University of Leeds, Leeds, UK, and University of Oxford, Oxford, UK.
St. Vincent's University Hospital and University College Dublin, Dublin, Ireland.
Arthritis Rheumatol. 2018 Mar;70(3):345-355. doi: 10.1002/art.40391. Epub 2018 Feb 6.
A meeting was convened by the Group for Research and Assessment of Psoriasis and Psoriatic Arthritis (GRAPPA) and Outcome Measures in Rheumatology (OMERACT) to further the development of consensus among physicians and patients regarding composite disease activity measures and targets in psoriatic arthritis (PsA).
Prior to the meeting, physicians and patients completed surveys on outcome measures. A consensus meeting of 26 rheumatologists, dermatologists, and patient research partners reviewed evidence on composite measures and potential treatment targets plus results of the surveys. The meeting consisted of plenary presentations, breakout sessions, and group discussions. International experts including members of GRAPPA and OMERACT were invited to the meeting, including the developers of all of the measures discussed. After discussions, participants voted on proposals for use, and consensus was established in a second survey.
Survey results from 128 health care professionals and 139 patients were analyzed alongside a systematic literature review summarizing evidence. A weighted vote was cast for composite measures. For randomized controlled trials, the most popular measures were the PsA disease activity score (40 votes) and the GRAPPA composite index (28 votes). For clinical practice, the most popular measures were an average of scores on 3 visual analog scales (45 votes) and the disease activity in PsA score (26 votes). After discussion, there was no consensus on a composite measure. The group agreed that several composite measures could be used and that future studies should allow further validation and comparison. The group unanimously agreed that remission should be the ideal target, with minimal disease activity (MDA)/low disease activity as a feasible alternative. The target should include assessment of musculoskeletal disease, skin disease, and health-related quality of life. The group recommended a treatment target of very low disease activity (VLDA) or MDA.
Consensus was not reached on a continuous measure of disease activity. In the interim, the group recommended several composites. Consensus was reached on a treatment target of VLDA/MDA. An extensive research agenda was composed and recommends that data on all PsA clinical domains be collected in ongoing studies.
GRAPPA（银屑病和银屑病关节炎研究与评估小组）和 OMERACT（风湿病结局测量）召集了一次会议，旨在进一步促进医生和患者在银屑病关节炎（PsA）的综合疾病活动衡量标准和目标方面达成共识。
在会议之前，医生和患者完成了关于结局衡量标准的调查。由 26 名风湿病学家、皮肤科医生和患者研究伙伴组成的共识会议审查了关于综合衡量标准和潜在治疗目标的证据，以及调查结果。会议包括全体会议、分组会议和小组讨论。国际专家，包括 GRAPPA 和 OMERACT 的成员，以及所有讨论措施的开发者都应邀参加了会议。讨论后，与会者对使用提案进行了投票，共识在第二次调查中达成。
对 128 名医疗保健专业人员和 139 名患者的调查结果进行了分析，并结合系统文献综述总结了证据。对综合衡量标准进行了加权投票。对于随机对照试验，最受欢迎的措施是 PsA 疾病活动评分（40 票）和 GRAPPA 综合指数（28 票）。对于临床实践，最受欢迎的措施是 3 个视觉模拟量表评分的平均值（45 票）和疾病活动度在 PsA 评分（26 票）。讨论后，没有就综合衡量标准达成共识。专家组一致认为可以使用几种综合衡量标准，未来的研究应该允许进一步验证和比较。专家组一致认为，缓解应该是理想的目标，最低疾病活动度（MDA）/低疾病活动度是可行的替代方案。目标应包括评估肌肉骨骼疾病、皮肤疾病和健康相关生活质量。专家组建议治疗目标为极低疾病活动度（VLDA）或 MDA。
未就疾病活动的连续衡量标准达成共识。在这期间，专家组推荐了几种综合衡量标准。在 VLDA/MDA 治疗目标上达成了共识。制定了一个广泛的研究议程，并建议在正在进行的研究中收集所有 PsA 临床领域的数据。
