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Research ArticlePsoriatic Arthritis

Physician’s Global Assessment in Psoriatic Arthritis: A Multicenter GRAPPA Study

Alberto Cauli, Dafna D. Gladman, Alessandro Mathieu, Ignazio Olivieri, Giovanni Porru, Paul P. Tak, Claudia Sardu, Raffaele Scarpa, Antonio Marchesoni, William J. Taylor, Carlo Salvarani, Joachim Kalden, Ennio Lubrano, Sueli Carneiro, Matteo Piga, Alberto Floris, Francesca Desiati, John A. Flynn, Salvatore D’Angelo, Arno W.R. van Kuijk, Maria Grazia Catanoso, Francesco Caso, Paolo Contu, Ilona Ujfalussy, Philip S. Helliwell and Philip J. Mease for the GRAPPA 3PPsA Study Group
The Journal of Rheumatology September 2018, 45 (9) 1256-1262; DOI: https://doi.org/10.3899/jrheum.171183
Alberto Cauli
From the Department of Medical Sciences, Policlinico of the University of Cagliari; Rheumatology Unit, and Department of Public Health, University of Cagliari, Cagliari; Rheumatology Department of Lucania, San Carlo Hospital of Potenza and Madonna delle Grazie Hospital of Matera, Matera; Rheumatology Research Unit, Department of Clinical and Experimental Medicine, University “Federico II,” Naples; Department of Rheumatology, ASST Gaetano Pini-Centro Traumatologico Ortopedico (CTO), Milan; Rheumatology Unit, Azienda USL-IRCCS di Reggio Emilia and Università di Modena e Reggio Emilia, Modena and Reggio Emilia; Dipartimento di Medicina e Scienze della Salute, Università degli Studi del Molise, Campobasso, Italy; University of Toronto, Toronto Western Hospital, Toronto, Ontario, Canada; Academic Medical Center/University of Amsterdam; Amsterdam Rheumatology and Immunology Center Reade, Amsterdam, the Netherlands; Rehabilitation Teaching and Research Unit, Department of Medicine, Wellington School of Medicine and Health Sciences, University of Otago, Wellington, New Zealand; Medizinische Klinik III mit Poliklinik, Friedrich-Alexander-Universität Erlangen-Nuernberg, Erlangen, Germany; Sector of Dermatology, HUCFF School of Medicine, Federal University of Rio de Janeiro and Sector of Dermatology, HUPE School of Medical Sciences, State University of Rio de Janeiro, Rio de Janeiro, Brazil; Spondyloarthritis Program, Johns Hopkins University, School of Medicine, Baltimore, Maryland; Swedish Medical Centre and University of Washington School of Medicine, Seattle, Washington, USA; Department of Rheumatology, Semmelweis University, Budapest, Hungary; Leeds Institute of Molecular Medicine, University of Leeds, Leeds, UK.
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  • For correspondence: cauli@medicina.unica.it
Dafna D. Gladman
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Alessandro Mathieu
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Ignazio Olivieri
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Giovanni Porru
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Paul P. Tak
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Claudia Sardu
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Raffaele Scarpa
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Antonio Marchesoni
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William J. Taylor
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Carlo Salvarani
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Joachim Kalden
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Ennio Lubrano
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  • ORCID record for Ennio Lubrano
Sueli Carneiro
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Matteo Piga
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Alberto Floris
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Francesca Desiati
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John A. Flynn
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Salvatore D’Angelo
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Arno W.R. van Kuijk
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Maria Grazia Catanoso
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Francesco Caso
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Paolo Contu
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Ilona Ujfalussy
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Philip S. Helliwell
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Philip J. Mease
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Abstract

Objective. Physician’s global assessment (PGA) of disease activity is a major determinant of therapeutic decision making. This study assesses the reliability of the PGA, measured by means of 0–100 mm visual analog scale (VAS), and the additional use of separate VAS scales for musculoskeletal (PhysMSK) and dermatologic (PhysSk) manifestations in patients with psoriatic arthritis (PsA).

Methods. Sixteen centers from 8 countries enrolled 319 consecutive patients with PsA. PGA, PhysMSK, and PhysSk evaluation forms were administered at enrollment (W0) and after 1 week (W1). Detailed clinical data regarding musculoskeletal (MSK) manifestations, as well as dermatological assessment, were recorded.

Results. Comparison of W0 and W1 scores showed no significant variation (intraclass correlation coefficients were PGA 0.87, PhysMSK 0.86, PhysSk 0.78), demonstrating the reliability of the instrument. PGA scores were dependent on PhysMSK and PhysSk (p < 0.0001) with a major effect of the MSK component (B = 0.69) compared to skin (B = 0.32). PhysMSK was correlated with the number of swollen joints, tender joints, and presence of dactylitis (p < 0.0001). PhysSk scores were correlated with the extent of skin psoriasis and by face, buttocks or intergluteal, and feet involvement (p < 0.0001). Finally, physician and patient assessments were compared showing frequent mismatch and a scattered dot plot: PGA versus patient’s global assessment (r = 0.36), PhysMSK versus patient MSK (r = 0.39), and PhysSk versus patient skin (r = 0.49).

Conclusion. PGA assessed by means of VAS is a reliable tool to assess MSK and dermatological disease activity. PGA may diverge from patient self-evaluation. Because MSK and skin/nail disease activity may diverge, it is suggested that both PhysMSK and PhysSk are assessed.

Key Indexing Terms:
  • PSORIATIC ARTHRITIS
  • ASSESSMENT MEASURES
  • DOMAINS
  • INSTRUMENTS
  • PHYSICIAN’S GLOBAL ASSESSMENT
  • Accepted for publication February 28, 2018.
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1 Sep 2018
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Physician’s Global Assessment in Psoriatic Arthritis: A Multicenter GRAPPA Study
Alberto Cauli, Dafna D. Gladman, Alessandro Mathieu, Ignazio Olivieri, Giovanni Porru, Paul P. Tak, Claudia Sardu, Raffaele Scarpa, Antonio Marchesoni, William J. Taylor, Carlo Salvarani, Joachim Kalden, Ennio Lubrano, Sueli Carneiro, Matteo Piga, Alberto Floris, Francesca Desiati, John A. Flynn, Salvatore D’Angelo, Arno W.R. van Kuijk, Maria Grazia Catanoso, Francesco Caso, Paolo Contu, Ilona Ujfalussy, Philip S. Helliwell, Philip J. Mease
The Journal of Rheumatology Sep 2018, 45 (9) 1256-1262; DOI: 10.3899/jrheum.171183

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Physician’s Global Assessment in Psoriatic Arthritis: A Multicenter GRAPPA Study
Alberto Cauli, Dafna D. Gladman, Alessandro Mathieu, Ignazio Olivieri, Giovanni Porru, Paul P. Tak, Claudia Sardu, Raffaele Scarpa, Antonio Marchesoni, William J. Taylor, Carlo Salvarani, Joachim Kalden, Ennio Lubrano, Sueli Carneiro, Matteo Piga, Alberto Floris, Francesca Desiati, John A. Flynn, Salvatore D’Angelo, Arno W.R. van Kuijk, Maria Grazia Catanoso, Francesco Caso, Paolo Contu, Ilona Ujfalussy, Philip S. Helliwell, Philip J. Mease
The Journal of Rheumatology Sep 2018, 45 (9) 1256-1262; DOI: 10.3899/jrheum.171183
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Keywords

PSORIATIC ARTHRITIS
ASSESSMENT MEASURES
DOMAINS
INSTRUMENTS
PHYSICIAN’S GLOBAL ASSESSMENT

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Keywords

  • PSORIATIC ARTHRITIS
  • ASSESSMENT MEASURES
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  • INSTRUMENTS
  • PHYSICIAN’S GLOBAL ASSESSMENT

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