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Updated: Nov 15, 2025

Author Spotlight: Self-Assessment Protocol for Predicting Psoriatic Arthritis in Psoriasis Patients
Published on: March 1, 2024
Composite Measures for Routine Clinical Practice in Psoriatic Arthritis: Testing of Shortened Versions in a UK
William Tillett1, Oliver FitzGerald1, Laura C Coates1
1As part of the supplement series GRAPPA 2020, this report was reviewed internally and approved by the Guest Editors for integrity, accuracy, and consistency with scientific and ethical standards. This report is independent research funded by the National Institute for Health Research (NIHR), Programme Grants for Applied Research (Early detection to improve outcome in patients with undiagnosed PsA [PROMPT], RP-PG-1212-20007). The views expressed are those of the authors and not necessarily those of the NIHR or the Department of Health and Social Care. W. Tillett, BSc, MBChB, PhD, FRCP, N.J. McHugh, MBChB, MD, FRCP, FRCPath, Department of Pharmacy and Pharmacology, University of Bath, and Royal National Hospital for Rheumatic Diseases, Bath, UK; O. FitzGerald, MD, FRCPI, FRCP(UK), Conway Institute for Biomolecular Research, University College Dublin, Dublin, Ireland; L.C. Coates, MB ChB, PhD, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK; J. Packham, DM, FRCP, Haywood Rheumatology Centre, Stoke-on-Trent, UK; D.R. Jadon, MBBCh, MRCP, PhD, University of Cambridge, Cambridge, UK; M. Massarotti, MD, Department of Rheumatology, University Hospitals Dorset NHS Foundation Trust, Christchurch, New Zealand; M. Brook, Patient Resesarch Partner, E. Korendowych, PhD, MRCP, Royal National Hospital for Rheumatic Diseases, Bath, UK; S. Lane, MBChB, MD, FRCP, Ipswich Hospital NHS Trust, Ipswich, UK; P. Creamer, MBChB, North Bristol NHS Foundation Trust, Bristol, UK; A. Antony, MBBS, School of Clinical Sciences, Monash University, Melbourne, Australia; A. Rambojun, PhD, Department of Pharmacy and Pharmacology, University of Bath, Bath, UK; P.S. Helliwell, MD, PhD, Professor of Clinical Rheumatology, Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, and National Institute for Health Research Leeds Biomedical Research Centre, Leeds, UK. SL has received sponsorship for both the European Alliance of Associations for Rheumatology and the American College of Rheumatology this year, both from AbbieVie, and last year for Madrid from Celgene, but no commercial work for any organizations. All other authors declare no conflicts of interest. Address correspondence to Dr. W. Tillett, Department of Rheumatology, Royal National Hospital for Rheumatic Diseases, Coombe Park, Bath, BA1 3NG, UK.
Shortened visual analog scale (VAS) measures, specifically 3VAS and 4VAS, demonstrate superior performance for assessing psoriatic arthritis (PsA) disease activity and treatment response compared to existing composite measures. These simplified tools are recommended for routine clinical practice.
Area of Science:
- Rheumatology
- Clinical Practice Guidelines
- Psoriatic Arthritis Assessment
Background:
- Psoriatic arthritis (PsA) requires validated composite measures for effective disease management.
- Existing composite measures may be lengthy for routine clinical practice.
- Development of shortened, efficient assessment tools is needed.
Purpose of the Study:
- To evaluate shortened versions of psoriatic arthritis (PsA) composite measures.
- To assess the utility of these measures in routine clinical practice.
- To compare the performance of shortened measures against established indices.
Main Methods:
- Clinical and patient-reported outcome measures (PROMs) were collected from PsA patients in a UK multicenter study.
- Shortened Composite Psoriatic Arthritis Disease Activity Index (sCPDAI) and Group for Research and Assessment of Psoriasis and Psoriatic Arthritis (GRAPPA) Composite Exercise (GRACE) measures were developed.
- Performance was tested against DAS28, Disease Activity in Psoriatic Arthritis, and RAPID3 using t-score, SRM, and ES; GRAPPA members voted on recommendations.
Main Results:
- Shortened GRACE versions (3VAS and 4VAS) showed higher standardized response means (SRM) (0.77 and 0.63) than sCPDAI (0.55).
- 3VAS and 4VAS demonstrated superior discrimination and responsiveness compared to sCPDAI, DAS28, Disease Activity in Psoriatic Arthritis, and RAPID3.
- A majority of GRAPPA members found VAS scales sufficient for assessing disease and response, with 53% recommending 4VAS for routine care.
Conclusions:
- Simplifying the GRACE measure to visual analog scale (VAS) scores alone improves detection of disease status and responsiveness.
- The 3VAS and 4VAS exhibit the best performance characteristics among the tested composite measures.
- GRAPPA members recommend further validation of 3VAS and 4VAS in observational and trial datasets.

