Report from the GRAPPA meeting in Miami, December 2010

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Meeting report:

An unprecedented 140 delegates attended the annual GRAPPA meeting in Miami, 10-12 December 2010. This wasn’t just because of the attraction of temperatures in the 70s in December but also because Miami is only a short journey for people from Central and South America. As a result, GRAPPA enjoyed more delegates than ever before for the annual meeting, and more dermatologists, who comprised 30% of those attending. With such a large group discussion was always going to be vigorous and challenging but this was healthy and resulted in rigorous outcomes, new collaborations and a strengthening of the link between the two specialties.

Day one:

The first session, always a crucial one, concerned the development of an index to measure the effect of new therapies on psoriatic arthritis. It has become clear in recent years that psoriasis is only one aspect of the disease and there are strong advocates, particularly from Italy, who would lump all the manifestations under one umbrella, called psoriatic disease. This means that we should take into consideration much wider aspects of the disease in clinical trials. In the past drugs such as the new biologic anti-TNF drugs have been measured only in terms of joint or skin inflammation, and rarely together in the same trial. The new measures promise to evaluate other and more varied aspects of the disease such as enthesitis, dactylitis and involvement of the spine. The GRAPPA membership, which comprises over 350 physicians world wide is now collecting information on over 450 patients with psoriatic arthritis in order to develop this new ‘composite’ measure of disease activity. This will mean that, in future, all facets of the disease will be taken into account when using new treatments. This may also include aspects of the disease usually neglected such as obesity, high blood pressure and high cholesterol, all of which may contribute to an increased risk of heart attack and stroke in psoriatic arthritis.

That first full session set the agenda for the rest of the meeting. People were happier to speak up and to make their voices known. Contributions from clinicians, epidemiologists, laboratory scientists really made an impact and the good thing is that, although many of these people were not ‘big names’ they were listened to and respected as part of this process. Many delegates noted this, and I think it occurs as a result of a refreshingly open and inclusive approach to the organisation.

And so to other issues. What do rheumatologists mean by musculoskeletal inflammation? This is an important question as dermatologists are often the first people to encounter psoriatic arthritis in their psoriasis patients. To have clear guidelines for recognizing arthritis would help pick this condition up earlier. Rheumatologists and dermatologists are also working together to develop a screening questionnaire to detect arthritis. There was a lot of animated discussion but such symptoms as prolonged morning stiffness in the joints, warmth and swelling and improvement with anti-inflammatory drugs were thought to be helpful. The dermatologists at the meeting felt that they could, with further training, recognize the features of arthritis themselves. Of course many of the oral drugs used for arthritis and psoriasis are the same, so that both skin and joints benefit. There was also discussion of new ways of looking at the joints with ultrasound, something both dermatologists and rheumatologists could develop.

Day two:

On the second day the meeting looked more at the science behind the diseases. Just recently there has been a lot of activity in genetics with large genome wide screens being performed in Europe and North America. New genes important in both the skin and the joints have been identified and are likely to lead to new treatments in due course. No doubt at some point in the near future we will be able to predict those people with psoriasis who are likely to go on to develop arthritis. And in a similar vein we are also likely to be in a position to predict those people with psoriatic disease who are most at risk of heart disease. More and more clinics are likely to be checking your blood pressure, weight and height and cholesterol as part of the routine check up.

The final session of the meeting was about new international collaborations. Latin America was described as a ‘sleeping giant’ in this field as it has such a large population and has hitherto not really contributed to international efforts. Only this year the GRAPPA group held a satellite meeting at the Brazilian society of rheumatology and further meetings are planned for Argentina and Colombia. Genetically of course there is a strong link to Spain and Portugal but we heard about the fascinating genetics of the native Indians, in whom psoriasis is virtually unknown. Racial intermixing is changing that pattern of course.

There is no doubt that the GRAPPA group is growing and gaining in strength and influence. For 2011 further meetings are planned in London and Naples. For 2012 already plans are being made to have another conference with the International Federation of Psoriasis Patients (IFPA) in Stockholm – this will be the third such venture and usually attracts large numbers of patients and dermatologists from around the world, This is an exciting area to work at the moment as the basic science is changing fast and every year new treatments become available. This is good news for patients with the disease.

About GRAPPA:

GRAPPA (Group for Research and Assessment of Psoriasis and Psoriatic Arthritis) is organized exclusively for non-profit, educational, and scientific purposes, specifically to facilitate sharing of information related to psoriasis and psoriatic arthritis, networking among different medical disciplines that see psoriasis and psoriatic arthritis patients and to enhance research, diagnosis and treatment of psoriasis and psoriatic arthritis.