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Ribeiro AL, Singla S, Chandran V, Chronis N, Liao W, Lindsay C, Soriano ER, Mease PJ, Proft F. Deciphering difficult-to-treat psoriatic arthritis (D2T-PsA): a GRAPPA perspective from an international survey of healthcare professionals. Rheumatol Adv Pract 2024; 8:rkae074. [PMID: 38912423 PMCID: PMC11193309 DOI: 10.1093/rap/rkae074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2024] [Accepted: 05/05/2024] [Indexed: 06/25/2024] Open
Abstract
Objectives This study contributes to the Group for Research and Assessment of Psoriasis and Psoriatic Arthritis (GRAPPA)'s effort to define 'difficult-to-treat' PsA (D2T-PsA), leveraging insights of healthcare professionals who are GRAPPA members. The primary objective is to inform GRAPPA's D2T PsA project, ensuring the consensus definition reflects clinical experience and expertise. Methods An online survey was conducted among GRAPPA's healthcare professionals managing PsA patients. The survey covered demographic details, structured questions, and open-ended queries to gather comprehensive insights into the experts' viewpoints. Results About 223 physicians completed the survey, comprising 179 (80.2%) rheumatologists and 40 (17.9%) dermatologists. The majority, 184 (82.5%), favoured establishing distinct definitions for D2T-PsA and complex-to-manage PsA (C2M-PsA). Furthermore, 202 (90.5%) supported a definition that includes objective inflammation signs (clinical, laboratory, imaging, among others). However, opinions varied on the criteria for prior treatment failures, with most (93, 41.7%) favouring a definition that includes at least one conventional synthetic disease-modifying anti-rheumatic drug and two or more biological- or targeted-synthetic-DMARDs with different mechanisms of action. Conclusion The survey reveals a majority opinion among GRAPPA experts favouring the differentiation between D2T-PsA and C2M-PsA, and the inclusion of objective inflammatory markers in these definitions. However, there is less than 50% agreement on the specific treatment failure criteria, particularly regarding the number of therapies needed to classify PsA as D2T. These findings suggest a need for continued discussion to reach a more unified approach in defining D2T-PsA, reflecting the complexity of the condition.
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Affiliation(s)
- Andre L Ribeiro
- Division of Rheumatology, University of Toronto, Women’s College Hospital, Toronto, ON, Canada
| | - Shikha Singla
- Department of Rheumatology, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Vinod Chandran
- Division of Rheumatology, Department of Medicine, University of Toronto, Toronto, Canada
- Psoriatic Arthritis Program, Schroeder Arthritis Institute, University Health Network, Toronto, Canada
| | - Nicholas Chronis
- Psoriatic Arthritis Program, Schroeder Arthritis Institute, University Health Network, Toronto, ON, Canada
| | - Wilson Liao
- Department of Dermatology, University of California San Francisco, San Francisco, USA
| | | | - Enrique R Soriano
- Rheumatology Section, Internal Medicine Service, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - Philip J Mease
- Swedish Medical Center/Providence St, Joseph Health and University of Washington School of Medicine, Seattle, USA
| | - Fabian Proft
- Department of Gastroenterology, Infectiology and Rheumatology (including Nutrition Medicine), Charité—Universitätsmedizin Berlin, Berlin, Germany
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Lubrano E, Scriffignano S, Perrotta FM. Clinical Characteristics of "Severe" Peripheral Psoriatic Arthritis: A Retrospective Analysis of a Longitudinal Cohort. Rheumatol Ther 2024; 11:663-674. [PMID: 38592646 PMCID: PMC11111618 DOI: 10.1007/s40744-024-00667-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2024] [Accepted: 03/13/2024] [Indexed: 04/10/2024] Open
Abstract
INTRODUCTION The concept of severity in a multidomain disease such as psoriatic arthritis (PsA) is still not well defined. The aim of this study was to identify the clinical characteristics of patients with severe peripheral PsA. METHODS Retrospective analysis of a longitudinal cohort. Demographic and clinical characteristics of patients with PsA were collected at baseline and at last follow-up. We defined the severe population using the modified Composite Psoriatic Disease Activity Index (mCPDAI); which excludes ankylosing spondylitis quality of life scale). Hence, patients with a score of 3 in at least one domain were defined as having severe PsA. Clinical characteristics of patients fulfilling the definition of severe PsA were compared to those non-severe. RESULTS We evaluated 177 patients with peripheral PsA (M/F: 98/76). Of these, 64 (36.1%) were identified as severe according to the mCPDAI criteria, at baseline. Eighteen patients (10.1%) at last follow-up still met the definition of severe PsA. At last follow-up visit, severe patients with PsA were only males (18/18, P < 0.01) and have worse outcomes in terms of disease activity, pain, function, and impact of disease. Male sex and the severity of skin involvement at baseline were factors associated with the presence of severe PsA. The agreement between the presence of severe PsA and the absence of minimal disease activity was slight [Cohen's k: 0.174 (0.084-0.264)]. CONCLUSIONS Our study showed that severe patients with PsA had more disease activity, pain, and impact of disease than non-severe patients. Furthermore, we demonstrated that severity and disease activity are not interchangeable concepts.
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Affiliation(s)
- Ennio Lubrano
- Academic Rheumatology Unit and MoRhe Project, Dipartimento di Medicina e Scienze della Salute "Vincenzo Tiberio", Università degli Studi del Molise, Via Giovanni Paolo II, C/da Tappino, 86100, Campobasso, Italy.
| | - Silvia Scriffignano
- Academic Rheumatology Unit and MoRhe Project, Dipartimento di Medicina e Scienze della Salute "Vincenzo Tiberio", Università degli Studi del Molise, Via Giovanni Paolo II, C/da Tappino, 86100, Campobasso, Italy
| | - Fabio Massimo Perrotta
- Academic Rheumatology Unit and MoRhe Project, Dipartimento di Medicina e Scienze della Salute "Vincenzo Tiberio", Università degli Studi del Molise, Via Giovanni Paolo II, C/da Tappino, 86100, Campobasso, Italy
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Marzo-Ortega H, Harrison SR, Nagy G, Machado PM, McGonagle DG, Aydin SZ, Almodovar-González R, Bautista-Molano W, Gossec L, Lubrano E, Nash P, Pimentel Santos F, Soriano ER, Siebert S. Time to address the challenge of difficult to treat psoriatic arthritis: results from an international survey. Ann Rheum Dis 2024; 83:403-404. [PMID: 37963707 DOI: 10.1136/ard-2023-225087] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2023] [Accepted: 11/05/2023] [Indexed: 11/16/2023]
Affiliation(s)
- Helena Marzo-Ortega
- NIHR Leeds Biomedical Research Centre and Leeds Institute of Rheumatic and Musculoskeletal Medicine, Leeds Teaching Hospitals Trust and University of Leeds, Leeds, UK
| | - Stephanie Rose Harrison
- NIHR Leeds Biomedical Research Centre and Leeds Institute of Rheumatic and Musculoskeletal Medicine, Leeds Teaching Hospitals Trust and University of Leeds, Leeds, UK
| | - György Nagy
- Departmnent of Rheumatology and Clinical Immunology & Department of Internal Medicine and Oncology, and Heart and Vascular Center, Hospital of the Hospitaller Order of Saint John of God & Semmelweis University, Budapest, Hungary
| | - Pedro M Machado
- MRC Centre for Neuromuscular Diseases, UCL, London, UK
- Rheumatology, University College London Centre for Rheumatology, London, UK
| | - Dennis G McGonagle
- NIHR Leeds Biomedical Research Centre and Leeds Institute of Rheumatic and Musculoskeletal Medicine, Leeds Teaching Hospitals Trust and University of Leeds, Leeds, UK
| | - Sibel Zehra Aydin
- Rheumatology, University of Ottawa Faculty of Medicine, Ottawa, Ontario, Canada
| | - Raquel Almodovar-González
- Rheumatology, Hospital Universitario Fundación Alcorcón, Alcorcon, Spain
- Preventive Medicine and Public Health, Universidad Rey Juan Carlos, Madrid, Spain
| | - Wilson Bautista-Molano
- Facultad de Medicina y Ciencias de la Salud, Universidad Militar Nueva Granada, Bogota, Colombia
| | - Laure Gossec
- INSERM, Institut Pierre Louis d'Epidémiologie et de Santé Publique, Sorbonne Universite, Paris, France
- APHP, Rheumatology Department, Hopital Universitaire Pitie Salpetriere, Paris, France
| | - Ennio Lubrano
- Dipartimento di Medicina e Scienze della Salute "Vincenzo Tiberio", Università degli Studi del Molise, Campobasso, Italy
| | - Peter Nash
- School of Medicine, Griffith University, Nathan, Queensland, Australia
| | | | - Enrique R Soriano
- Rheumatology Unit, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - Stefan Siebert
- Institute of Infection, Immunity & Inflammation, University of Glasgow, Glasgow, UK
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Singla S, Ribeiro A, Torgutalp M, Mease PJ, Proft F. Difficult-to-treat psoriatic arthritis (D2T PsA): a scoping literature review informing a GRAPPA research project. RMD Open 2024; 10:e003809. [PMID: 38191215 PMCID: PMC10806599 DOI: 10.1136/rmdopen-2023-003809] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2023] [Accepted: 12/06/2023] [Indexed: 01/10/2024] Open
Abstract
BACKGROUND Psoriatic arthritis (PsA) is a multifaceted condition with a broad spectrum of manifestations and a range of associated comorbidities. A notable segment of patients with PsA remains resistant to even advanced therapeutic interventions. This resistance stems from myriad causes, including inflammatory and non-inflammatory factors. OBJECTIVES To collate and critically assess the various definitions and criteria of difficult-to-treat (D2T PsA present in the literature. METHODS Using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) guidelines, we conducted a scoping review in July 2023, searching PubMed, American College of Rheumatology Convergence 2022, European Alliance of Associations for Rheumatology Congress 2023, Google Scholar and cited articles. Selection was made by two independent authors using Rayyan software, and conflicts were adjudicated by a third author. Eligibility criteria for PubMed focused on all article designs that were written in English, with full-text available, from the past decade, excluding only those not defining D2T PsA or targeting other populations. RESULTS From the 565 references sourced, 15 studies were analysed, revealing considerable variations in defining both 'active disease' and 'resistant PsA', which was most often termed 'D2T' PsA. CONCLUSION The definitions and criteria for D2T PsA and for 'active disease' are notably heterogeneous, with considerable variation across sources. The ongoing Group for Research and Assessment of Psoriasis and Psoriatic Arthritis initiative stands to bridge these definitional gaps and aims to provide guidance for clinicians and illuminate a path for pharmaceuticals and regulatory agencies to follow.
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Affiliation(s)
- Shikha Singla
- Department of Rheumatology, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Andre Ribeiro
- Rheumatology, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil
| | - Murat Torgutalp
- Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Department of Gastroenterology, Infectious Diseases and Rheumatology (including Nutrition Medicine), Charite Universitatsmedizin Berlin, Berlin, Germany
| | - Philip J Mease
- School of Medicine, Swedish Medical Center and University of Washington, Seattle, Washington, USA
| | - Fabian Proft
- Department of Gastroenterology, Infectiology and Rheumatology (including Nutrition Medicine), Charite Universitatsmedizin Berlin, Berlin, Germany
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