Abstract
A key mission of the Group for Research and Assessment of Psoriasis and Psoriatic Arthritis (GRAPPA) is to provide education about psoriasis and psoriatic arthritis (PsA) to clinicians. Among the global educational initiatives in 2012, GRAPPA worked collaboratively with several Latin American medical societies to organize a meeting of rheumatologists and dermatoligists in Buenos Aires; a second meeting is planned for Mexico City in September 2013. GRAPPA members also collaborated with the Spondyloarthritis Research and Therapy Network to conduct a series of continuing medical education symposia throughout the United States to update rheumatologists about new findings in PsA and spondyloarthritis. Finally, GRAPPA faculty presented a teaching module on PsA at an Asian regional conference in Singapore. Summaries of these activities are presented here.
In September 2012, in conjunction with several Latin American organizations (Latin American Psoriasis and Psoriatic Arthritis Society, Society of Latin American Psoriasis, and Pan-American League Against Rheumatism), GRAPPA members hosted 260 dermatologists and rheumatologists in a 2-day symposium on psoriasis and PsA. [Financial support was provided by Abbott.] Meeting organizers were Enrique Soriano and Morton Scheinberg, and GRAPPA presenters included Alberto Berman, Wolf-Henning Boehncke, Luis Espinosa, Dafna Gladman, Philip Helliwell, Philip Mease, Claudia Schainberg, Morton Scheinberg, Enrique Soriano, Sergio Toloza, and Rafael Valle-Onate. In plenary lectures on disease genetics, pathogenesis, epidemiology, clinical presentation, assessment, and treatment, significant emphasis was placed on collaboration between dermatologists and rheumatologists. Meet-the-professor sessions to discuss difficult cases and treatment approaches were included, as were hands-on workshops for physical examination and ultrasound of PsA and spondyloarthritis (SpA) patients. Enthusiasm in this interdisciplinary meeting was palpable, and a second meeting will occur in Mexico City in September 2013.
Another GRAPPA collaboration is a continuing medical educational (CME) project being conducted with the Spondyloarthritis Research and Therapy Network (SPARTAN). As new findings about PsA and SpA have emerged recently, we recognize the need for in-depth education of rheumatologists, rheumatology fellows, nurse practitioners, and physician assistants. Members of SPARTAN and North American members of GRAPPA, the majority of whom belong to both organizations, created a program of plenary lectures and breakout workshops. Table 1 provides a typical agenda of the day-long symposium. To date, 6 well attended symposia have been held in cities around the US. Lectures are updated as new information becomes available from scientific meetings. Some key new educational messages: (1) Genetic data on ankylosing spondylitis (AS) and PsA. (2) US epidemiology data from a recent NHANES survey, which suggests that 0.9%–1.4% of the US population may have axial SpA, compared to 0.5% with AS. (3) Classification criteria for PsA, axial SpA, and peripheral SpA. (4) Discovery of a unique population of resident entheseal T cells in an SpA animal model, which become activated by IL-23 and lead to activation of the TH17 pathway, which in turn can lead to inflammation and both erosive and osteoproliferative effects. (5) Understanding the pathogenic role of HLA-B27. (6) Clinical presentation and assessment of heterogeneous domains of arthritis, enthesitis, dactylitis, spondylitis, and skin and nail disease. (7) Composite disease severity and response measures that can provide thresholds for targeted treatment. (8) Treatment recommendations. (9) Data on emerging therapies. (10) Classification, clinical presentation, and management of pediatric enthesitis-related arthritis (ERA), juvenile PsA, and juvenile AS. (11) Comorbidities of PsA and SpA, with an emphasis on cardiovascular disease that has been particularly associated with PsA and metabolic syndrome. (12) Hands-on evaluation of patients to learn PsA and SpA-specific physical examination and ultrasound technique; includes focused workshop on evaluation of magnetic resonance imaging (MRI) scans.
In addition to full-day symposia, GRAPPA/SPARTAN faculty have developed half-day (4 lectures) and quarter-day (2 lectures) symposia that distill key educational messages and provide CME options for regional events. To date, one each of these half-day and quarter-day events has occurred.
In October 2012, 3 GRAPPA members, Peter Nash, Katy Leung Ying Ying, and James Louie, provided PsA education in the Ten Topics in Rheumatology Asia meeting in Singapore, a recurring annual conference that brings state-of-the-art lectures to Asia at affordable cost. In this conference, disease activity assessment, management updates, and the cardiovascular profile in PsA were discussed among 177 delegates from 9 Asian countries. A preconference workshop in spondyloarthropathies attracted 50 rheumatology trainees, where assessments of psoriasis disease activity in PsA were discussed, and hands-on sessions were included for assessment of skin, joints, and various manifestations of PsA.
Several educational initiatives are planned in 2013. The CME series on PsA and SpA conducted by GRAPPA and SPARTAN will continue in cities throughout the US. Three GRAPPA members, Philip Helliwell, Oliver FitzGerald, and Laura Coates, will lecture on various aspects of PsA in the Fourth Congress of Psoriasis International Network in Paris in early July. In mid-July, the annual meeting of GRAPPA will be held in Toronto, where a day-long educational symposium on PsA will be conducted in conjunction with the 35th year of the Psoriatic Arthritis Research Program led by Dafna Gladman at the University of Toronto.
Additional educational projects were proposed at the GRAPPA annual meeting, including the creation of a CME symposium series on psoriasis and PsA (analogous to the PsA-SpA symposia), targeting a dermatology and rheumatology audience in selected cities globally. Philip Helliwell also proposed creation of educational slides on psoriasis and PsA, to be posted online for teaching purposes (analogous to those on SpA available on the Assessment of Spondyloarthritis international Society website). Amit Garg described the unmet need for training of dermatology residents about psoriasis and PsA. He proposed a curriculum development project for dermatology and rheumatology training programs, which might include GRAPPA members in a visiting faculty program.
Suggested one-day SPARTAN-GRAPPA Educational Symposium Agenda* (names of experts who developed each talk are shown in italics).
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