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Physician's Global Assessment in Psoriatic Arthritis: A Multicenter GRAPPA Study.
Alberto Cauli1,2, Dafna D Gladman3,4, Alessandro Mathieu3,4
1From 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.
Physician
Area of Science:
- Rheumatology
- Dermatology
- Clinical Assessment
Background:
- Physician's global assessment (PGA) is crucial for treatment decisions in psoriatic arthritis (PsA).
- Assessing disease activity in PsA requires evaluating both musculoskeletal (MSK) and dermatologic components.
Purpose of the Study:
- To evaluate the reliability of the Physician's Global Assessment (PGA) using a visual analog scale (VAS).
- To assess the utility of separate VAS scales for musculoskeletal (PhysMSK) and dermatologic (PhysSk) manifestations in PsA patients.
- To compare physician and patient self-evaluations of disease activity.
Main Methods:
- 319 PsA patients from 16 centers across 8 countries were enrolled.
- Physician's Global Assessment (PGA), PhysMSK, and PhysSk were administered at baseline (W0) and 1 week (W1).
- Clinical data on MSK and dermatologic manifestations were collected.
Main Results:
- High reliability was found for PGA (0.87), PhysMSK (0.86), and PhysSk (0.78) between W0 and W1.
- PGA scores were significantly influenced by both PhysMSK (B=0.69) and PhysSk (B=0.32) components.
- PhysMSK correlated with joint counts and dactylitis; PhysSk correlated with psoriasis extent and specific body areas.
- Physician and patient assessments showed significant discrepancies across all measures.
Conclusions:
- Physician's Global Assessment (PGA) via VAS is a reliable tool for evaluating MSK and skin disease activity in PsA.
- PGA may not align with patient self-assessment, highlighting potential for divergence.
- Assessing both musculoskeletal (PhysMSK) and dermatologic (PhysSk) components is recommended due to their distinct contributions to overall disease activity.