Abstract
The 2010 Annual Meeting of the Group for Research and Assessment of Psoriasis and Psoriatic Arthritis (GRAPPA) was held in December 2010 in Miami Beach, Florida, USA, with attendance by rheumatologists, dermatologists, and representatives of biopharmaceutical companies and patient groups. In a training session that preceded the GRAPPA meeting, members served as faculty while rheumatology fellows and dermatology residents presented their original research. During the 2-day GRAPPA meeting, presentations included a review of composite measures for psoriatic arthritis (PsA) and psoriasis, updates on imaging in psoriatic disease (ultrasound and magnetic resonance imaging), a 3-part discussion of the definition of inflammatory musculoskeletal disease, a 4-part discussion of the status and path forward in psoriatic disease biomarker research, an update on comorbidities in psoriasis and PsA, and a review of global education and partnering opportunities. Introductions to the discussions at the GRAPPA 2010 meeting are included in this prologue.
The Group for Research and Assessment of Psoriasis and Psoriatic Arthritis (GRAPPA) held its 2010 annual meeting in Miami Beach, Florida, USA. GRAPPA was formed in 2003 and has grown to 349 members worldwide who are investigators in the fields of rheumatology and dermatology, representatives of biopharmaceutical companies, or from patient service leagues (Table 1). The goals of GRAPPA and a list of core projects already accomplished have been enumerated1. The annual meeting provides an opportunity for members to be updated on new developments in the fields of psoriasis and psoriatic arthritis (PsA) in general, as well as particular projects that individual members are pursuing.
GRAPPA members, December 2010.
For the third year, the 2-day annual meeting was preceded by a meeting of trainees in rheumatology or dermatology who were members of GRAPPA or who were nominated by GRAPPA members to submit abstracts based on recent research in psoriasis or PsA. Six abstracts were selected for oral presentation, and 19 were presented as posters. Christopher Ritchlin (Rochester, NY, USA) chaired the session, and more than 100 GRAPPA members attended the presentations and queried the trainees during the oral and poster sessions. The sessions generated lively discussion and helpful suggestions from the GRAPPA faculty, who observed the high quality of their presentations of psoriasis and PsA research2.
The next day, following a welcome by GRAPPA president Philip Mease (Seattle, WA, USA), a review of composite measures for PsA and psoriasis was co-chaired by Philip Helliwell (Leeds, United Kingdom), Oliver FitzGerald (Dublin, Ireland), and Dr. Mease3. Development of a single composite measure is important to permit an assessment of PsA in totality, including all musculoskeletal, and if psychometrically feasible, cutaneous features, and enable the cutoffs for low, moderate, and high disease activity, as well as the magnitude of any change. The status of several composite indices for PsA was reviewed, followed by initial data from the GRAPPA Composite Exercise (GRACE), which has been under way for 3 years and may be ready for candidate measures to be adopted in new studies or tested in existing databases.
The next module of the GRAPPA meeting was a 2-part review of imaging in psoriatic disease. First, a comprehensive literature review of the current use of ultrasound was presented by Gurjit Kaeley (Jacksonville, FL, USA), followed by a presentation of the PREPARE (Prevalence of Psoriatic Arthritis in Adults with Psoriasis) study design by Catherine Bakewell (Seattle, WA, USA)4. GRAPPA members expressed interest in future collaborations in the use of ultrasound to detect subclinical disease, provide insight into the heterogeneous pathophysiology of musculoskeletal inflammation, and assist in correlating patient disease activity measures. The second part of the imaging module was a review by Mikkel Østergaard (Glostrup, Denmark) of magnetic resonance imaging (MRI)5, which was described as an excellent tool for evaluation of patients with PsA because it can detect both peripheral and axial disease manifestations. Dr. Østergaard emphasized, however, that further scientific work needs to be done to clarify the value of different MRI techniques in diagnosis, monitoring, and prognostication of PsA. A research agenda was suggested, and international collaborative research initiatives, e.g., from GRAPPA, were encouraged.
A 3-part module followed, where co-chairs Amit Garg (Boston, MA, USA), Dafna Gladman (Toronto, Ontario, Canada), and Philip Mease led GRAPPA members in discussing the definition of inflammatory musculoskeletal disease, which is essential in order to apply the CASPAR (ClASsification of Psoriatic ARthritis) criteria, the most widely applied criteria for classifying PsA6. Most members agreed that the primary symptoms were pain, swelling, and the presence of prolonged morning stiffness. In a companion paper, Dr. Mease discussed the steps that GRAPPA members are taking to define the key variables that must be met to distinguish inflammatory arthritis, enthesitis, and dactylitis from degenerative, traumatic, mechanical, or infectious forms of these conditions7. Finally, Dr. Gladman discussed the difficulties of identifying axial disease in patients with PsA; she reviewed the Ankylosing SpondyloArthritis International Society (ASAS) criteria used to identify inflammatory back pain in AS patients and how those criteria might be applied to PsA patients8.
The first day of the GRAPPA meeting concluded with an update, by co-chairs Kristina Callis Duffin (Salt Lake City, UT, USA) and Philip Mease, on the development of online training videos that teach clinicians how to examine skin, nails, joints, entheses, dactylitis, and the spine. Web-based interactive multimedia presentations for psoriasis assessments (skin, nails, and scalp) have been completed; rheumatology modules (tender and swollen joints, enthesitis, dactylitis, and axial disease) are under way. The next phase of the project will include analysis of interobserver reliability and translation into languages other than English for international users9.
The second day of the GRAPPA meeting opened with a 4-part discussion of translational science led by Christopher Ritchlin, who summarized the rationale for biomarker research in PsA, discussed types and sources of biomarkers, cited examples of important biomarker studies in PsA and reviewed some trial designs, and ended with a discussion of potential funding sources10. Next, Oliver FitzGerald and Vinod Chandran (Toronto, Ontario, Canada) discussed biomarkers used to screen patients with psoriasis for PsA and to assess disease activity and severity, including biomarkers that distinguish subjects with PsA from those with psoriasis alone, others that may prove useful as biomarkers of PsA activity, and some that are strong candidates as biomarkers of radiographic change11. Proton Rahman (St. John’s, Newfoundland, Canada) and James Elder (Ann Arbor, MI, USA) discussed the inter-relationship of psoriasis vulgaris and PsA, in particular mapping studies and genome-wide association scans that have led to a substantial increase in the number of candidate genes reaching genome-wide significance in psoriasis and PsA cohorts12. Finally, Drs. Gladman, Ritchlin, and FitzGerald co-chaired discussions regarding the path forward in psoriatic disease biomarker research, with GRAPPA members agreeing on 2 areas of priority: soluble biomarkers of radiographic progression and comorbidity biomarkers in a psoriasis inception cohort13.
A 2-part discussion of comorbidities in psoriatic disease was conducted by co-chairs Wolf Henning Boehncke (Frankfurt am Main, Germany) and Siba Raychaudhuri (Geneva Place, CA, USA). Dr. Raychaudhuri reviewed the constellation of comorbid conditions associated with PsA, emphasizing the risks of coronary artery disease and metabolic syndrome and discussing the concept of total care, i.e., development of a comprehensive approach for the management of comorbidities of PsA14. Dr. Boehncke reviewed the available evidence supporting the concept of a causal link between psoriasis and cardiovascular disease, in particular, the cascade of events leading to type 2 diabetes mellitus (the “psoriatic march”), given initial findings on insulin resistance among psoriasis patients15.
The final session was co-chaired by Philip Mease and Luis Espinoza (New Orleans, LA, USA) and was a discussion of global education and partnering opportunities and challenges of psoriasis and PsA in Latin America. Emphasizing the need to understand the biologic basis, estimate the disease burden, and determine the clinical treatment of PsA in Latin America, and as part of GRAPPA’s global outreach initiative, members are coordinating with the Latin American Psoriasis and PsA Society (LAPPAS), the Pan American League of Associations for Rheumatology (PANLAR), and the Asia Pacific League of Associations for Rheumatology (APLAR) to increase the understanding of psoriasis and PsA16. Educational symposia for both rheumatologists and dermatologists will continue to be conducted by GRAPPA members in various countries in Latin America and Asia.
Conclusion
A business meeting was held as part of the GRAPPA annual meeting, with some changeover in committee membership (Table 2). Overall, GRAPPA members agreed on the success of their 2010 annual meeting; the meeting was attended by 140 rheumatologists and dermatologists, and engaging discussions were held of exciting ongoing and new research projects.
GRAPPA Executive and Steering Committee Membership 2010–2011.
Footnotes
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Supported by Abbott, Amgen, Bristol-Myers-Squibb, Celgene, Centocor, Eli Lilly & Company, Novartis, Pfizer, and UCB.
