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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

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 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


  • 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