The top 10 research priorities in psoriatic arthritis: a James Lind Alliance Priority Setting Partnership

OBJECTIVES

To identify and prioritize the top 10 research questions for PsA.

METHODS

The British Psoriatic Arthritis Consortium (BritPACT) formed a Priority Setting Partnership (PSP) comprising of people living with PsA, carers and clinicians, supported by the James Lind Alliance (JLA). This PSP followed the established three-stage JLA process: first, an online survey of people living with PsA, carers and clinicians to identify PsA questions, asking, 'What do you think are the most important unanswered questions in psoriatic arthritis research?' The questions were checked against existing evidence to establish 'true uncertainties' and grouped as 'indicative questions' reflecting the overarching themes. Then a second online survey ranked the 'true uncertainties' by importance. Finally, a workshop including people living with PsA and clinician stakeholders finalized the top 10 research priorities.

RESULTS

The initial survey attracted 317 respondents (69% people living with PsA, 15% carers), with 988 questions. This generated 46 indicative questions. In the second survey, 422 respondents (78% people living with PsA, 4% carers) prioritized these. Eighteen questions were taken forward to the final online workshop. The top unanswered PsA research question was 'What is the best strategy for managing patients with psoriatic arthritis including non-drug and drug treatments?' Other top 10 priorities covered diagnosis, prognosis, outcome assessment, flares, comorbidities and other aspects of treatment (https://www.jla.nihr.ac.uk).

CONCLUSION

The top 10 priorities will guide PsA research and enable PsA researchers and those who fund research to know the most important questions for people living with PsA.

OA33 The top 10 research priorities in psoriatic arthritis: a James Lind Alliance Priority Setting Partnership

Background/Aims

This process aimed to identify and prioritise the top 10 research questions or evidence uncertainties for psoriatic arthritis (PsA) in adults. The British Psoriatic Arthritis Consortium (BritPACT) formed a Priority Setting Partnership (PSP) comprising people with PsA, carers and healthcare professionals, in association with the James Lind Alliance (JLA) to identify the key questions and priorities.

Methods

The JLA methodology involved a three-stage process: 1. A steering group composed of stakeholders conducted an initial online survey of people with PsA, families, carers and healthcare professionals to identify PsA questions. Participants were asked, “What do you think are the most important unanswered questions in psoriatic arthritis research?”. Duplicate questions and those which were out of scope were removed. Questions were checked against existing evidence to establish “true uncertainties”, which were then grouped as “indicative questions” reflecting the overarching themes of the original submissions (diagnosis, effects of disease and treatment, flares, psychological, financial and social factors, gender-associated issues, Covid-19 and treatment) to facilitate prioritisation in stage two. 2. In a second online survey, people with PsA, carers and healthcare professionals ranked the “true uncertainties” by importance. 3. During the final workshop, including people with PsA and clinicians, participants worked together to rank the questions to generate a top 10 list of research priorities.

Results

The initial survey recruited 317 respondents, submitting a total of 988 questions. The individual submissions generated 46 indicative questions. 69% of the respondents were people with PsA, and 15% were friends, relatives, or carers of someone affected by PsA. In the second survey, 422 respondents, of whom 82% were people with PsA, their carers, relatives or friends, prioritised these uncertainties; 18 of these questions were shortlisted and taken forward to the final online workshop. In the last stage, people with PsA, carers, and healthcare professionals met and reached a consensus on the final top 10 research priorities (Table 1).

Conclusion

The top 10 priorities identified will guide PsA research, ensuring that PsA researchers and those who fund research know the most urgent needs of people living with PsA, their families and carers, and those treating people with PsA.

Disclosure

L. Hailey: None. S. Kinsella: None. C. Bundy: None. H. Burstow: None. D. Chandler: None. R. Cowper: None. P. Helliwell: None. L. Joannes: None. A. Kelly: None. B. Kennedy: None. H. McAteer: None. S. Mukherjee: None. J. Packham: None. E. Wise: None. H. Young: None. L. Coates: None.

AB0808 IMPLEMENTING IPad-BASED ASSESSMENTS TO IMPROVE PERFORMANCE IN A PSORIATIC ARTHRITIS CLINIC AT A DISTRICT GENERAL HOSPITAL

Background:

Psoriatic Arthritis (PsA) is a complex disease with profound physical and psychosocial effects. The core domain set for this condition was updated by the Group for Research and Assessment of Psoriasis and Psoriatic Arthritis (GRAPPA)-Outcome Measures in Rheumatology (OMERACT) PsA working group in 20161and the TICOPA (TIght COntrol of Psoriatic Arthritis) study suggested that adopting a ‘treat-to-target’ approach aiming for Minimal Disease Activity (MDA) could result in better clinical outcomes2.

Objectives:

To improve assessment of all the core domains of PsA during clinic appointments and aim to treat these patients using a ‘treat-to-target’ approach to improve clinical outcomes.

Methods:

We were able to confirm through a retrospective baseline audit that all core domains of PsA were not being fully addressed in our general rheumatology clinics. A dedicated weekly PsA clinic was then set up at our district general hospital. Subsequently, iPads incorporated with GRAPPA App were implemented in these clinics to facilitate multi-domain assessments aiming for MDA. This was supported by a Health Education England (Wessex) Quality Improvement Fellowship that involved rheumatology and dermatology team members working in close collaboration. We then carried out a re-audit to assess our performance. Additionally we set up quarterly combined Rheumatology and Dermatology clinics for patients with severe joint and skin involvement. We also conducted a baseline survey by asking patients for their opinion about the ‘setting up of the dedicated PsA service’, the ‘quarterly combined clinics’ and the ‘use of iPad-based assessments’. We asked them to score each of these on a scale of 0 to 10, with 0 being ‘very negative’ and 10 ‘very positive’.

Results:

We had pragmatically set a standard of 75% for our baseline audit but we found an overall compliance of only 27.4%. There was also a wide variation between different domains with a compliance of even 0% for some. Domains that are not assessed are unlikely to be fully taken into account when deciding about treatment. The re-audit following the implementation of iPad-based assessments in dedicated PsA clinics showed a significant improvement in each of the domains and the overall compliance went up to 97.9% (Table 1). The patient survey findings were also excellent with mean scores of 9.5, 9.0 and 9.5 respectively for the three items (Figure 1).

Table. 1Audit(n = 25)Re-audit(n = 29)ComplianceQ1. Documented evidence of joint count being performed?84.0%100.0%Q2. If yes, then was it a 66/68 count for swollen and tender joints?4.7%100.0%Q3. Documented evidence of dactylitis being assessed?8.0%100.0%Q4. Documented evidence of enthesitis being assessed?4.0%100%Q5. Documented evidence of assessment of spinal involvement?8.0%100.0%Q6. Documented evidence of assessment of skin involvement?36.0%100.0%Q7. Documented evidence of assessment of nail involvement?4.0%93.1%Q8. Documented evidence of assessment of fatigue?8.0%96.6%Q9. Documented evidence of assessment of degree of pain?60.0%100.0%Q10. Documented evidence of patient’s global assessment?68.0%96.6%Q11. Documented evidence of assessment of physical function?0.0%96.6%Q12. Documented evidence of assessment of health-related quality of life?0.0%93.1%Q13. Documented evidence of assessment of systemic inflammation?72.0%96.6%Overall Compliance27.4%97.9%

Conclusion:

Dedicated PsA clinics using the GRAPPA App on iPads could facilitate comprehensive multi-domain assessments of patients with PsA and potentially lead to better outcomes as well as greater patient satisfaction.

References:

[1]Orbai AMet al., (2017) Updating the psoriatic arthritis (PsA) core domain set: a report from the PsA workshop at OMERACT 2016. J Rheumatol 44(10):1522–1528

[2]Coates LCet al., Effect of tight control of inflammation in early psoriatic arthritis (TICOPA): a UK multicentre, open-label, randomised controlled trial. Lancet. 2015; 386(10012):2489–2498

Acknowledgments

Disclosure of Interests:

None declared