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Research ArticleAnnual Meeting of the Group for Research and Assessment of Psoriasis and Psoriatic Arthritis (GRAPPA), Toronto, Canada, July 12–13, 2013

Composite Disease Activity and Responder Indices for Psoriatic Arthritis: A Report from the GRAPPA 2013 Meeting on Development of Cutoffs for Both Disease Activity States and Response

Phillip S. Helliwell, Oliver FitzGerald and Jaap Fransen
The Journal of Rheumatology June 2014, 41 (6) 1212-1217; DOI: https://doi.org/10.3899/jrheum.140172
Phillip S. Helliwell
From the University of Leeds, Leeds, UK, and Bradford Hospitals National Health Service (NHS) Foundation Trust, Bradford, UK; Department of Rheumatology, St. Vincent’s University Hospital, Elm Park, Dublin, Ireland; Department of Rheumatology, Radboud University Medical Centre, Nijmegen, The Netherlands.
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  • For correspondence: p.helliwell@leeds.ac.uk
Oliver FitzGerald
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Jaap Fransen
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  • Article
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Article Figures & Data

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  • Figure 1.
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    Figure 1.

    Score distributions for PASDAS in GRACE study. The “change” group had its treatment changed or escalated for “active” disease. The “no change” group did not have treatment change and was therefore deemed to be in stable disease activity. The broken lines represent the 50th percentile values. PASDAS: Psoriatic ArthritiS Disease Activity Score; GRACE: GRAppa Composite scorE (index).

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    Figure 2.

    Receiver-operating curve (ROC) for PASDAS with decision to change treatment as discriminator. The value of PASDAS at 90% specificity was 5.62 (at this point sensitivity was 40%, as indicated by the dotted line). Area under the curve was 0.78 (95% CI: 0.75–0.81). PASDAS: Psoriatic ArthritiS Disease Activity Score.

Tables

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    Table 1.

    Cutoffs for disease activity for PASDAS using physician and patient global scores.

    ScoreCutoff
    Low (sens, spec)Moderate (sens, spec)High (sens, spec)
    Physician global3.59 (73.2, 90.2)4.44 (83.6, 90.0)5.65 (80.8, 90.0)
    Patient global2.67 (84.4, 90.2)3.67 (81.3, 90.0)5.07 (71.1, 90.0)
    • PASDAS: Psoriatic ArthritiS Disease Activity Score; Low: cutoff between low and moderate disease activity; Moderate: cutoff between moderate and high disease activity; High: cutoff between high and very high disease activity; sens, spec: sensitivity, specificity.

    • View popup
    Table 2.

    Cutoffs for disease activity in composite measures.

    MeasureScore Distribution
    50th PercentileROCVAS GlobalMean*
    Column No.12345
    PASDASLow3.7N/A2.73.2
    ModN/AN/A3.7N/A
    High5.55.65.15.4
    GRACELow3.0N/A1.62.3
    ModN/AN/A2.9N/A
    High4.65.24.34.7
    CPDAILow4N/A44
    ModN/AN/A6N/A
    High7888
    DAS28-CRPLow2.8N/A2.72.8
    ModN/AN/A3.3N/A
    High3.94.74.14.2
    DAPSALow18.5N/A18.518.5
    ModN/AN/A31.2N/A
    High33.155.247.045.1
    • ↵* Mean of estimates (50th percentile, ROC, and VAS global). CPDAI: Composite Psoriatic Disease Activity Index; DAPSA: Disease Activity score for PSoriatic Arthritis; DAS28-CRP: Disease Activity Score for 28 joints–C-reactive protein; GRACE: GRAPPA Composite Exercise; GRAPPA: Group for Research and Assessment of Psoriasis and Psoriatic Arthritis; N/A: not available; PASDAS: Psoriatic ArthritiS Disease Activity Score; ROC: receiver-operating curve; VAS: visual analog score.

    • View popup
    Table 3.

    Percentiles for each score distribution.

    Percentile
    Measure5102550759095
    PASDASNo change1.301.702.673.664.916.106.51
    Change2.963.614.495.456.196.897.14
    GRACENo change0.570.781.542.954.325.416.26
    Change1.202.233.424.575.686.607.16
    CPDAINo change1.002.003.004.007.009.0010.00
    Change2.003.005.007.009.0010.0011.00
    DAS28-CRPNo change1.341.501.942.833.744.985.72
    Change1.822.163.093.884.765.575.70
    DAPSANo change2.804.559.4818.4532.8360.75107.60
    Change7.0114.4022.3033.1055.2572.27105.81
    • CPDAI: Composite Psoriatic Disease Activity Index; DAPSA: Disease Activity score for PSoriatic Arthritis; DAS28-CRP: Disease Activity Score for 28 joints–C-reactive protein; GRACE: GRAPPA Composite Exercise; GRAPPA: Group for Research and Assessment of Psoriasis and Psoriatic Arthritis; PASDAS: Psoriatic ArthritiS Disease Activity Score.

    • View popup
    Table 4.

    Results of regression using interperiod correlation coefficients.

    MeasureroSDeR2
    PASDAS0.8261.690.7760.734
    GRACE0.7821.880.9890.459
    CPDAI0.6922.781.8530.533
    DAS28-CRP0.7551.340.7630.660
    DAPSA0.82731.0814.2150.892
    • ro: derived from the regression equation of the interperiod correlation coefficients and represents the correlation at time zero; SD: standard deviation of ro; e: measurement error; R2: measure of goodness of fit of regression equation; CPDAI: Composite Psoriatic Disease Activity Index; DAPSA: Disease Activity score for PSoriatic Arthritis; DAS28-CRP: Disease Activity Score for 28 joints–C-reactive protein; GRACE: GRAPPA Composite Exercise; GRAPPA: Group for Research and Assessment of Psoriasis and Psoriatic Arthritis; PASDAS: Psoriatic ArthritiS Disease Activity Score.

    • View popup
    Table 5A.

    Response criteria for the Psoriatic ArthritiS Disease Activity Score (PASDAS).

    Final PASDAS ScoreImprovement
    > 1.6< 1.6 but > 0.8< 0.8
    ≤ 3.2123
    > 3.2 but < 5.4223
    ≥ 5.4233
    • 1: good response; 2: moderate response; 3: poor response.

    • View popup
    Table 5B.

    Response criteria for the GRAPPA Composite Exercise (GRACE).

    Final GRACE ScoreImprovement
    > 2.0< 2.0 but > 1.0< 1.0
    ≤ 2.3123
    > 2.3 but < 4.7223
    ≥ 4.7233
    • 1: good response; 2: moderate response; 3: poor response.

    • View popup
    Table 5C.

    Response criteria for the Composite Psoriatic Disease Activity Index (CPDAI).

    Final CPDAI ScoreImprovement
    > 4.0< 4.0 but > 2.0< 2.0
    ≤ 4.0123
    > 4.0 but < 8.0223
    ≥ 8.0233
    • 1: good response; 2: moderate response; 3: poor response.

    • View popup
    Table 5D.

    Response criteria for Disease Activity Score (DAS28-CRP).

    Final DAS28-CRP ScoreImprovement
    > 1.6< 1.6 but > 0.8< 0.8
    ≤ 2.8123
    > 2.8 but < 4.2223
    ≥ 4.2233
    • 1: good response; 2: moderate response; 3: poor response. CRP: C-reactive protein.

    • View popup
    Table 5E.

    Response criteria for Disease Activity score for PSoriatic Arthritis (DAPSA).

    Final DAPSA ScoreImprovement
    > 28.4< 28.4 but > 14.2< 14.2
    ≤ 18.5123
    > 18.5 but < 45.1223
    ≥ 45.1233
    • 1: good response; 2: moderate response; 3: poor response.

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The Journal of Rheumatology
Vol. 41, Issue 6
1 Jun 2014
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Composite Disease Activity and Responder Indices for Psoriatic Arthritis: A Report from the GRAPPA 2013 Meeting on Development of Cutoffs for Both Disease Activity States and Response
Phillip S. Helliwell, Oliver FitzGerald, Jaap Fransen
The Journal of Rheumatology Jun 2014, 41 (6) 1212-1217; DOI: 10.3899/jrheum.140172

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Composite Disease Activity and Responder Indices for Psoriatic Arthritis: A Report from the GRAPPA 2013 Meeting on Development of Cutoffs for Both Disease Activity States and Response
Phillip S. Helliwell, Oliver FitzGerald, Jaap Fransen
The Journal of Rheumatology Jun 2014, 41 (6) 1212-1217; DOI: 10.3899/jrheum.140172
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Keywords

PSORIATIC ARTHRITIS
OUTCOME MEASURES
COMPOSITE DISEASE ACTIVITY INDEX
RESPONSE MEASURE

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Show more Annual Meeting of the Group for Research and Assessment of Psoriasis and Psoriatic Arthritis (GRAPPA), Toronto, Canada, July 12–13, 2013

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