Table 3.

A proposed modification of the GRAPPA grid to guide treatment decisions.

	Grade
Domain	Never Involved (E)	Inactive (D)	Mild Requiring NSAID (C)	Moderate Requiring DMARD (B)	Active Requiring Biologics (A)
Peripheral arthritis		Joint count = 0, normal function	1–4 joints (swollen or tender); normal function (HAQ < 0.5)	≤ 4 joints but function impaired; or > 4 joints, normal function	>4 joints and function impaired
Skin disease		PASI < 1	PASI 1–10 and DLQI ≤ 10	PASI ≤ 10 but DLQI > 10; or PASI > 10 but DLQI ≤ 10	PASI > 10 and DLQI > 10
Enthesitis		LEI = 0	1–3 sites; normal function (HAQ < 0.5)	≤ 3 sites but function impaired; or > 3 sites but normal function	>3 sites and function impaired
Dactylitis		No tender dactylitis	1–3 digits; normal function (HAQ < 0.5)	≤ 3 digits but function impaired; or > 3 digits but normal function	> 3 digits and has function impaired
Spinal disease		BASDAI < 2	BASDAI 2–4; normal function (ASQoL < 6)	BASDAI > 4 but normal function; BASDAI < 4 but function impaired	BASDAI > 4 and function impaired

ASQoL: Ankylosing Spondylitis Quality of Life Questionnaire³¹; BASDAI: Bath Ankylosing Spondylitis Disease Activity Index²³; DLQI: Dermatology Quality of Life Index³²; HAQ: Health Assessment Questionnaire³³; LEI: Leeds Enthesitis Index²⁹; PASI: Psoriasis Area and Severity Index³⁴.