Identifying domains of inquiry in psoriatic arthritis
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Identifying Domains of Inquiry in Psoriatic Arthritis. Dafna D. Gladman, Professor of Medicine, University of Toronto, Director, Psoriatic Arthritis Program University Health Network. Identifying Domains of Inquiry in Psoriatic Arthritis.

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Identifying domains of inquiry in psoriatic arthritis

Identifying Domains of Inquiry in Psoriatic Arthritis

Dafna D. Gladman,

Professor of Medicine,

University of Toronto,

Director, Psoriatic Arthritis Program University Health Network


Identifying domains of inquiry in psoriatic arthritis1

Identifying Domains of Inquiry in Psoriatic Arthritis

  • Review of existing instruments used to assess health status in PsA (Gladman et al, Arthritis Rheum 2004;50:24-35)

  • Development of a list of potential domains via email discussion amongst steering committee of GRAPPA

  • Delphi process to rank and prioritize these domains amongst members of CASPAR plus others nominated by the steering committee


Delphi technique

Delphi technique

  • The features of consensus methods are anonymity, iteration, controlled feedback, statistical group response

  • Useful when evidence on an issue is lacking or contradictory

  • Delphi involves some kind of questionnaire to indicate agreement with particular issues, the group average and variation are then fed back on subsequent rounds to permit changes in participants’ opinions


Delphi process

Delphi Process

  • The questionnaire requested 100 points to be distributed amongst 26 possible outcome domains, under the four measurement contexts

  • The point allocation reflects the relative importance of that domain to the measurement context

  • Three rounds were held by email or fax


Delphi process1

Delphi Process

  • 32 of 54 rheumatologists with an interest in PsA responded to the first round

  • 32 responded to 2nd round; 29 responded to 3rd round (last observation carried forward)

  • Clear reduction in variability over the three rounds, but the relative ranking of domains didn’t alter a great deal


Identifying domains of inquiry in psoriatic arthritis

Disease Controlling Anti-Rheumatic Drugs


Conclusion dcart

Conclusion - DCART

  • The following domains are ranked highest:

    • Active joint count, xray damage, patient global, pain, physical function, acute phase response (score 7-12)

  • Several other possible domains

    • Dactylitis, enthesitis, damaged joint count, skin disease, physician global, quality of life (score 5)


Identifying domains of inquiry in psoriatic arthritis2

Identifying Domains of Inquiry in Psoriatic Arthritis

Summary of Delphi Process

  • List of possible domains for discussion has been significantly shortened

    • However, major concern about lack of skin assessment as a domain

  • Now requires involvement of patients, other rheumatologists and dermatologists, and industry

  • Next step should probably be face-to-face discussion to refine the core lists


Grappa objectives for august 15 17 2003

GRAPPA Objectives for August 15-17, 2003

  • Further define domains for the assessment of PsA by a group of rheumatologists, dermatologists, patients and industry

  • Achieve consensus on those domains.

  • Identify instruments to be used for the domains.

  • Develop a research agenda.


Grappa participants ny august 15 17 2003

ChristianAntoni, Germany

DominiqueBaeten, Belgium

JurgenBraun, Germany

JaneBruckel, SpAA

GerdBurmester, Germany

David A. Chandler, PsAA

Daniel O.Clegg, USA

John J.Cush, USA

James T.Elder, USA D

Luis R.Espinoza, USA

Steven R.Feldman, USA D

DafnaGladman, Canada

PeterGorevic, USA

AliceGottlieb, USA R+D

Philip S.Helliwell, UK

JoachimKalden, Germany

ArthurKavanaugh, USA

Muhammad AsimKhan, USA

JamesKrueger, USA D

Gerald G.Krueger, USA D

RobertLandewe, Netherlands

RichardLangley, Canada D

Mark G.Lebwohl, USA D

PhilipMease, USA

AlanMenter, USA D

LangdonMorris, USA

PeterNash, Australia

IgnazioOlivieri, Italy

Jean-PaulOrtonne, France

ProtonRahman, Canada

JohnReveille, USA

ChristopherRitchlin, USA

JosephSmolen, Austria

VibekeStrand, USA

WilliamTaylor, New Zealand

Filipvan Den Bosch, Belgium

Douglas J.Veale, UK

Gail M.Zimmerman, NPF

CliftonBingham, USA

Joachim PeterKaltwasser, Germany

MarissaLassere, Australia

SoumyaReddy, USA

BruceStrober, USA D

GRAPPA participants NY August 15-17, 2003


Group exercise domains in psa

Group exercise – Domains in PsA

  • Process

    • 3 Groups

      • Group leader

      • Scribe

    • Starting from the results of the Delphi process, each group to develop a list of domains and vote on the domains that should be included

    • If possible, identify instruments for each domain

    • Each Group to present at the combined session which will hopefully lead to a final consensus on domains +/- instruments


Domains in psa breakout groups

Domains in PsA – Breakout Groups


Domains in psa clinical assessment

Domains in PsA Clinical Assessment

Joint Disease

  • Peripheral arthritis

    • Inflammation

  • Axial disease

    • Inflammation

  • Physician Global


Domains in psa clinical assessment1

Domains in PsA Clinical Assessment

Other Features

  • Dactylitis

    • Acute

    • Chronic

  • Enthesitis

  • Tendonitis


Domains in psa clinical assessment2

Domains in PsA Clinical Assessment

Skin Disease

  • Skin psoriasis

    • Extent of involvement

    • +/- lesions


Domains in psa imaging

Domains in PsAImaging

  • Radiographs

    • Hands

    • Feet

    • Pelvis


Domains in psa

Domains in PsA

Biomarkers

  • Acute phase reactants (ESR, CRP)


Domains in psa1

Domains in PsA

Patient derived features

  • Pain (Patient Global)

  • Quality of life

    • Related to joint disease

    • Related to skin disease

    • Itching

  • Function


Domains in psa slotted for further research

Domains in PsASlotted For Further Research

  • Tendonitis

  • Change in Nails- determine its importance for disease classification

  • Cytokines

  • Genetic Markers

  • Fatigue

  • Disability- characterization


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