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Abstract Number: 0305

A Delphi Consensus Study to Standardize Terminology for the Pre-clinical Phase of Psoriatic Arthritis

Rebecca Haberman1, Lourdes Perez-Chada2, Vinod Chandran3, Cheryl Rosen4, Christopher Ritchlin5, Lihi Eder6, Philip Mease7, Soumya Reddy8, Alexis Ogdie9, Joseph Merola10 and Jose Scher1, 1NYU School of Medicine, New York City, 2Brigham and Women's Hospital, Harvard Medical School, Boston, MA, 3Krembil Research Institute, Toronto Western Hospital, Toronto, ON, Canada, 4University of Toronto, Toronto, ON, Canada, 5Department of Medicine, University of Rochester Medical Center, Rochester, NY, 6Women’s College Research Institute, University of Toronto, Toronto, ON, Canada, 7Seattle Rheumatology Associates, P.L.L.C., Seattle, WA, 8NYU School of Medicine, New York, NY, 9University of Pennsylvania, Philadelphia, PA, 10Brigham and Women’s Hospital, Harvard Medical School, Boston, MA

Meeting: ACR Convergence 2020

Keywords: Psoriatic arthritis, risk factors

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Session Information

Date: Friday, November 6, 2020

Session Title: Spondyloarthritis Including Psoriatic Arthritis – Diagnosis, Manifestations, & Outcomes Poster I: Psoriatic Arthritis

Session Type: Poster Session A

Session Time: 9:00AM-11:00AM

Background/Purpose: The concept of prevention of psoriatic arthritis (PsA) has gained increased interest given the physical limitation and poor quality-of-life experienced by PsA patients coupled with low remission rates observed with the use of currently available therapies. The transition from psoriasis to PsA offers a unique window of opportunity to identify individuals at increased risk for PsA, to study and implement preventive strategies. Herein, we propose terminology to define specific subgroups during the pre-clinical and early clinical phases of PsA to facilitate and harmonize recruitment for research studies.

Methods: We conducted a 3-round online Delphi exercise including international experts in psoriatic disease. Experts were recruited from the Group for Research and Assessment of Psoriasis and Psoriatic Arthritis (GRAPPA) and the Psoriasis and Psoriatic Arthritis Clinics Multicenter Advancement Network (PPACMAN). Participants were asked to vote on and rank their preferred (a) terms and (b) definitions to describe pre-clinical PsA populations. Consensus for multiple choice and ranking questions was defined a priori as ≥ 70%. For questions based on a visual analogue scale, items were retained if the median was > 70.  Delphi items that had < 15% of the votes or the median was < 15 were removed. If consensus was not reached, the question was carried through to the next round.

Results: A total of 29, 33, and 35 experts participated in the first, second and third Delphi round, respectively. Consensus was met for the following terms and associated definitions: “Increased risk for PsA”, “Psoriasis with asymptomatic synovio-entheseal imaging abnormalities”, and “Psoriasis with musculoskeletal symptoms not explained by other diagnosis” (Figure). Risk factors for progression to PsA that met consensus included obesity, presence of arthralgia, severe psoriasis, history of uveitis, nail psoriasis, scalp psoriasis, and first-degree relative with PsA. Specific imaging modalities to evaluate these populations were also included in the exercises and consensus was achieved.

Conclusion: In these Delphi exercises, there was agreement on three terms and definitions that characterize the psoriasis-to-PsA transition that can to be used for research purposes. The adoption of standardized nomenclature and common definitions for research in this area should improve the communication of ideas in the field and help to enroll well-defined, homogenous cohorts of psoriasis patients, for comparison across future studies.  These terms and definitions may evolve as increasing evidence regarding the molecular, clinical, and imaging features of the psoriasis-to-PsA continuum emerges.


Disclosure: R. Haberman, Janssen, 5; L. Perez-Chada, None; V. Chandran, Abbvie, 2, 5, Amgen, 2, 5, Celgene, 2, 5, Eli Lilly, 5, Eli Lilly, 3, Janssen, 8, Novartis, 5, Pfizer, 5, UCB, 5; C. Rosen, Abbvie, 5, Eli Lily, 5, Novartis, 5; C. Ritchlin, None; L. Eder, AbbVie, 2, 5, 8, Eli Lilly, 2, 5, Pfizer Inc, 2, 5, UCB, 2, 5, 8, Celgene, 5, Novartis, 5; P. Mease, Amgen, 2, 5, 8, Bristol-Myers Squibb, 2, 5, Novartis, 2, 5, 8, Pfizer Inc, 2, 5, 8, Sun, 2, 5, UCB, 2, 5, 8, AbbVie, 2, 5, 8, Gilead, 2, 5, Janssen, 2, 5, 8, Eli Lilly, 2, 5, 8, Galapagos, 5, GlaxoSmithKline, 5; S. Reddy, Amgen, 5, Novartis, 5, Janssen, 5, Pfizer, 5; A. Ogdie, abbvie, 1, amgen, 1, bms, 1, celgene, 1, corona, 1, lilly, 1, janssen, 1, novartis, 1, 2, novartis, 1, pfizer, 1; J. Merola, AbbVie, 1, Arena, 1, Avotres, 1, Biogen, 1, Celgene, 1, Dermavant, 1, Eli Lilly, 1, EMD Serono, 1, Janssen, 1, LEO Pharma, 5, Merck, 1, Novartis, 1, Pfizer Inc, 5, Sanofi, 1, Regeneron, 1, Sun Pharma, 1, UCB Pharma, 5; J. Scher, UCB, 5, Janssen, 5, Abbvie, 5, Pfizer, 5, Novartis, 5, Sanofi, 5.

To cite this abstract in AMA style:

Haberman R, Perez-Chada L, Chandran V, Rosen C, Ritchlin C, Eder L, Mease P, Reddy S, Ogdie A, Merola J, Scher J. A Delphi Consensus Study to Standardize Terminology for the Pre-clinical Phase of Psoriatic Arthritis [abstract]. Arthritis Rheumatol. 2020; 72 (suppl 10). https://acrabstracts.org/abstract/a-delphi-consensus-study-to-standardize-terminology-for-the-pre-clinical-phase-of-psoriatic-arthritis/. Accessed January 30, 2023.
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