Psoriatic Arthritis Workshop Part 2 OMERACT May 15 th, 2004 Steering Committee Dafna Gladman, Philip Mease, Gerald Krueger, Désirée van der Heidje, Christian Antoni, Philip Helliwell, Arthur Kavanaugh, Peter Nash, Christopher Ritchlin, Vibeke Strand, William Taylor

PsA Workshop Breakout Groups GroupRoomFacilitatorsRapporteurs Nautilus Triton Lodge Scripps Marlin Curlew Dolphin Heather Acacia Toyan Pirates Den Merril Alan Silman Maarten Boers George Wells Desiree van der Heijde Doug Veale Peter Nash Phil Conahan Thasia Woodworth Paul Emery Malcolm Smith Peter Brooks Vibeke Strand Jurgen Braun Philip Mease Philip Helliwell Oliver Fitzgerald Artie Kavanaugh Jerry Krueger Christian Antoni Christopher Ritchlin Proton Rahman Will Taylor Neil McHugh Dan Clegg

Results of Delphi Exercise DMARD 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

PsA Workshop – Breakout Groups u Instructions: –Each group to rank items to be included in a clinical trial from 1-14 in terms of importance. –If there are others not included which the group feels should be included, add them. –Identify those that are absolutely critical for inclusion in a core set.

Discussion Issues u Several items were not actually domains –Active joint count is used to assess inflammation – replace with JOINT ACTIVITY –Radiology is a method not a domain – replace with STRUCTURAL DAMAGE –Spinal mobility is used to assess axial involvement – replace with AXIAL INVOLVEMENT

Discussion issues (Cont’d) u Three core sets ? –(skin, peripheral, axial disease) –One core set (psoriasis plus arthritis) u Should we look at peripheral joints and axial involvement separately? –Obviously different tools will be used –Should all patients with PsA be assessed for axial involvement? u How many joints to count? –68, 76, 44, 28 (parcimony vs. comprehensiveness)

Discussion issues (Cont’d) u Include Imaging to assess inflammation u Dactylitis and enthesitis combined –Concern about double counting u Meaning of damaged joint count –Deformities, flail joints, ankylosed joints, surgery u Patient global to reflect both skin and joint disease u Should add fatigue and sleep u Tissue assessment

Results of Breakout Groups

Composite Scores

Ranking From Breakout Groups

PsA Workshop – Research Agenda u Optimal joint count u Axial assessment u Enthesitis u Dactylitis u Skin assessment u Imaging (inflammation and damage) u Composite responder indices u Differential tissue response to therapies u Fatigue u Patient Global u Participation