Abstract
The 2011 Annual Meeting of the Group for Research and Assessment of Psoriasis and Psoriatic Arthritis (GRAPPA) was held in July 2011 in Naples, Italy, and attended by rheumatologists, dermatologists, and representatives of biopharmaceutical companies and patient groups from around the world. The meeting began with a trainee symposium, where 25 rheumatology fellows and dermatology residents presented their original research work. Presentations and discussions by GRAPPA members during the remaining 2-day meeting included a 2-part discussion of the status of psoriatic disease biomarker research, summaries of the GRAPPA Composite Exercise and the GRAPPA video projects, a contribution from Italian members on their psoriasis and PsA projects, a lengthy discussion of research and collaborative initiatives from GRAPPA dermatologists, updates on ultrasound imaging in psoriatic disease and on plans to define inflammatory musculoskeletal disease, a presentation of the results of a small study of psoriasis and PsA in aboriginal people of Peru, and a review of global education and partnering opportunities. Introductions to these discussions are included in this prologue.
The Group for Research and Assessment of Psoriasis and Psoriatic Arthritis (GRAPPA) held its 2-day 2011 annual meeting in Naples, Italy. GRAPPA was formed in 2003 and includes members worldwide who are investigators in the fields of rheumatology and dermatology, representatives of biopharmaceutical companies, or from patient service leagues (Table 1, Table 2). The goals of GRAPPA have been enumerated elsewhere, as have a list of core projects already accomplished (see also: www.grappanetwork.org)1,2. Every year, GRAPPA members assemble to discuss new developments in the fields of psoriasis and psoriatic arthritis (PsA), particularly ongoing and projected individual and collaborative research and education initiatives.
Composition of GRAPPA members, 2011.
GRAPPA Executive and Steering Committee membership, 2011.
Following a welcome by GRAPPA president Philip Mease (Seattle, WA, USA), the 2011 annual meeting began with a symposium for rheumatology and dermatology trainees who were members of GRAPPA or who were nominated by GRAPPA members to submit abstracts based on recent research in psoriasis or PsA.
At the 2011 meeting, 25 trainees, representing 10 countries from North and South America and Europe, presented their findings in oral abstract or poster presentations. Christopher Ritchlin (Rochester, NY, USA) chaired the session, and about 100 GRAPPA members attended presentations and queried the trainees during the oral and poster sessions3.
A 2-part session on biomarkers followed the trainee symposium. A discussion of biomarkers of radiographic progression (erosion and new bone formation) in PsA was co-chaired by Oliver FitzGerald (Dublin, Ireland) and Drs. Ritchlin and Mease4. After a review of recent data that confirmed these biomarkers as a critical research issue in patients with PsA, members discussed the development of a pivotal, observational study (PsA Biodam study) to determine the validity of several soluble biomarkers in predicting structural damage in patients with PsA receiving standard therapies. Next, Dr. Dafna Gladman (Toronto, ON, Canada) led a discussion of biomarkers of comorbidities in psoriatic disease. Dr. Gladman presented an overview of recent genome-wide association studies identifying genes common to both psoriasis and PsA5. Dr. Gladman also discussed a report from the current database of the International Psoriasis and Psoriatic Arthritis Research Team, whose goals include addressing the issue of biomarkers for comorbidities.
Transitioning from translational science to outcome measures, co-chairs Philip Helliwell (Leeds, UK) and Drs. FitzGerald, Mease, and Gladman led a discussion of the GRAPPA Composite Exercise (GRACE) study, a project to develop composite disease activity and responder measures6. Two new indices were derived from the GRACE data. The first was a weighted index incorporating patient and physician global disease activity, tender and swollen joint counts, dactylitis and enthesitis, and the physical subscale component of a quality-of-life instrument. The second new index was based on cutoffs for domains such that individual desirability functions could be combined to represent a composite index. Dr. Fitzgerald also updated the group on the performance characteristics of the Comprehensive Psoriatic Disease Activity Index. Further developments of these 3 measures will be presented at the Outcome Measures in Rheumatology Clinical Trials (OMERACT) meeting in May 2012.
GRAPPA has developed several online training modules that teach clinicians how to examine skin, nails, joints, entheses, dactylitis, and the spine. At the 2011 meeting, status of the video project was presented by co-chairs Kristina Callis Duffin (Salt Lake City, UT, USA), April Armstrong (Sacramento, CA, USA), and Dr. Mease7. Several Internet-based multimedia teaching modules on physical examination techniques for psoriasis and PsA assessments have been completed, which comprehensively address psoriasis, arthritis, enthesitis, dactylitis, and nail disease. An axial disease module is near completion.
A group of Italian rheumatologists presented current data from several collaborative multicenter research projects8. Co-chairs Alberto Cauli (Monserrato, Italy), Ennio Lubrano (Campobasso, Italy), Raffaele Scarpa (Naples, Italy), and Ignazio Olivieri (Matera, Italy) emphasized that their efforts had assisted in the development of classification/diagnostic criteria and disease-specific outcome measures for PsA.
On the second day of the GRAPPA meeting, dermatology members gave introductory presentations and led panel discussions on priority research areas in psoriasis, including evaluation of PsA screening tools, updates on psoriasis comorbidities, and new developments in genetics and comparative effectiveness research9. Lengthy, spirited discussions were led by co-chairs April Armstrong, Amit Garg (Boston, MA, USA), Joel Gelfand (Philadelphia, PA, USA), Alice Gottlieb (Boston, MA, USA), Gerald Krueger (Salt Lake City, UT, USA), Abrar Qureshi (Boston, MA, USA), Cheryl Rosen (Toronto, ON, Canada), and Dr. Callis Duffin.
Next, the use of sonography for evaluating enthesitis and dactylitis in psoriasis and PsA was discussed by co-chairs Gurjit Kaeley (Jacksonville, FL, USA), Maria Antonietta D’Agostino (Paris, France), Walter Grassi (Ancona, Italy), and Ignazio Olivieri10. Initial proposals were presented to develop ultrasound joint indices to assess enthesitis and dactylitis in PsA, one of which was an outline of a GRAPPA-sponsored pilot sonographic project.
Drs. Garg, Gladman, and Mease led a discussion of the need to develop a framework for defining inflammatory arthritis, enthesitis, dactylitis, and spondylitis, as they relate to PsA11. GRAPPA members first addressed this subject at their 2010 meeting, and a research project to develop definitions of musculoskeletal inflammation will be proposed at the next GRAPPA meeting in 2012.
The final session of the day focused on global outreach. Sergio Toloza (Catamarca, Argentina), Oscar Vega-Hinojosa (Juliaca, Peru), Vinod Chandran (Toronto, ON, Canada), Rafael Valle-Onate (Bogota, Colombia), and Luis Espinoza (New Orleans, LA, USA) presented the results of a small (n = 16) study to determine the presence of psoriasis and PsA in aboriginal people living in the Andean Mountains of Peru12. Although limited in size, this was the first study of a native population living at a higher altitude.
Following this presentation, Dr. Mease updated the membership on education initiatives being conducted internationally by GRAPPA. The most notable was a 3-day meeting held in Fortaleza, Brazil, in which numerous rheumatologists and dermatologists from across Latin America participated. Organized by GRAPPA, this meeting included plenary lectures and workshops on a variety of topics related to psoriasis and PsA, including hands-on physical examination teaching sessions. Funding for this meeting was provided by Merck, Sharp, and Dohme. A similar meeting, involving collaborations between GRAPPA and several Latin American dermatology and rheumatology professional societies, will be held in Buenos Aires in 2012. Similar initiatives are to be undertaken in Asia and North America.
A highlight of the meeting was the attendance of Prof. John Moll (Leeds, UK), one of the pioneers of our clinical understanding of PsA. An inspiring moment was the award ceremony, in which Prof. Moll presented awards to each of the fellows and residents who had presented original research in the trainee abstract session. A special thanks goes to Pam Love for her tireless organizational efforts, which kept the meeting running smoothly, and to Prof. Scarpa and other Italian members who graciously hosted GRAPPA in Naples.
A business meeting was held at the conclusion of the GRAPPA annual meeting, with discussions of the GRAPPA website and other action items. The next annual meeting will be held in Stockholm, Sweden, in June 2012.
Footnotes
-
Financial support for these meetings was provided in 2011 by Abbott, Amgen, Bristol Myers Squibb, Celgene, Covagen, Janssen, Eli Lilly & Company, Novartis, Pfizer, and UCB.
