On Defining Musculoskeletal Inflammation: A Report from the GRAPPA 2011 Annual Meeting

2012 ◽  
Vol 39 (11) ◽  
pp. 2214-2215 ◽  
Author(s):  
AMIT GARG ◽  
DAFNA D. GLADMAN ◽  
PHILIP J. MEASE
Keyword(s):  
Psoriatic Arthritis ◽  
Annual Meeting ◽  
Inflammatory Arthritis ◽  
Classification Criteria ◽  
Musculoskeletal Disease ◽  
Group Discussions ◽  
Diagnostic Measure ◽  
Breakout Group

At the 2011 annual meeting of the Group for Research and Assessment of Psoriasis and Psoriatic Arthritis (GRAPPA), members discussed the need to develop a framework for defining inflammatory arthritis, enthesitis, dactylitis, and spondylitis, particularly as they relate to psoriatic arthritis (PsA). GRAPPA members first addressed this subject at their 2010 meeting, where the CASPAR (ClASsification of Psoriatic ARthritis) criteria were discussed. Although these are classification criteria, the CASPAR are also often applied as a diagnostic measure by clinicians screening for PsA, particularly its core criterion: recognizing the presence of inflammatory musculoskeletal disease. In breakout group discussions, GRAPPA members discussed the difficulties in recognizing overlapping or mimicking features that may result in underdiagnosing or misdiagnosing PsA.

The Need to Define Musculoskeletal Inflammation: A Report from the GRAPPA 2010 Annual Meeting

2012 ◽  
Vol 39 (2) ◽  
pp. 413-414 ◽  
Author(s):  
AMIT GARG ◽  
DAFNA D. GLADMAN ◽  
PHILIP J. MEASE
Keyword(s):  
Psoriatic Arthritis ◽  
Annual Meeting ◽  
Inflammatory Arthritis ◽  
Disease Classification ◽  
Group Discussions ◽  
Diagnostic Measure ◽  
Breakout Group

Psoriatic arthritis (PsA) is a form of spondyloarthritis, a group of conditions that share a spectrum of components including arthritis, enthesitis, dactylitis, and spine inflammation. In PsA, however, the unpredictable, heterogeneous, and often insidious involvement of joints or juxtaarticular tendons and ligaments can sometimes make clinical recognition of the disease a challenge. Underrecognition of PsA may be due to the absence of a single sensitive and specific diagnostic measure. Although the ClASsification of Psoriatic ARthritis (CASPAR) criteria introduced in 2006 have improved disease classification, they are designed to be applied to cases already diagnosed with inflammatory arthritis. Therefore, in order for these criteria to be applied, the clinician is required to recognize the presence of inflammatory arthritis, enthesitis, or spondylitis. At the 2010 annual meeting of GRAPPA (Group for Research and Assessment of Psoriasis and Psoriatic Arthritis), the need to define inflammatory arthritis, enthesitis, dactylitis, and spondylitis, especially for nonrheumatologists, was discussed. Conclusions from breakout group discussions are summarized.

Distinguishing Inflammatory from Noninflammatory Arthritis, Enthesitis, and Dactylitis in Psoriatic Arthritis: A Report from the GRAPPA 2010 Annual Meeting: Table 1.

2012 ◽  
Vol 39 (2) ◽  
pp. 415-417 ◽  
Author(s):  
PHILIP J. MEASE
Keyword(s):  
Primary Care ◽  
Psoriatic Arthritis ◽  
Annual Meeting ◽  
Inflammatory Arthritis ◽  
Primary Care Providers ◽  
Musculoskeletal Disease ◽  
Care Providers ◽  
Key Variables

The most widely applied criteria for classifying psoriatic arthritis (PsA) are the CASPAR (ClASsification of Psoriatic ARthritis) criteria. A patient who fulfills the CASPAR criteria must have evidence of inflammatory arthritis, enthesitis, or spondylitis, and may have an inflammatory musculoskeletal component, dactylitis. Although the criteria were developed by rheumatologists, not all patients with PsA are seen by rheumatologists. Thus, it is important for clinicians such as dermatologists, primary care providers, physiatrists, and orthopedists, and patients themselves, to be able to recognize the presence of inflammatory musculoskeletal disease and distinguish it from degenerative or traumatic musculoskeletal disease. At their 2010 annual meeting, members of the Group for Research and Assessment of Psoriasis and Psoriatic Arthritis (GRAPPA) discussed the steps they are taking to define the key variables that must be present to distinguish inflammatory arthritis, enthesitis, and dactylitis from degenerative, traumatic, mechanical, or infectious forms of these conditions.

Arthritis Mutilans: A Report from the GRAPPA 2012 Annual Meeting

2013 ◽  
Vol 40 (8) ◽  
pp. 1419-1422 ◽  
Author(s):  
Vinod Chandran ◽  
Dafna D. Gladman ◽  
Philip S. Helliwell ◽  
Björn Gudbjörnsson
Keyword(s):  
Psoriatic Arthritis ◽  
Annual Meeting ◽  
Clinical Features ◽  
Severe Form ◽  
Group Discussions ◽  
Epidemiological Research ◽  
Breakout Group ◽  
Definition Of ◽  
Arthritis Mutilans ◽  
Broad Consensus

Arthritis mutilans is often described as the most severe form of psoriatic arthritis. However, a widely agreed on definition of the disease has not been developed. At the 2012 annual meeting of the Group for Research and Assessment of Psoriasis and Psoriatic Arthritis (GRAPPA), members hoped to agree on a definition of arthritis mutilans and thus facilitate clinical and molecular epidemiological research into the disease. Members discussed the clinical features of arthritis mutilans and definitions used by researchers to date; reviewed data from the ClASsification for Psoriatic ARthritis study, the Nordic psoriatic arthritis mutilans study, and the results of a premeeting survey; and participated in breakout group discussions. Through this exercise, GRAPPA members developed a broad consensus on the features of arthritis mutilans, which will help us develop a GRAPPA-endorsed definition of arthritis mutilans.

scholarly journals Review of the Psoriatic Arthritis Working Group at OMERACT 12: A Report from the GRAPPA 2014 Annual Meeting

2015 ◽  
Vol 42 (6) ◽  
pp. 1048-1051 ◽  
Author(s):  
William Tillett ◽  
Lihi Eder ◽  
Niti Goel ◽  
Maarten de Wit ◽  
Alexis Ogdie ◽  
...  
Keyword(s):  
Psoriatic Arthritis ◽  
Annual Meeting ◽  
Outcome Measures ◽  
Working Group ◽  
Patient Perspective ◽  
Patient Involvement ◽  
Group Discussions ◽  
The Core ◽  
Breakout Group ◽  
Core Set

At the 2014 annual meeting of the Group for Research and Assessment of Psoriasis and Psoriatic Arthritis (GRAPPA), the psoriatic arthritis (PsA) working group of OMERACT (Outcome Measures in Rheumatology) presented a review of the progress made at the OMERACT 12 meeting, held in 2014. Members of the PsA OMERACT working group presented work from the Patient Involvement in Outcome Measures for PsA initiative to improve the incorporation of patient research partners in PsA outcomes research, the results of discussions within the OMERACT breakout groups, and finally the voting results. The OMERACT 12 participants had endorsed the need to update the PsA core set according to the Filter 2.0 framework. The breakout group discussions identified potential opportunities for revising the core set, including consolidating existing redundancy within the core set, improving incorporation of the patient perspective, and including disease effects such as fatigue as a core criterion. GRAPPA members of the OMERACT working group now have a program of research to update the core set with the goal of seeking endorsement at OMERACT 13, to be held in 2016.

Development of Simple Clinical Criteria for the Definition of Inflammatory Arthritis, Enthesitis, Dactylitis, and Spondylitis: A Report from the GRAPPA 2014 Annual Meeting

2015 ◽  
Vol 42 (6) ◽  
pp. 1041-1043 ◽  
Author(s):  
Philip J. Mease ◽  
Jane J. Park ◽  
Amit Garg ◽  
Dafna D. Gladman ◽  
Philip S. Helliwell
Keyword(s):  
Psoriatic Arthritis ◽  
Physical Examination ◽  
Inflammatory Arthritis ◽  
Nominal Group Technique ◽  
Musculoskeletal Disease ◽  
Nominal Group ◽  
Clinical Criteria ◽  
Expert Clinician ◽  
Primary Care Clinicians ◽  
Definition Of

Rheumatologists are trained to determine the presence of musculoskeletal inflammation through history, physical examination, and if needed, laboratory tests and imaging. However, primary care clinicians, dermatologists, surgeons, and others who may initially see patients with musculoskeletal pain are not necessarily able to make the distinction between inflammatory (e.g., rheumatoid arthritis or psoriatic arthritis) and noninflammatory disease (osteoarthritis, traumatic or degenerative tendonitis, back pain, or fibromyalgia). If such clinicians could more readily suspect and identify possible inflammatory musculoskeletal disease, it would lead to more timely diagnosis and triage to rheumatologists for diagnosis and appropriate management. The Group for Research and Assessment of Psoriasis and Psoriatic Arthritis (GRAPPA) has been developing evidence-based, practical and reliable criteria that can be used by clinicians to identify inflammatory musculoskeletal disease. The research initiative involves a sequential process of expert clinician nominal group technique, patient focus groups, and Delphi exercises to identify core definitive features of inflammatory disease. The goal is to develop simple clinical criteria (history and physical examination elements) to identify inflammatory arthritis, enthesitis, dactylitis, and spondylitis and distinguish these from degenerative, mechanical, or other forms of these conditions, to achieve more timely and accurate diagnosis and referral of patients with inflammatory arthritis.

Development of Simple Clinical Criteria for the Definition of Inflammatory Arthritis, Enthesitis, Dactylitis, and Spondylitis: A Report from the GRAPPA 2012 Annual Meeting

2013 ◽  
Vol 40 (8) ◽  
pp. 1442-1445 ◽  
Author(s):  
Philip J. Mease ◽  
Amit Garg ◽  
Dafna D. Gladman ◽  
Philip S. Helliwell
Keyword(s):  
Psoriatic Arthritis ◽  
Annual Meeting ◽  
Inflammatory Disease ◽  
Inflammatory Arthritis ◽  
Nominal Group Technique ◽  
Nominal Group ◽  
Clinical Criteria ◽  
Expert Clinician ◽  
Primary Care Clinicians ◽  
Definition Of

Dermatologist and primary care clinicians are in an ideal position to identify the emergence of psoriatic arthritis (PsA) in patients with psoriasis. Yet these clinicians are not well trained to distinguish inflammatory musculoskeletal disease from other more common problems such as osteoarthritis, traumatic or degenerative tendonitis and back pain, or fibromyalgia. A simple set of clinical criteria to identify inflammatory disease would aid recognition of PsA. At its 2012 annual meeting, the Group for Research and Assessment of Psoriasis and Psoriatic Arthritis (GRAPPA) discussed development of evidence-based, practical, and reliable definitions of inflammatory arthritis, enthesitis, dactylitis, and spondylitis. This project will be a sequential process of expert clinician nominal-group technique, patient surveys and focus groups, and Delphi exercises to identify core features of inflammatory disease, testing these in a small group of patients with and without inflammatory disease, and finally validating these criteria in larger groups of patients.

GRAPPA 2013 Annual Meeting, Rheumatology Updates: Psoriatic Arthritis (PsA) Biomarker Project, Arthritis Mutilans, PsA-Peripheral Spondyloarthritis Epidemiology Project

2014 ◽  
Vol 41 (6) ◽  
pp. 1244-1248 ◽  
Author(s):  
Oliver FitzGerald ◽  
Philip J. Mease ◽  
Philip S. Helliwell ◽  
Vinod Chandran
Keyword(s):  
Psoriatic Arthritis ◽  
Annual Meeting ◽  
Joint Damage ◽  
Classification Criteria ◽  
Undifferentiated Arthritis ◽  
Psoriatic Disease ◽  
Inflammatory Bowel ◽  
Peripheral Spondyloarthritis ◽  
Arthritis Mutilans ◽  
Made In

At the 2013 annual meeting of the Group for Research and Assessment of Psoriasis and Psoriatic Arthritis (GRAPPA), several key GRAPPA projects on musculoskeletal aspects of psoriatic disease were reviewed. In this article, lead investigators summarize the progress made in a multicenter study, the PsA BioDam (Psoriatic Arthritis Biomarkers for Joint Damage), to identify soluble biomarkers for joint damage, as well as developing classification criteria for arthritis mutilans. Also reviewed are concepts and rationale behind a proposal to study classification criteria for peripheral spondyloarthritis, including PsA, reactive arthritis, inflammatory bowel disease-associated arthritis, and undifferentiated arthritis.

GRAPPA 2015 Research and Education Project Reports

2016 ◽  
Vol 43 (5) ◽  
pp. 979-985 ◽  
Author(s):  
Philip J. Mease ◽  
Philip S. Helliwell ◽  
Wolf-Henning Boehncke ◽  
Laura C. Coates ◽  
Oliver FitzGerald ◽  
...  
Keyword(s):  
Psoriatic Arthritis ◽  
Annual Meeting ◽  
Joint Damage ◽  
Treatment Recommendations ◽  
Musculoskeletal Disease ◽  
Education Project ◽  
Publication Committee ◽  
Structural Joint ◽  
Research And Education

At the 2015 annual meeting of the Group for Research and Assessment of Psoriasis and Psoriatic Arthritis (GRAPPA), attendees were presented with brief updates on several ongoing initiatives, including educational projects. Updates were presented on the treatment recommendations project, the development of simple criteria to identify inflammatory musculoskeletal disease, new patient/physician Delphi exercises, and BIODAM (identifying biomarkers that predict progressive structural joint damage). The publication committee also gave a report. Herein we summarize those project updates.

Psoriatic Arthritis Screening and Evaluation (PASE) Questionnaire and the Role of Dermatologists: A Report from the GRAPPA 2009 Annual Meeting: Table 1.

2011 ◽  
Vol 38 (3) ◽  
pp. 548-550 ◽  
Author(s):  
PATRICK DOMINGUEZ ◽  
M. ELAINE HUSNI ◽  
AMIT GARG ◽  
ABRAR A. QURESHI
Keyword(s):  
Psoriatic Arthritis ◽  
Annual Meeting ◽  
Physical Disability ◽  
Inflammatory Arthritis ◽  
Critical Role ◽  
Diagnosis And Treatment ◽  
Major Focus ◽  
Delay In Diagnosis ◽  
Erosive Arthropathy

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.

The Path Forward to Biomarker Discovery in Psoriatic Disease: A Report from the GRAPPA 2010 Annual Meeting

2012 ◽  
Vol 39 (2) ◽  
pp. 434-436 ◽  
Author(s):  
DAFNA D. GLADMAN ◽  
CHRISTOPHER T. RITCHLIN ◽  
OLIVER FITZGERALD
Keyword(s):  
Psoriatic Arthritis ◽  
Annual Meeting ◽  
Radiographic Progression ◽  
Biomarker Discovery ◽  
Clinical Phenotype ◽  
Inception Cohort ◽  
Psoriatic Disease ◽  
Definition Of ◽  
Biomarker Research

At the 2010 annual meeting of the Group for Research and Assessment of Psoriasis and Psoriatic Arthritis (GRAPPA), wide-ranging discussions were held regarding biomarker research in psoriatic disease. Consensus was reached on 2 areas of priority: (1) the study of soluble biomarkers of radiographic progression in psoriatic arthritis (PsA); and (2) the analysis of comorbidity biomarkers, specifically cardiovascular and articular, in a psoriasis inception cohort. For each of these areas, rigorous definition of the clinical phenotype of PsA will be essential. To date, 2 instruments have been identified to define the phenotype: the ClASsification of Psoriatic ARthritis criteria and various screening questionnaires. In this overview, we discuss the challenges of the clinical phenotype of PsA and review GRAPPA plans for developing a research program for biomarker discovery.

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