REPORT

Assessment: domains and instruments

Psoriatic arthritis assessment tools in clinical trials

P J Mease¹, C E Antoni², D D Gladman³, W J Taylor⁴

¹ Seattle Rheumatology Associates and Swedish Medical Center Rheumatology Research Division, University of Washington School of Medicine Seattle, WA, USA
² Department of Medicine III, Friedrich-Alexander University Erlangen-Nuernberg, Germany
³ Toronto Western Research Institute, Psoriatic Arthritis Program, University Health Network, Centre for Prognosis Studies in the Rheumatic Diseases, Toronto Western Hospital, Toronto, Ontario, Canada
⁴ Department of Medicine, Wellington School of Medicine and Health Sciences, University of Otago, Wellington, New Zealand

Correspondence to:
Correspondence to:
Dr P J Mease
Seattle Rheumatology Associates, 1101 Madison St, 10th floor, Seattle, WA 98104, USA; pmease{at}nwlink.com

In order to measure disease activity, progression, and change with therapy in psoriatic arthritis (PsA), it is important to use accurate, reliable, and feasible outcome measures that can ideally be employed in longitudinal cohorts, clinical trials, and clinical practice. Until recently, there has been little focus on this methodology in PsA. Clinical trials and long term clinical registries have used disparate outcome measures. With emerging therapies, the focus on the methodology of outcome assessment has increased to ensure that discriminant and responsive instruments are used. The Group for Research and Assessment of Psoriasis and Psoriatic Arthritis (GRAPPA), in conjunction with the society, Outcome Measures in Rheumatology (OMERACT), is focused on refining and developing outcome measures for a variety of disease domains reviewed in this report. Key domains to assess include joints, skin, enthesitis, dactylitis, spine, joint damage as assessed radiologically, quality of life, and function. These domains can be assessed by individual and composite measures. A number of measures have been "borrowed" from the fields of rheumatoid arthritis, ankylosing spondylitis, and psoriasis and adapted to PsA. Others are being developed specifically for PsA. Few are validated but most have been shown to perform well in distinguishing placebo from treatment response. This report reviews the current state of the art of assessment in PsA and points toward future directions of development of this field.

Abbreviations: ACR, American College of Rheumatology; BASDAI, Bath Ankylosing Spondylitis Disease Activity Index; CRP, C-reactive protein; DAS, disease activity score; ESR, erythrocyte sedimentation rate; EULAR, European League Against Rheumatism; GRAPPA, Group for Research and Assessment of Psoriasis and Psoriatic Arthritis; HAQ, Health Assessment Questionnaire; OMERACT, Outcome Measures in Rheumatology; PsA, psoriatic arthritis; PsARC, psoriatic arthritic response criteria; RA, rheumatoid arthritis; VAS, visual analogue scale

Keywords: psoriatic arthritis; disease activity; outcome measures; psoriasis; quality of life

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