Psoriatic Arthritis Workshop OMERACT May 14 th, 2004 Steering Committee Dafna Gladman, Philip Mease,...
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Transcript of Psoriatic Arthritis Workshop OMERACT May 14 th, 2004 Steering Committee Dafna Gladman, Philip Mease,...
Psoriatic Arthritis WorkshopOMERACT May 14th, 2004
Steering Committee
Dafna Gladman, Philip Mease, Gerald Krueger, Désirée van der Heijde, Christian Antoni, Philip Helliwell, Arthur Kavanaugh, Peter Nash, Christopher Ritchlin, Vibeke Strand, William Taylor
Outcome Measures in Psoriatic Arthritis
Results of Dephi exercise and Nominal Group Process
Dafna D. Gladman,
Professor of Medicine,
University of Toronto,
Director, Psoriatic Arthritis Program University Health Network
Outcome Measures in PsA
To arrive at a consensus-based list of core domains that should be used in outcome studies of PsA, including:– Disease controlling anti-rheumatic therapy trials– Symptom modifying anti-rheumatic therapy trials– Clinical record keeping and observational studies– Rehabilitation intervention studies
Delphi ProcessObjectives
Outcome Measures in PsA
Review of existing assessment tools in PsA– Gladman et al, A&R 2004;50:24-35
Development of a list of potential domains via email discussion.
Delphi process to rank and prioritize these domains with controlled feedback.
Questionnaires sent to 54 rheumatologists, 32 responded and were included in 2 further rounds.
Delphi ProcessMethods
Outcome Measures in PsA
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
Clear reduction in variability over the three rounds, but the relative ranking of domains didn’t alter a great deal
Delphi ProcessMethods
Group median scores for DCART
0
2
4
6
8
10
12
14
Active
JC
Xray
damag
e
Patien
t glob
alPain
Physic
al fu
nctio
n
Acute
phas
eQOL
Dactyl
itis
Enthes
itis
Damag
ed J
CSkin
Physic
ian g
lobal
Mornin
g sti
ffnes
s
Spinal
mobilit
y - l
umba
r
Utility
index
Sleep
Extra-
skele
tal
Fatig
ue
Sacro
iliac
tests
Xray
joint
inflam
mation
Spinal
mobilit
y - t
hora
cic
Spinal
mobilit
y - c
ervic
al
Tend
initis
Obser
ved
phys
ical
Wor
k lim
itatio
ns
Wor
k inc
apac
ity
Round1 Median Round2 Median Round3 Median
Disease Controlling Anti-Rheumatic Drugs
Results of Delphi ExerciseDMARD
Active Joint Count
Pain
Patient global
X-ray damage
Physical function
Acute Phase Reactant
Quality of Life
Physician global
Skin disease
Damaged Joint Count
Enthesitis
Dactylitis
Morning stiffness
Lumbar mobility
Work disability
Work limitation
Performance
Tendonitis
Cervical mobility
Thoracic mobility
MRI/US
Sacroiliac signs
Fatigue
Extra-skeletal
Sleep
Utility indices
Identifying Domains of Inquiry in Psoriatic Arthritis
List of possible domains for discussion has been significantly shortened– However, major concern about lower ranking
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
Summary of Delphi Process
GRAPPA Objectives for August 15-17, 2003
Further define domains for the assessment of PsA by a group of rheumatologists, dermatologists, patients and industry, through a nominal group process (3 breakout groups).
Achieve consensus on those domains. Identify instruments to be used for the
domains. Develop a research agenda.
Outcome Measures in PsAClinical Disease Activity
Domain Proposed Instrument
Peripheral arthritis ACR joint count(68/66; 78/76)
Axial Disease To be determined
Skin Disease To be determined (PASI, Target, Nails)
Physician Global Visual analogue scale
Biomarkers ESR, CRP (cytokines, Genetic markers)
Outcome Measures in PsA
Other Features
Domain Instrument
Dactylitis(Acute, chronic)
To be determined
Enthesitis To be determined
Tendonitis To be determined
Outcome Measures in PsA
Patient derived features
Domain Proposed instrument
Pain VAS
Quality of life SF-36, (DLQI,PsAQoL)
Function HAQ (Other)
Fatigue To be determined(Krupp, FACIT, MFI)
Outcome Measures in PsA
Damage
Domain Instrument
Imaging Radiographs
Hands, feet, AP pelvis
(MRI, US)