GRAPPA held a workshop and business meeting about their projects, and many of the young GRAPPiAns contributed as coauthors of the articles in this supplement. Debates focused on whether clinical enthesitis indices reflect true enthesitis and whether they should be discontinued, and whether musculoskeletal symptoms in PsD should be managed by dermatologists or rheumatologists. Here we provide an overview of the features of the GRAPPA 2024 annual meeting and introduce the manuscripts published together in this supplement as a meeting report.