Project Highlights From the GRAPPA 2022 Annual Meeting: Education Initiatives and Axial Involvement in Psoriatic Arthritis

Educational initiatives

The Group for Research and Assessment of Psoriasis and Psoriatic Arthritis (GRAPPA) has a core objective of offering comprehensive education on a global scale about psoriasis (PsO) and psoriatic arthritis (PsA). This mission encompasses a diverse range of initiatives such as in-person and virtual lectures, interactive discussions, podcasts, and archived videos, all tailored to healthcare professionals and researchers engaged in the field of psoriatic disease (PsD) care. Additionally, GRAPPA collaborates with patient service leagues to extend educational resources to individuals living with PsD. The GRAPPA education committee comprises 21 members, representing all parts of the world, both rheumatologists and dermatologists, 4 patient research partners (PRPs), and 2 members of the Young-GRAPPA (Y-GRAPPA) group. The co-chairs are Drs. Philip Mease (US), Philip Helliwell (UK), and Amit Garg (US). The committee oversees educational initiatives, aided by GRAPPA administrators Judi Pickell, Janine Kowack, and Annie Spangler. GRAPPA also conducts educational programs in collaboration with other associations and organizations, including Spondyloarthritis Research and Treatment Network (SPARTAN), Assessment of Spondyloarthritis international Society (ASAS), National Psoriasis Foundation (NPF), Spondyloarthritis Association of America (SAA), International Federation of Psoriasis Associations (IFPA), American College of Rheumatology (ACR), Pan American League Against Rheumatism (PANLAR), Asia Pacific League Against Rheumatism (APLAR), African League Against Rheumatism (AFLAR), as well as pharmaceutical companies. The majority of the initiatives undertaken in 2022, due to the pandemic, were either wholly virtual or hybrid (virtual and in-person), with programming supported by several technology companies.

As in previous years, GRAPPA conducted symposia on PsA and PsO as part of the following professional meetings: ACR (Philadelphia), PANLAR (Miami), and APLAR (Hong Kong). These were both in-person and hybrid events, with lectures by both international and regional faculty. The ACR symposium was presented in conjunction with SPARTAN and ASAS. “Year in Review” lectures on PsA and axial spondyloarthritis (axSpA) highlighted key clinical and basic science research topics. Other lectures focused on such topics as PsA treatment and axial PsA. Hundreds of clinicians attended. By conducting the symposia in a hybrid fashion, the attendance was greater than previous in-person only symposia. Prior to the APLAR meeting, members of the education committee met virtually with APLAR leaders to discuss and agree on making the GRAPPA symposium a regular occurrence at each APLAR meeting, similar to the way it has been with ACR and PANLAR. In 2022, a new partnership between the Indian Association of Dermatologists, Venereologists, and Leprologists (IADVL) and GRAPPA developed from a relationship between Dr. Garg, a US dermatologist and co-chair of the education committee, and Dr. Rashmi Sarkar, president of IADVL. IADVL is the largest association of dermatologists in India, many of whom provide care for patients with PsO and PsA. The inaugural virtual symposium was conducted on August 7, 2022, and involved both international and regional dermatologists and rheumatologists.

As in 2021, Pfizer awarded a substantial educational grant to a consortium of associations, including GRAPPA, SPARTAN, NPF, and SAA. The request for proposals was to supply educational content on PsA and axSpA to both clinicians and patients that is focused primarily on a US audience. To accomplish this, GRAPPA and SPARTAN partnered with NPF and SAA to conduct outreach to patients and clinicians. The following topics, not covered in the 2021 initiative, were included: pediatric PsA and spondyloarthritis (SpA); pain and fatigue in PsA and SpA; treatment update for PsA and SpA—all these topics were directed to clinicians and patients. The fourth topic, wellness/diet/exercise, was directed toward patients. All were conducted in the form of live webinars, which were also archived for subsequent viewing, and podcasts. Each included expert lectures as well as panel discussions with experts and PRPs. To date, these have been viewed and/or listened to by over a thousand clinicians and patients.

GRAPPA has partnered with individual pharmaceutical companies to conduct 1- to 2-day symposia in several parts of the world, either virtually or in-person with a hybrid format. These have taken place in India, China (Hong Kong), Taiwan, Kuwait, UK (Leeds), USA (Cleveland), UAE (Dubai), Saudi Arabia (Riyadh), and Italy (Milan and Naples). GRAPPA is currently partnering with several CME companies, including Medscape, Paradigm, and VuMedi, to provide content for broad clinician audiences that include rheumatologists, dermatologists, and primary care practitioners.

Representatives from the Y-GRAPPA group have participated in the education committee and are now involved with updating and maintaining the GRAPPA educational slide library. In this process, a Y-GRAPPA member is paired with a senior member.

GRAPPA is collaborating with Springer Publishing to update the GRAPPA PsA textbook. In a similar fashion as the updating of the slide library, Y-GRAPPA members and other junior associates will be paired with senior mentees to update each chapter.

GRAPPA has an ongoing relationship with Trifecta to make physical exam (skin and musculoskeletal) videos available.

A unique collaboration between GRAPPA and UCB began in 2022. Education specialists from UCB met with members of the GRAPPA education committee to create unique educational programming. In addition to providing educational content about PsD, the focus will also be on teaching empathic communication skills when interacting with patients. The point of this approach is to improve shared decision making in the clinic.

Looking forward to 2023, we anticipate an expanded number of educational opportunities, continuing in the formats described above and pushing into new virtual and hybrid symposia in various parts of the world, including several in South America. We also expect increased use of newer teaching methods such as podcasts, and new educational content, such as those resulting from the GRAPPA-UCB initiative. We are very grateful to have the support of an energetic and enthusiastic group of Y-GRAPPA members and PRPs.

Axial involvement in PsA

The debate on how axial involvement should be defined in patients with PsA and whether this condition is distinct from axSpA (with or without PsO) is still ongoing.^1,2 Some typical features of axial involvement in PsA have been described, but making a clear distinction between axial PsA and axSpA is not always straightforward due to the natural overlap of these conditions. Although some recently published studies have improved our understanding of this topic, there is currently no widely accepted definition and/or criteria for axial involvement in PsA. Further, only a few treatment studies have addressed patients with axial PsA specifically, thus contributing to some limitations when developing treatment recommendations for this patient group.³ Therefore, there is an unmet need to establish a universally accepted definition or criteria for axial involvement in PsA.

Since 2019, GRAPPA and ASAS have been working together to develop classification criteria that will help identify a homogeneous subgroup of patients with axial involvement for research purposes. The Axial Involvement in Psoriatic Arthritis Cohort (AXIS) study⁴ is an ongoing joint GRAPPA/ASAS project that aims to systematically evaluate the characteristics of axial involvement in patients with PsA. Drs. Dafna Gladman and Denis Poddubnyy are co-principal investigators of the study. The overall study coordination is in the hands of Dr. Murat Torgutalp. AXIS has been established as a multicenter, international, cross-sectional study involving more than 50 centers with expertise in axSpA and PsA. The study will enroll 400 patients who are required to fulfill the Classification Criteria for Psoriatic Arthritis (CASPAR), have a symptom duration of less than 10 years, and are not taking biologic/targeted synthetic disease-modifying antirheumatic drugs (b/tDMARDs).⁴ Participating clinicians are encouraged to include consecutive patients with recently diagnosed PsA. Included patients undergo clinical evaluation, laboratory and imaging procedures (radiographs and magnetic resonance images of sacroiliac joints and spine), and blood sample collection for HLA typing. The expert judgment on the presence or absence of axial involvement will be considered as the primary endpoint of the study.

The central reading of the images is performed by an imaging committee consisting of rheumatologists and musculoskeletal radiologists with expertise in PsA and axSpA (Torsten Diekhoff, Kay-Geert Hermann, Robert Lambert, Walter Maksymowych, Mikkel Østergaard, Xenofon Baraliakos). Ultimately, the central clinical committee (Filip van den Bosch, Dafna Gladman, Philip Mease, Denis Poddubnyy) will decide on the presence of axial involvement, considering all clinical, laboratory, and imaging information provided by the clinician and the imaging committee.

The study started in 4 countries in 2022 and the recruitment rate increased throughout 2022 as active centers steadily increased, with more than 100 patients recruited by the end of 2022. It is expected that patient recruitment will be finished by the end of 2023. The data analysis and the development of the draft classification criteria will be performed thereafter, with the input of the entire working group.

In summary, GRAPPA has continued to develop educational material in multiple formats for clinicians and researchers involved with PsD care. Partnership with patient service leagues has also allowed us to provide education to patients with PsD. Both the educational and research aims of GRAPPA are being enhanced through the AXIS cohort established in collaboration with ASAS. Further reports on these ongoing projects will be presented in future GRAPPA meetings.