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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 Arthritis.

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Identifying Domains of Inquiry in Psoriatic Arthritis

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

  2. 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

  3. 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

  4. 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

  5. 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

  6. Disease Controlling Anti-Rheumatic Drugs

  7. 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)

  8. 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

  9. 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.

  10. 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

  11. 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

  12. Domains in PsA – Breakout Groups

  13. Domains in PsA Clinical Assessment Joint Disease • Peripheral arthritis • Inflammation • Axial disease • Inflammation • Physician Global

  14. Domains in PsA Clinical Assessment Other Features • Dactylitis • Acute • Chronic • Enthesitis • Tendonitis

  15. Domains in PsA Clinical Assessment Skin Disease • Skin psoriasis • Extent of involvement • +/- lesions

  16. Domains in PsAImaging • Radiographs • Hands • Feet • Pelvis

  17. Domains in PsA Biomarkers • Acute phase reactants (ESR, CRP)

  18. Domains in PsA Patient derived features • Pain (Patient Global) • Quality of life • Related to joint disease • Related to skin disease • Itching • Function

  19. 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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