Abstract
The Group for Research and Assessment of Psoriasis and Psoriatic Arthritis (GRAPPA) is an international group dedicated to improving the lives of patients suffering from psoriasis and psoriatic arthritis (PsA). At the 2008 annual meeting of GRAPPA in Leeds, United Kingdom, members reviewed the status of imaging, including a new ultrasound measure, ultra-short echo time (UTE), and magnetic resonance imaging (MRI) in PsA and the imaging of musculoskeletal tissues in psoriasis; discussed the value and current status of composite measures for the assessment of PsA, including a breakout session where members addressed several issues related to developing PsA-specific composite measures; and reviewed biomarker development in psoriatic disease, including an interactive section on design considerations for a longitudinal study of biomarkers for joint damage. Summaries of those discussions are presented in this supplement.
The Group for Research and Assessment of Psoriasis and Psoriatic Arthritis (GRAPPA) is an international group dedicated to improving the lives of patients suffering from psoriasis and psoriatic arthritis (PsA). GRAPPA’s mission includes: increasing awareness and advancing early diagnosis of PsA; developing and validating assessment tools for psoriasis and PsA; evaluating treatment modalities to promote clinical research, with the ultimate goal of improving disease outcome; promoting basic research about disease pathophysiology; and fostering interdisciplinary communication and communication with patient service leagues, industry, regulatory agencies, and other concerned bodies. GRAPPA became a not-for-profit organization in 2006 with a constitution and governing body. There is a steering committee of 20 individuals, 6 of whom form the executive committee. In addition, there is a publications committee, research committee, treatment recommendations committee, and other committees formed ad hoc to deal with specific issues. GRAPPA numbers 244 members from around the world, including rheumatologists, dermatologists, methodologists, and the representatives of patient organizations, federal agencies and pharmaceutical companies.
GRAPPA has been successful in meeting its objectives since its inception in 2003. Classification criteria were developed in order to facilitate diagnosis and hopefully allow uniform and early disease recognition. Several screening questionnaires have been developed by GRAPPA members. These were presented at the GRAPPA meeting in Boston, Massachusetts, September 20071. A study has been initiated to compare these screening tools, which are hoped to further help in early identification of patients with PsA as they were developed as self-reported measures, thus not dependent on rheumatologist’s consultation.
GRAPPA, in collaboration with OMERACT (Outcome Measures in Rheumatology Clinical Trials), developed a core set of domains to assess patients with psoriasis and PsA2,3. These domains include assessment of peripheral joints, skin, enthesitis, and dactylitis, as well as patient-reported outcomes.
Having reviewed the literature on the treatment of psoriasis and PsA including peripheral joints, axial disease, enthesitis, and dactylitis, GRAPPA has developed treatment recommendations for PsA4. Members of GRAPPA achieved consensus on recommendations for treatment of these various features of the disease. These recommendations are based on the evidence, as well as expert opinion. A major project of GRAPPA is the development of a response measure specifically for PsA.
Interdisciplinary communication is an important objective of GRAPPA. This is achieved through an annual meeting to which all members are invited and which includes dermatologists and rheumatologists. In addition, GRAPPA holds smaller meetings adjacent to rheumatology meetings (American College of Rheumatology and European League of Associations of Rheumatology) as well as dermatology meetings (American Academy of Dermatology and European Academy for Dermatology and Venereology). The committees that oversee the activities of GRAPPA, the steering committee and executive committee, are structured to include members of both disciplines. Moreover, the content of the annual meetings is decided through interaction between the 2 disciplines.
GRAPPA has now had several annual meetings. This supplement provides a review of the 2008 annual meeting, which took place in Leeds, UK, September 5–6, 2008. The meeting, hosted by Philip Helliwell of Leeds, was preceded by a Fellows Day, in which rheumatology and dermatology trainees presented their research. There were 18 submissions ranging from basic science to clinical research. The content was superb and the session provided an opportunity for the trainees to interact both socially and scientifically. Christopher Ritchlin (rheumatologist, USA) discussed pathogenesis of PsA, while Amit Garg (dermatologist, USA) discussed psoriasis.
GRAPPA 2008 consisted of 3 parts: The first, on Friday afternoon, was a plenary session on imaging chaired by Philip Helliwell (rheumatologist, UK) and Paolo Gisondi (dermatologist, Italy). Laura Coates (rheumatologist, UK) introduced the session. Dennis McGonagle (rheumatologist, UK) presented his concept of the synovial-entheseal complex. Richard Hodgson (radiologist, UK) presented on a new ultrasound measure, ultra-short echo time (UTE), and magnetic resonance imaging (MRI) in PsA. Paolo Gisondi presented on imaging musculoskeletal tissues in psoriasis. Following the plenary presentations, breakout groups discussed topics related to imaging. These presentations and discussion are reviewed in Imaging in Psoriasis and Psoriatic Arthritis5.
The Saturday morning topic on composite measures in PsA began as a plenary session that included a review by Robert Landewé (rheumatologist, The Netherlands) on development of the Disease Activity Score in rheumatoid arthritis where the same methodology could be used in PsA; a review by Neil McHugh (rheumatologist, UK) on deployment and validation of the British Isles Lupus Activity Group (BILAG) disease activity index for systemic lupus erythematosus (SLE); a description of the development and validation of a disease activity score for PsA by Dafna Gladman (rheumatologist, Canada); an approach using a points system based on domains by Oliver FitzGerald (rheumatologist, Ireland); the combining of skin assessments in a meaningful way by Diamant Thaci (dermatologist, Germany); and a report on a preliminary attempt to develop minimal disease activity based on different disease domains by Laura Coates. The plenary session was similarly followed by a breakout session where members addressed several issues related to the development of composite measures, reported in Composite Measures in Psoriatic Arthritis6.
The Saturday afternoon session was dedicated to biomarkers in PsA. The plenary session included a presentation on a translational approach to biomarker development in psoriatic disease by Christopher Ritchlin; a description of biomarkers for psoriasis and biomarkers for progression to PsA by Abrar Qureshi (dermatologist, USA); and new data on biomarkers for damage in PsA by Kurt de Vlam (rheumatologist, Belgium). The session concluded with an interactive section on design considerations for a longitudinal study of biomarkers for joint damage in PsA by Oliver FitzGerald, all reported in Biomarkers in Psoriasis and Psoriatic Arthritis7.
Following the scientific sessions, John Moll (rheumatologist, UK), who with Verna Wright first defined PsA8, gave a dinner meeting address on the history of rheumatology in the UK.
The Leeds annual meeting proved very successful. Not only did it provide an opportunity for individuals from various disciplines to interact, but it resulted in an important research agenda. A design for a longitudinal study of biomarkers was finalized, and the study can now begin. A new study to develop a composite measure for PsA was established.
GRAPPA plans to continue its annual meetings. The next meeting takes place in Stockholm, Sweden, adjacent to the Second World Congress of Psoriasis and Psoriatic Arthritis, organized by the International Federation of Psoriasis Associations.
Footnotes
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Supported by GRAPPA.