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J Rheumatol. 2018 Aug;45(9):1256-1262. doi: 10.3899/jrheum.171183. Epub 2018 Jun 15.

Physician's Global Assessment in Psoriatic Arthritis: A Multicenter GRAPPA Study.

Author information

1
From the Department of Medical Sciences, Policlinico of the University of Cagliari; Rheumatology Unit, and Department of Public Health, University of Cagliari, Cagliari; Rheumatology Department of Lucania, San Carlo Hospital of Potenza and Madonna delle Grazie Hospital of Matera, Matera; Rheumatology Research Unit, Department of Clinical and Experimental Medicine, University "Federico II," Naples; Department of Rheumatology, ASST Gaetano Pini-Centro Traumatologico Ortopedico (CTO), Milan; Rheumatology Unit, Azienda USL-IRCCS di Reggio Emilia and Università di Modena e Reggio Emilia, Modena and Reggio Emilia; Dipartimento di Medicina e Scienze della Salute, Università degli Studi del Molise, Campobasso, Italy; University of Toronto, Toronto Western Hospital, Toronto, Ontario, Canada; Academic Medical Center/University of Amsterdam; Amsterdam Rheumatology and Immunology Center Reade, Amsterdam, the Netherlands; Rehabilitation Teaching and Research Unit, Department of Medicine, Wellington School of Medicine and Health Sciences, University of Otago, Wellington, New Zealand; Medizinische Klinik III mit Poliklinik, Friedrich-Alexander-Universität Erlangen-Nuernberg, Erlangen, Germany; Sector of Dermatology, HUCFF School of Medicine, Federal University of Rio de Janeiro and Sector of Dermatology, HUPE School of Medical Sciences, State University of Rio de Janeiro, Rio de Janeiro, Brazil; Spondyloarthritis Program, Johns Hopkins University, School of Medicine, Baltimore, Maryland; Swedish Medical Centre and University of Washington School of Medicine, Seattle, Washington, USA; Department of Rheumatology, Semmelweis University, Budapest, Hungary; Leeds Institute of Molecular Medicine, University of Leeds, Leeds, UK. cauli@medicina.unica.it.
2
A. Cauli, MD, PhD, Department of Medical Science, Policlinico di Monserrato, University of Cagliari; D.D. Gladman, MD, FRCPC, Professor of Medicine, University of Toronto, and Senior Scientist, Krembil Research Institute, and Director, Psoriatic Arthritis Program University Health Network; A. Mathieu, MD, Professor of Rheumatology and Head of Rheumatology Unit, University of Cagliari; G. Porru, MD, Department of Medical Science, Policlinico di Monserrato, University of Cagliari; P.P. Tak, MD, PhD, Professor of Rheumatology, Academic Medical Center/University of Amsterdam; C. Sardu, MD, Department of Public Health, University of Cagliari; R. Scarpa, MD, Professor of Rheumatology, Rheumatology Research Unit, Department of Clinical and Experimental Medicine, University "Federico II"; A. Marchesoni, MD, Department of Rheumatology, ASST Gaetano Pini-CTO; W.J. Taylor, PhD, MBChB, FRACP, FAFRM, Rehabilitation Teaching and Research Unit, and Department of Medicine, Wellington School of Medicine and Health Sciences, University of Otago; C. Salvarani, MD, Professor of Rheumatology, Rheumatology Unit, Azienda USL-IRCCS di Reggio Emilia and Università di Modena e Reggio Emilia; J. Kalden, MD, Medizinische Klinik III mit Poliklinik, Friedrich-Alexander-Universität Erlangen-Nuernberg; E. Lubrano, MD, PhD, Associate Professor of Rheumatology, Dipartimento di Medicina e Scienze della Salute, Università degli Studi del Molise; S. Carneiro, MD, PhD, Dermatologist and Rheumatologist, HUCFF Federal University of Rio de Janeiro, and Associate Professor of Dermatology, School of Medical Sciences, State University of Rio de Janeiro; M. Piga, MD, Department of Medical Science, Policlinico di Monserrato, University of Cagliari; A. Floris, MD, Rheumatology Unit, University of Cagliari; F. Desiati, MD, Department of Rheumatology, ASST Gaetano Pini-CTO; J.A. Flynn, MD, MBA, Med, Professor of Medicine, Director Spondyloarthritis Program, Johns Hopkins University, School of Medicine; S. D'Angelo, MD, Rheumatology Department of Lucania, San Carlo Hospital of Potenza and Madonna delle Grazie Hospital of Matera Italy, and PhD Scholarship in Health Sciences, Department of Health Sciences, University of Molise; A.W. van Kuijk, MD, PhD, Amsterdam Rheumatology and Immunology Center Reade; M.G. Catanoso, MD, Rheumatology Unit, Azienda USL-IRCCS di Reggio Emilia and Università di Modena e Reggio Emilia; F. Caso, MD, PhD, Assistant Professor, Rheumatology Research Unit, Department of Clinical and Experimental Medicine, University "Federico II"; P. Contu, MD, Department of Public Health, University of Cagliari; I. Ujfalussy, MD, Department of Rheumatology Semmelweis University; P.S. Helliwell, MD, PhD, Leeds Institute of Molecular Medicine, University of Leeds; P.J. Mease, MD, Swedish Medical Center Rheumatology Research Division; Clinical Professor, University of Washington School of Medicine. Ignazio Olivieri, MD, died July 28, 2017; he was Director of the Rheumatology Department of Lucania, San Carlo Hospital of Potenza and Madonna delle Grazie Hospital of Matera. cauli@medicina.unica.it.
3
From the Department of Medical Sciences, Policlinico of the University of Cagliari; Rheumatology Unit, and Department of Public Health, University of Cagliari, Cagliari; Rheumatology Department of Lucania, San Carlo Hospital of Potenza and Madonna delle Grazie Hospital of Matera, Matera; Rheumatology Research Unit, Department of Clinical and Experimental Medicine, University "Federico II," Naples; Department of Rheumatology, ASST Gaetano Pini-Centro Traumatologico Ortopedico (CTO), Milan; Rheumatology Unit, Azienda USL-IRCCS di Reggio Emilia and Università di Modena e Reggio Emilia, Modena and Reggio Emilia; Dipartimento di Medicina e Scienze della Salute, Università degli Studi del Molise, Campobasso, Italy; University of Toronto, Toronto Western Hospital, Toronto, Ontario, Canada; Academic Medical Center/University of Amsterdam; Amsterdam Rheumatology and Immunology Center Reade, Amsterdam, the Netherlands; Rehabilitation Teaching and Research Unit, Department of Medicine, Wellington School of Medicine and Health Sciences, University of Otago, Wellington, New Zealand; Medizinische Klinik III mit Poliklinik, Friedrich-Alexander-Universität Erlangen-Nuernberg, Erlangen, Germany; Sector of Dermatology, HUCFF School of Medicine, Federal University of Rio de Janeiro and Sector of Dermatology, HUPE School of Medical Sciences, State University of Rio de Janeiro, Rio de Janeiro, Brazil; Spondyloarthritis Program, Johns Hopkins University, School of Medicine, Baltimore, Maryland; Swedish Medical Centre and University of Washington School of Medicine, Seattle, Washington, USA; Department of Rheumatology, Semmelweis University, Budapest, Hungary; Leeds Institute of Molecular Medicine, University of Leeds, Leeds, UK.
4
A. Cauli, MD, PhD, Department of Medical Science, Policlinico di Monserrato, University of Cagliari; D.D. Gladman, MD, FRCPC, Professor of Medicine, University of Toronto, and Senior Scientist, Krembil Research Institute, and Director, Psoriatic Arthritis Program University Health Network; A. Mathieu, MD, Professor of Rheumatology and Head of Rheumatology Unit, University of Cagliari; G. Porru, MD, Department of Medical Science, Policlinico di Monserrato, University of Cagliari; P.P. Tak, MD, PhD, Professor of Rheumatology, Academic Medical Center/University of Amsterdam; C. Sardu, MD, Department of Public Health, University of Cagliari; R. Scarpa, MD, Professor of Rheumatology, Rheumatology Research Unit, Department of Clinical and Experimental Medicine, University "Federico II"; A. Marchesoni, MD, Department of Rheumatology, ASST Gaetano Pini-CTO; W.J. Taylor, PhD, MBChB, FRACP, FAFRM, Rehabilitation Teaching and Research Unit, and Department of Medicine, Wellington School of Medicine and Health Sciences, University of Otago; C. Salvarani, MD, Professor of Rheumatology, Rheumatology Unit, Azienda USL-IRCCS di Reggio Emilia and Università di Modena e Reggio Emilia; J. Kalden, MD, Medizinische Klinik III mit Poliklinik, Friedrich-Alexander-Universität Erlangen-Nuernberg; E. Lubrano, MD, PhD, Associate Professor of Rheumatology, Dipartimento di Medicina e Scienze della Salute, Università degli Studi del Molise; S. Carneiro, MD, PhD, Dermatologist and Rheumatologist, HUCFF Federal University of Rio de Janeiro, and Associate Professor of Dermatology, School of Medical Sciences, State University of Rio de Janeiro; M. Piga, MD, Department of Medical Science, Policlinico di Monserrato, University of Cagliari; A. Floris, MD, Rheumatology Unit, University of Cagliari; F. Desiati, MD, Department of Rheumatology, ASST Gaetano Pini-CTO; J.A. Flynn, MD, MBA, Med, Professor of Medicine, Director Spondyloarthritis Program, Johns Hopkins University, School of Medicine; S. D'Angelo, MD, Rheumatology Department of Lucania, San Carlo Hospital of Potenza and Madonna delle Grazie Hospital of Matera Italy, and PhD Scholarship in Health Sciences, Department of Health Sciences, University of Molise; A.W. van Kuijk, MD, PhD, Amsterdam Rheumatology and Immunology Center Reade; M.G. Catanoso, MD, Rheumatology Unit, Azienda USL-IRCCS di Reggio Emilia and Università di Modena e Reggio Emilia; F. Caso, MD, PhD, Assistant Professor, Rheumatology Research Unit, Department of Clinical and Experimental Medicine, University "Federico II"; P. Contu, MD, Department of Public Health, University of Cagliari; I. Ujfalussy, MD, Department of Rheumatology Semmelweis University; P.S. Helliwell, MD, PhD, Leeds Institute of Molecular Medicine, University of Leeds; P.J. Mease, MD, Swedish Medical Center Rheumatology Research Division; Clinical Professor, University of Washington School of Medicine. Ignazio Olivieri, MD, died July 28, 2017; he was Director of the Rheumatology Department of Lucania, San Carlo Hospital of Potenza and Madonna delle Grazie Hospital of Matera.

Abstract

OBJECTIVE:

Physician's global assessment (PGA) of disease activity is a major determinant of therapeutic decision making. This study assesses the reliability of the PGA, measured by means of 0-100 mm visual analog scale (VAS), and the additional use of separate VAS scales for musculoskeletal (PhysMSK) and dermatologic (PhysSk) manifestations in patients with psoriatic arthritis (PsA).

METHODS:

Sixteen centers from 8 countries enrolled 319 consecutive patients with PsA. PGA, PhysMSK, and PhysSk evaluation forms were administered at enrollment (W0) and after 1 week (W1). Detailed clinical data regarding musculoskeletal (MSK) manifestations, as well as dermatological assessment, were recorded.

RESULTS:

Comparison of W0 and W1 scores showed no significant variation (intraclass correlation coefficients were PGA 0.87, PhysMSK 0.86, PhysSk 0.78), demonstrating the reliability of the instrument. PGA scores were dependent on PhysMSK and PhysSk (p < 0.0001) with a major effect of the MSK component (B = 0.69) compared to skin (B = 0.32). PhysMSK was correlated with the number of swollen joints, tender joints, and presence of dactylitis (p < 0.0001). PhysSk scores were correlated with the extent of skin psoriasis and by face, buttocks or intergluteal, and feet involvement (p < 0.0001). Finally, physician and patient assessments were compared showing frequent mismatch and a scattered dot plot: PGA versus patient's global assessment (r = 0.36), PhysMSK versus patient MSK (r = 0.39), and PhysSk versus patient skin (r = 0.49).

CONCLUSION:

PGA assessed by means of VAS is a reliable tool to assess MSK and dermatological disease activity. PGA may diverge from patient self-evaluation. Because MSK and skin/nail disease activity may diverge, it is suggested that both PhysMSK and PhysSk are assessed.

KEYWORDS:

ASSESSMENT MEASURES; DOMAINS; INSTRUMENTS; PHYSICIAN’S GLOBAL ASSESSMENT; PSORIATIC ARTHRITIS

PMID:
29907666
DOI:
10.3899/jrheum.171183

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