A Unique Structure for Tackling Psoriatic Disease

“I think GRAPPA’s biggest achievement is getting 350 people, including dermatologists, worldwide, as part of this organization,” says Dr. Helliwell. Abrar A. Qureshi, MD, MPH, vice chair of the department of dermatology at Brigham and Women’s Hospital, and assistant professor at Harvard Medical School in Boston, is currently communications lead for GRAPPA’s Identification of PsA committee. He agrees with Dr. Helliwell. “GRAPPA has become a place where rheumatologists and dermatologists can share knowledge about their respective care paradigms in a very open and free environment, without being concerned about competition,” he notes.

The core GRAPPA group at their infamous inaugural meeting in New York, which occurred during the 2003 blackout.

“We’re very appreciative of the efforts of GRAPPA,” says Bruce F. Bebo, Jr., PhD, director of research and medical programs at the National Psoriasis Foundation (NPF) in Portland, Ore. “I am particularly excited about their work promoting PsA and PsC registries, as there is a significant unmet need for more information on the natural history of these diseases,” he notes. The NPF is now collecting DNA and clinical information from 2,000 PsC and PsA patients through the Victor Henschel BioBank.

World-renowned psoriasis expert Dr. Krueger, who is professor of dermatology and Benning Presidential Endowed Chair at the University of Utah in Salt Lake City, has been leading the Utah Psoriasis Initiative (UPI) to quantify the phenotypic variants of psoriatic disease in a 1,300-patient cohort. “The ‘elephant in the room’ was psoriatic arthritis,” says Dr. Krueger. “We’ve found with time that PsA is present 24.6% of the time in the UPI. What I’ve learned from this group of investigators is that psoriatic arthritis also has many phenotypic variants, and those have come into much sharper focus as a result of GRAPPA.”

While rheumatologists can help their dermatology colleagues learn to make the diagnosis of PsA in PsC patients, dermatologists can work with their rheumatology colleagues to help manage the nails, scalp, plantar disease, and inverse psoriasis. “The synergy in GRAPPA really enables diagnosis, management, and further research into the etiology of the disease,” says Dr. Qureshi. He has developed a patient self-report questionnaire called Psoriatic Arthritis Screening and Evaluation tool (PASE), which is now showing approximately 93% sensitivity and 82% specificity for identifying inflammatory arthritis in the PsC patient. He has been collaborating with Dr. Enrique Soriano in Buenos Aires, whose data from a small study using the PASE suggest that questionnaire scores correlate with the DAS-28.

Structure Evolves

Early on, says Dr. Gladman, the group’s structure consisted of several key committees—steering, executive, publications, and treatment recommendations—while she and Philip Mease acted as a two-person ad-hoc organizing committee. In 2005, Dr. Helliwell proposed that the group adopt a more formal structure for governance, both to allow more democratic input and to ensure that leadership positions would rotate. He had been involved with several other organizations and drew on that experience to do so. In the first elections, Dr. Gladman was elected president and Philip Mease, MD, became vice president. After three years, Dr. Mease assumed the title of president and Wolf Henning-Boehncke, MD, that of vice president. It’s a healthier configuration, says Dr. Helliwell, which will allow more room for expansion. Dr. Kavanaugh agrees. “You have to have turnover and to have other people involved than just the founders. Otherwise, things don’t evolve. I think GRAPPA has built a good foundation that will support that, and hopefully it’ll exist 20 years from now and even take things in a different direction.”

During August 2010, several GRAPPA members were filmed for the musculoskeletal portion of the GRAPPA Video Training Project. Pictured are Dr. Helliwell (left) and a patient volunteer.

Vital Expansions

In March, rheumatologists Drs. Chandran, Helliwell, and Mease, and dermatologists Drs. Krueger and Langley traveled to Fortaleza, Brazil, to lead a reliability exercise for the assessment of joints, dactylitis, enthesitis, skin, and nails in psoriasis patients, using some newly minted training videos and direct examination of patients to teach a large group of rheumatologists and dermatologists gathered from many Latin American countries. The effort was organized in conjunction with the Latin American Psoriasis and Psoriatic Arthritis Society (LAPPAS), which will soon launch a prospective study to characterize the phenotype of PsA in Latin American patients. Similar projects in Asia are also forming.