One of the most important areas of research in psoriatic arthritis is identifying and developing the best composite measures to allow accurate tracking of disease activity and be facile enough to perform in the clinic without requiring clinicians to spend time they don’t have making such measurements. Current composite measures include the Disease Activity in Psoriatic Arthritis (DAPSA), the Composite Psoriatic Disease Activity Index (CPDAI) and the Psoriatic Arthritis Disease Activity Score (PASDAS). Each composite measure has its strengths and weaknesses; for example, the DAPSA lacks a skin component. It’s likely that composite measures created in the future will also be less than perfect in certain respects, but Dr. Husni noted that, as a field, rheumatologists should continue work in this area and think critically and creatively about how best to measure outcomes for all variations of psoriatic arthritis.
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Explore This IssueDecember 2019
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An Overview of the Literature
Philip Mease, MD, clinical professor at the University of Washington School of Medicine and director of rheumatology research at the Swedish Medical Center, Seattle, provided a masterful overview of the literature to date on the subject of treatments for psoriatic arthritis. He discussed many of the key trials and summarized recommendations from GRAPPA, the ACR and the European League Against Rheumatism (EULAR). Some of the key themes that emerged were the ideas that different pathophysiologic mechanisms may explain the different domains of psoriatic arthritis disease activity (i.e., arthritis, enthesitis, skin and nail involvement, etc.), that the role of methotrexate in the treatment of psoriatic arthritis is still a point of some debate, and that there is emerging evidence that the Janus kinase (JAK) inhibitors will likely be a helpful treatment option for many patients with psoriatic arthritis.
Perhaps most important as an overall principle, Dr. Mease noted, is that the GRAPPA clinical practice guidelines take the approach of assessing each domain of psoriatic arthritis manifestation and treating the individual patient on the basis of the most prominent domains expressed by that patient.
Dr. Mease did explain that variations in the GRAPPA, ACR and EULAR guidelines indicate there is still a paucity of data and head-to-head comparisons of medications to enable clinicians to say with confidence what the best treatment algorithm should be, but this should not stop clinicians from doing the best they can for their patients. It is the role of the field as a whole to advance the study of psoriatic arthritis.
The session was extremely helpful and lent itself to productive discourse on these important topics. The audience was left with one last piece of advice: When thinking about patients with psoriatic arthritis, go more than skin deep and truly seek to understand the disease and its manifestations.