Psoriasis: Helliwell P

Kyle S, Chandler D, Griffiths CE, Helliwell P, Lewis J, McInnes I, Oliver S, Symmons D, McHugh N, Anonymous00081. · Royal National Hospital for Rheumatic Diseases, Upper Borough Wells, Bath, BA1 IRL, UK. · Rheumatology (Oxford). · Pubmed #15695305 links to  free full text

This publication has no abstract.

Gladman DD, Helliwell P, Mease PJ, Nash P, Ritchlin C, Taylor W. · University of Toronto, Toronto Western Hospital, Toronto, Ontario, Canada. · Arthritis Rheum. · Pubmed #14730596 links to  free full text

This publication has no abstract.

Gladman DD, Inman RD, Cook RJ, Maksymowych WP, Braun J, Davis JC, Landewé RB, Mease P, Brandt J, Vargas RB, Chandran V, Helliwell P, Kavanaugh A, O'Shea FD, Khan MA, Pipitone N, Rahman P, Reveille JD, Stone MA, Taylor W, Veale DJ, van der Heijde D. · Centre for Prognosis Studies in the Rheumatic Diseases, University of Toronto, Toronto, Ontario, Canada. · J Rheumatol. · Pubmed #17659754 No free full text.

Abstract: OBJECTIVE: To determine whether the assessments of peripheral joints and enthesitis were reproducible for both AS and PsA with axial disease, and whether dactylitis assessment is reproducible in patients with PsA. METHODS: A group of 20 rheumatologists from 11 countries with expertise in spondyloarthritis (SpA) met for a combined physical examination exercise to assess 10 patients with PsA with axial involvement (9 men, 1 woman, mean age 52 yrs, disease duration 17 yrs) and 9 patients with AS (7 men, 2 women, mean age 38 yrs, disease duration 16 yrs). A modified Latin-square design that enabled assessment of patient, assessor, and order effect was used. Measures included were number of tender and swollen joints, presence of enthesitis using 6 different indices, and dactylitis score. Data were analyzed using intraclass correlation (ICC) adjusted for order of measurements. RESULTS: The majority of the variance was contributed by the patients. There was no order effect. The assessment of tender joints (ICC 0.69) was more reliable than the assessment of swollen joints (ICC 0.54). Moreover, there was better agreement in patients with PsA (ICC 0.78) than in patients with AS (ICC 0.62). There was excellent agreement on the number of active enthesitis sites (ICC 0.86). All the enthesitis indices provided substantial to excellent agreement among observers. Agreement for the dactylitis score was substantial (ICC 0.70). CONCLUSION: The assessment of peripheral joints is more reliable in patients with PsA. Enthesitis instruments can be used reliably in patients with AS and patients with PsA with spinal involvement. The Leeds dactylitis instrument functions well in PsA.

Gladman DD, Inman RD, Cook RJ, van der Heijde D, Landewé RB, Braun J, Davis JC, Mease P, Brandt J, Vargas RB, Chandran V, Helliwell P, Kavanaugh A, O'Shea FD, Khan MA, Pipitone N, Rahman P, Reveille JD, Stone MA, Taylor W, Veale DJ, Maksymowych WP. · Division of Rheumatology, University of Toronto, Toronto, Ontario, Canada. · J Rheumatol. · Pubmed #17611985 No free full text.

Abstract: OBJECTIVE: To determine whether the axial measures used in primary ankylosing spondylitis (AS) were reproducible for both AS and psoriatic arthritis (PsA) with axial disease. METHODS: A group of 20 rheumatologists from 11 countries with expertise in spondyloarthritis (SpA) met for a combined physical examination exercise to assess 10 patients with PsA with axial involvement (9 men, 1 woman, mean age 52 yrs, mean disease duration 17 yrs) and 9 AS patients (7 men, 2 women, mean age 38 yrs, mean disease duration 16 yrs). A modified Latin-square design was used. Measures included were occiput to wall, tragus to wall, cervical rotation, chest expansion, lateral spinal bending, modified Schober, and hip mobility. Data were analyzed using intraclass correlation coefficients (ICC) adjusted for order of measurements. RESULTS: The majority of the variance was contributed by the patients. There was no order effect. Observer effect was noted especially for chest expansion for both AS and PsA patients, and for the modified Schober in PsA. The ICC demonstrated very good to excellent agreement for most measures for both AS and PsA. Chest expansion provided only moderate agreement for AS and PsA. CONCLUSION: Overall, measures of spinal mobility used in primary AS perform well with respect to interobserver reliability, and are equally reproducible when applied to PsA patients with axial involvement. Thus, these measures should now be evaluated in therapeutic trials of patients with PsA to determine sensitivity to change and concordance with other measures of structural damage.

Qureshi AA, Dominguez P, Duffin KC, Gladman DD, Helliwell P, Mease PJ, Husni ME. · Department of Dermatology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA. · J Rheumatol. · Pubmed #18609737 No free full text.

Abstract: Psoriatic arthritis (PsA) is an inflammatory arthritis associated with psoriasis, with an indolent and progressive course. A delay in diagnosis and treatment may lead to an erosive arthropathy, leading further to physical disability and deformity. To help clinicians screen for PsA, the Group for Research and Assessment of Psoriasis and Psoriatic Arthritis (GRAPPA) has led an effort to develop and validate 3 PsA screening tools. Administration of a well designed screening tool can increase detection of PsA, help determine the prevalence of PsA in a given population, record clinical data for genotype-phenotype studies, and track response to therapy. The development and validation of these screening tools was a major focus at the GRAPPA annual meeting at Boston in September 2007; we summarize that portion of the meeting.

Taylor W, Gladman D, Helliwell P, Marchesoni A, Mease P, Mielants H, Anonymous00006. · University of Otago, Wellington, New Zealand. · Arthritis Rheum. · Pubmed #16871531 links to  free full text

Abstract: OBJECTIVE: To compare the accuracy of existing classification criteria for the diagnosis of psoriatic arthritis (PsA) and to construct new criteria from observed data. METHODS: Data were collected prospectively from consecutive clinic attendees with PsA and other inflammatory arthropathies. Subjects were classified by each of 7 criteria. Sensitivity and specificity were compared using conditional logistic regression analysis. Latent class analysis was used to calculate criteria accuracy in order to confirm the validity of clinical diagnosis as the gold standard definition of "case"-ness. Classification and Regression Trees methodology and logistic regression were used to identify items for new criteria, which were then constructed using a receiver operating characteristic curve. RESULTS: Data were collected on 588 cases and 536 controls with rheumatoid arthritis (n = 384), ankylosing spondylitis (n = 72), undifferentiated arthritis (n = 38), connective tissue disorders (n = 14), and other diseases (n = 28). The specificity of each set of criteria was high. The sensitivity of the Vasey and Espinoza method (0.97) was similar to that of the method of McGonagle et al (0.98) and greater than that of the methods of Bennett (0.44), Moll and Wright (0.91), the European Spondylarthropathy Study Group (0.74), and Gladman et al (0.91). The CASPAR (ClASsification criteria for Psoriatic ARthritis) criteria consisted of established inflammatory articular disease with at least 3 points from the following features: current psoriasis (assigned a score of 2; all other features were assigned a score of 1), a history of psoriasis (unless current psoriasis was present), a family history of psoriasis (unless current psoriasis was present or there was a history of psoriasis), dactylitis, juxtaarticular new bone formation, rheumatoid factor negativity, and nail dystrophy. These criteria were more specific (0.987 versus 0.960) but less sensitive (0.914 versus 0.972) than those of Vasey and Espinoza. CONCLUSION: The CASPAR criteria are simple and highly specific but less sensitive than the Vasey and Espinoza criteria.

Symmons DP, Lunt M, Watkins G, Helliwell P, Jones S, McHugh N, Veale D. · ARC Epidemiology Unit, University of Manchester, United Kingdom. · J Rheumatol. · Pubmed #16463433 No free full text.

Abstract: OBJECTIVE: The study of psoriatic arthritis (PsA) is hampered by the absence of a widely accepted, validated case definition. We investigated whether the physician's opinion can be used as a gold standard when developing classification criteria for peripheral joint PsA. METHODS: UK rheumatologists who had published on PsA and attendees at 3 international meetings on PsA held in the UK were polled by questionnaire. There were 3 phases. The first questionnaire asked whether rheumatologists believed in the construct of PsA. The second survey developed a list of features thought to distinguish patients with PsA from other forms of peripheral arthritis. The final phase was development of a series of 61 "paper" patients with various combinations of the features of PsA. The paper patients were assessed by 15 rheumatologists who were asked whether, in their opinion, the patient had PsA. Latent class analysis was used to identify subgroups of patients and cross-tabulations were used to identify which clinical and laboratory features were associated with each subgroup. RESULTS: Rheumatologists agreed on the construct of PsA and that not all patients with psoriasis and an inflammatory polyarthritis have PsA. Latent class analysis identified 3 classes, corresponding to definite PsA; a middle group that was very likely to be given a diagnosis of PsA by some rheumatologists (high diagnosers), but unlikely to be given the diagnosis by others (low diagnosers); and a third group corresponding to "probably not PsA." CONCLUSION: For the group of patients with "definite PsA" the physician's opinion can be taken as the gold standard when developing classification criteria. However, for patients in the "middle group" there will always be disagreement with the gold standard whether the standard is based on the opinion of the high diagnosers or the low diagnosers.

Marchesoni A, Helliwell P, Gallazzi M, Gibertini P, Rossetti A, Galli L. · Rheumatology Department, G. Pini Orthopaedic Institute, Milan, Italy. · J Rheumatol. · Pubmed #10606372 No free full text.

Abstract: OBJECTIVE: To investigate the similarities and differences in pattern and severity of clinical expression of psoriatic arthritis (PsA) in British and Italian patients. METHODS: Detailed clinical data were obtained on 48 British patients with PsA and compared with the data of 48 Italian patients. A systematic evaluation of joints, spine, and skin was performed. Forty-one British and 42 Italian patients also underwent a whole body bone scintigram. Radiographic details of hands and wrists were also taken. RESULTS: The Italian patients did not differ from their British counterparts with respect to duration of arthritis, sex, clinical subgroups, axial involvement, number of tender and swollen joints, or radiographic score. However, significant differences were found with respect to age, duration of psoriasis, number of joints with deformity and/or loss of function, number of affected joints, and number of "active" joints on scintigraphy, which were all higher in the British group. After correction for age, duration of arthritis, and duration of psoriasis the only significant difference was the number of affected joints. CONCLUSION: Our findings suggest that British patients with PsA are more severely affected than a matched cohort of Italian patients.