Abstract
The 2013 Annual Meeting of the Group for Research and Assessment of Psoriasis and Psoriatic Arthritis (GRAPPA) was held in July 2013 in Toronto, Canada, and attended by rheumatologists, dermatologists, and representatives of biopharmaceutical companies and patient groups. We introduce the articles that summarize the meeting: A summary of a GRAPPA-organized Fellows Symposium adjacent to the 2013 European Academy of Dermatology and Venereology meeting in Istanbul; at the GRAPPA meeting proper, proceedings of a trainee symposium, where rheumatology fellows and dermatology residents presented their research; a summary of experiences and perspectives of psoriasis and psoriatic arthritis (PsA) research of 8 patient research partners with PsA who were invited to participate as delegates. Other presentations and discussions included an interactive session on composite measures of disease severity and response, including voting by GRAPPA members; a 3 part update of basic/translational/clinical science, including new bone formation, enthesitis pathophysiology, and comorbidity monitoring; a 3 part dermatology update on psoriasis outcome measures, the Brigham Scalp Nail Inverse Palmoplantar Psoriasis Composite Index, and large-scale databases; a short summary of the ongoing GRAPPA effort to update treatment guidelines for PsA; updates on several GRAPPA educational and rheumatology-related projects; and a discussion of clinical criteria to identify inflammatory arthritis, enthesitis, dactylitis, and spondylitis as distinguished from non-inflammatory conditions.
The 2013 annual meeting of the Group for Research and Assessment of Psoriasis and Psoriatic Arthritis (GRAPPA) was held in Toronto, Canada. Investigators in the fields of rheumatology and dermatology, and representatives of biopharmaceutical companies or from patient service leagues (Table 1, Table 2) discussed individual and collaborative research and education initiatives in the fields of psoriasis and psoriatic arthritis (PsA). GRAPPA was originally formed in 2003, and the goals and list of core projects have been reported (www.grappanetwork.org)1,2,3,4.
Composition of GRAPPA members.
GRAPPA executive and steering committee membership.
Prior to the 2013 GRAPPA meeting, a reception was held honoring Dafna D. Gladman, Past President of GRAPPA, at the University of Toronto on the occasion of the 35th anniversary of Toronto’s Psoriatic Arthritis Program.
In a report from a Fellows Symposium adjacent to an October 2013 meeting of the European Academy of Dermatology and Venereology Congress in Istanbul, Turkey, 3 GRAPPA members, Wolf-Henning Boehncke (Geneva, Switzerland), Brian Kirby (Dublin, Ireland), and Diament Thaci (Lübeck, Germany), summarized the proceedings of that meeting. Of 27 abstracts that were submitted and judged, 9 were chosen for discussion, including 5 that focused on comorbidities in patients with psoriasis or PsA5.
As in past years, the 2013 GRAPPA meeting began with a Trainees Symposium, chaired by Christopher Ritchlin (Rochester, New York, USA). Forty abstracts from dermatology and rheumatology trainees were submitted and ranked by a committee of reviewers. Five trainees with the highest-scored abstracts delivered oral presentations; the remainder presented posters that outlined their research. GRAPPA members provided feedback on how to transition current research projects to the next level6.
For the first time, 8 patients with PsA participated as full delegates at the 2013 GRAPPA meeting, where they were invited to provide their perspective for different sessions of the conference program. A summary is included of the presentations on patient participation in research, the experiences of these patient research partners, and plans to enhance the patient perspective in psoriasis and PsA research7.
Philip Helliwell (Leeds, UK) and Oliver FitzGerald (Dublin, Ireland) led a discussion of composite measures of disease severity and response for PsA, which included a vote by GRAPPA members on cutoffs for low/high disease activity in several scoring indices. Response criteria for the new composite indices have now been developed, but they require further validation and testing in other datasets8.
Three summaries of basic, translational, or clinical science issues important to GRAPPA members were discussed at the meeting. The first was presented by Georg Schett (Erlangen, Germany) on current research into the cytokine signature in PsA and its effects on new bone formation9. The second was a presentation by Dr. Ritchlin on enthesitis pathophysiology, which included enthesis anatomy, its central role in PsA, and new data that may address the contribution of enthesial inflammation to key pathophysiologic pathways in the psoriatic joint10. A third presentation was by Dr. Boehncke on cardiovascular risk factors in psoriasis and PsA, with emphasis on current comorbidity screening guidelines for use by dermatologists and rheumatologists11.
Next, 3 dermatologic reports were presented. First, Alice Gottlieb (Boston, Massachusetts, USA) discussed the need for outcome measures for patients with dermatological conditions. She reported on the International Dermatology Outcome Measures group, which includes patients, physicians, payers, and pharmaceutical scientists, with a goal of developing outcome measures that address the needs of all involved12. Next, a group led by Joseph Merola (Boston) led a discussion of the Brigham Scalp Nail Inverse Palmoplantar Psoriasis Composite Index, as a complementary objective measure to the Psoriasis Area and Severity Index13. Finally, April Armstrong (Denver, Colorado, USA) led a discussion on large databases, including research networks, electronic medical records, and disease registries, that address real-world, clinically relevant dermatology questions14.
One of GRAPPA’s central missions is to develop guidelines for the optimal treatment of patients with PsA. Although guidelines have previously been published, updated ones are necessary that reflect recent developments and ongoing research. A report was provided by Laura Coates (Leeds, UK), et al of the efforts to publish these new guidelines separately in 201415.
GRAPPA members are also active in several educational areas in psoriasis and PsA. In an article by Kristina Callis Duffin (Salt Lake City, Utah, USA) et al, summaries are presented of the GRAPPA video project, the GRAPPA Educational Outreach Project, the Dermatology and Rheumatology Trainee Educational Initiative, and the GRAPPA Educational Slide Library16.
Several rheumatology projects were also summarized at the meeting. In an article by FitzGerald, et al, members were updated on progress made in a multicenter study to identify soluble biomarkers for joint damage in the PsA BioDam Study, in developing classification criteria for arthritis mutilans, and in a proposal to study classification criteria for peripheral spondyloarthritis (e.g., PsA, reactive arthritis, inflammatory bowel disease-associated arthritis, and undifferentiated arthritis)17.
Finally, Philip Mease (Seattle, Washington, USA), et al described a research project to develop clinical criteria to aid in the identification of inflammatory arthritis, enthesitis, dactylitis, and spondylitis and to distinguish these from noninflammatory conditions. Breakout group exercises and planned project activities will eventually lead to the development of practical criteria to provide appropriate clinical care to patients with chronic inflammatory musculoskeletal conditions18.
A business meeting was held at the conclusion of the GRAPPA annual meeting, with discussions of action items. The next annual meeting will be held in New York, New York, USA, in July 2014.
Acknowledgments
Special thanks go to Pam Love for her tireless organizational efforts, which kept the meeting running smoothly; and to Linda Melvin, writer/editor for GRAPPA 2013 papers.
Footnotes
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Financial support to enable these meetings was provided in 2013 by AbbVie, Amgen, Bristol Myers Squibb, Celgene, Covagen, Janssen, Eli Lilly & Company, Novartis, Pfizer, and UCB.
