Arthur Kavanaugh

La Jolla Institute for Allergy & Immunology, لا هویا, California, United States

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Publications (310)1737.1 Total impact

  • Tristan Boyd · A Kavanaugh ·
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    ABSTRACT: Introduction: Improved understanding of the immunopathogenic mechanisms in psoriatic arthritis (PsA) has led to the development of targeted biological therapies, which demonstrate superior clinical efficacy to traditional disease-modifying antirheumatic drugs (DMARDs). There are currently 3 classes of biological agents that are approved for the treatment of psoriatic disease: tumor necrosis factor alpha inhibitors (TNFi), including etanercept, infliximab, adalimumab, golimumab, and certolizumab pegol; ustekinumab, a monoclonal antibody (mAb) directed against interleukin (IL)-12 and IL-23; and secukinumab, a human anti-IL-17A mAb. Other agents are in development. Our growing experience with these medications has revolutionized the approach to disease management in PsA. Areas covered: This article discusses the rationale for using biological therapies in PsA, highlighting clinical trial evidence that supports the use of these agents. We summarize novel treatment approaches using biological therapies in the management of PsA, including early intervention, targeted therapy, TNFi switching, combination therapy, and tapering or discontinuation of biological therapy. We conclude with a discussion of the importance comorbidities have on selection of therapy. Expert opinion: The advent of highly effective biological therapies has revolutionized the management of patients with PsA. Growing experience with these agents has led to novel treatment approaches that may improve clinical outcomes for PsA patients.
    Expert Opinion on Biological Therapy 11/2015; DOI:10.1517/14712598.2016.1118045 · 3.74 Impact Factor
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    ABSTRACT: Objective: To develop a new evidence-based, pharmacologic treatment guideline for rheumatoid arthritis (RA). Methods: We conducted systematic reviews to synthesize the evidence for the benefits and harms of various treatment options. We used the Grading of Recommendations Assessment, Development and Evaluation (GRADE) methodology to rate the quality of evidence. We employed a group consensus process to grade the strength of recommendations (either strong or conditional). A strong recommendation indicates that clinicians are certain that the benefits of an intervention far outweigh the harms (or vice versa). A conditional recommendation denotes uncertainty over the balance of benefits and harms and/or more significant variability in patient values and preferences. Results: The guideline covers the use of traditional disease-modifying antirheumatic drugs (DMARDs), biologic agents, tofacitinib, and glucocorticoids in early (<6 months) and established (≥6 months) RA. In addition, it provides recommendations on using a treat-to-target approach, tapering and discontinuing medications, and the use of biologic agents and DMARDs in patients with hepatitis, congestive heart failure, malignancy, and serious infections. The guideline addresses the use of vaccines in patients starting/receiving DMARDs or biologic agents, screening for tuberculosis in patients starting/receiving biologic agents or tofacitinib, and laboratory monitoring for traditional DMARDs. The guideline includes 74 recommendations: 23% are strong and 77% are conditional. Conclusion: This RA guideline should serve as a tool for clinicians and patients (our two target audiences) for pharmacologic treatment decisions in commonly encountered clinical situations. These recommendations are not prescriptive, and the treatment decisions should be made by physicians and patients through a shared decision-making process taking into account patients' values, preferences, and comorbidities. These recommendations should not be used to limit or deny access to therapies.
    11/2015; DOI:10.1002/acr.22783
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    ABSTRACT: Objective: We conducted a longitudinal observational study of biological disease-modifying antirheumatic drugs (bDMARD) to describe the proportions of patients with rheumatoid arthritis in remission who discontinued these agents, and to assess the potential predictors of the decision to discontinue. Methods: We used data from the US COnsortium of Rheumatology Researchers Of North America (CORRONA) and the Japanese National Database of Rheumatic Diseases by iR-net in Japan (NinJa) registries, and ran parallel analyses. Patients treated with bDMARD who experienced remission (defined by the Clinical Disease Activity Index ≤ 2.8) were included. The outcome of interest was the occurrence of bDMARD discontinuation while in remission. The predictors of discontinuation were assessed in the Cox regression models. Frailty models were also used to examine the effects of individual physicians in the discontinuation decision. Results: The numbers of eligible patients who were initially in remission were 6263 in the CORRONA and 744 in the NinJa. Among these patients, 10.0% of patients in CORRONA and 11.8% of patients in NinJa discontinued bDMARD while in remission over 5 years, whereas many of the remaining patients lost remission before discontinuing bDMARD. Shorter disease duration was associated with higher rates of discontinuation in both cohorts. In CORRONA, methotrexate use and lower disease activity were also associated with discontinuation. In frailty models, physician random effects were significant in both cohorts. Conclusion: Among patients who initially experienced remission while receiving bDMARD, around 10% remained in remission and then discontinued bDMARD in both registries. Several factors were associated with more frequent discontinuation while in remission. Physician preference likely is also an important correlate of bDMARD discontinuation, indicating the need for standardization of practice.
    The Journal of Rheumatology 11/2015; DOI:10.3899/jrheum.150240 · 3.19 Impact Factor

  • Journal of Clinical and Aesthetic Dermatology 10/2015; 8(9 Suppl):S4-S26.
  • Tristan Boyd · Arthur Kavanaugh ·
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    ABSTRACT: Greater understanding of the underlying disease process has led to the development of targeted therapeutic agents and innovative strategies in the treatment of psoriatic arthritis (PsA). This report addresses novel medications targeting the T helper 17 cell pathway, specifically those inhibiting interleukin-17A and its receptor, and discusses their role as effective therapies in the management of PsA.
    Clinical and experimental rheumatology 10/2015; · 2.72 Impact Factor
  • Ennio Lubrano · Fabio Massimo Perrotta · Arthur Kavanaugh ·
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    ABSTRACT: Psoriatic arthritis (PsA) is a complex, multisystem and potentially disabling disease with musculoskeletal and skin manifestations. In PsA, as well as in the other chronic rheumatic conditions, a state of low disease activity or remission should be the target of treatment but to reach this objective, in the assessment of PsA patients, is still an unmet need due to the heterogeneity of disease manifestations. With the introduction of anti-TNF treatment, low disease activity or remission become an achievable and suitable state that could be reached by 50%-60% of PsA patients. The aim of this paper is to briefly summarise the concept of low disease activity and remission in PsA, with particular focus on anti-TNF therapy.
    Clinical and experimental rheumatology 10/2015; · 2.72 Impact Factor
  • Arthur Kavanaugh · Tristan Boyd ·
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    ABSTRACT: A greater understanding of the underlying disease process, combined with the development of novel therapeutic agents, has led to innovative strategies in the treatment of psoriatic arthritis (PsA). This report addresses unmet needs in clinical trial design in PsA, and proposes some amendments that may yield data that can potentially improve patient outcomes in the management of PsA.
    Clinical and experimental rheumatology 10/2015; · 2.72 Impact Factor
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    ABSTRACT: Background In a phase 2 study, the inhibition of the interleukin-17A receptor improved signs and symptoms of psoriatic arthritis. We sought to evaluate the efficacy and safety of secukinumab, an anti-interleukin-17A monoclonal antibody, in such patients. Methods In this double-blind, phase 3 study, 606 patients with psoriatic arthritis were randomly assigned in a 1:1:1 ratio to receive intravenous secukinumab (at a dose of 10 mg per kilogram) at weeks 0, 2, and 4, followed by subcutaneous secukinumab at a dose of either 150 mg or 75 mg every 4 weeks, or placebo. Patients in the placebo group were switched to subcutaneous secukinumab at a dose of 150 mg or 75 mg at week 16 or 24, depending on clinical response. The primary end point was the proportion of patients with an American College of Rheumatology 20 (ACR20) response at week 24, defined as a 20% improvement from baseline in the number of tender and swollen joints and at least three other important domains. Results ACR20 response rates at week 24 were significantly higher in the group receiving secukinumab at doses of 150 mg (50.0%) and 75 mg (50.5%) than in those receiving placebo (17.3%) (P<0.001 for both comparisons with placebo). Secondary end points, including the ACR50 response and joint structural damage, were significantly better in the secukinumab groups than in the placebo group. Improvements were sustained through 52 weeks. Infections, including candida, were more common in the secukinumab groups. Throughout the study (mean secukinumab exposure, 438.5 days; mean placebo exposure, 128.5 days), four patients in the secukinumab groups had a stroke (0.6 per 100 patient-years; 95% confidence interval [CI], 0.2 to 1.5), and two had a myocardial infarction (0.3 per 100 patient-years; 95% CI, 0.0 to 1.0), as compared with no patients in the placebo group. Conclusions Secukinumab was more effective than placebo in patients with psoriatic arthritis, which validates interleukin-17A as a therapeutic target. Infections were more common in the secukinumab groups than in the placebo group. The study was neither large enough nor long enough to evaluate uncommon serious adverse events or the risks associated with long-term use. (Funded by Novartis Pharma; number, NCT01392326 .).
    New England Journal of Medicine 09/2015; 373(14):1329-1339. DOI:10.1056/NEJMoa1412679 · 55.87 Impact Factor
  • Tristan Boyd · Arthur Kavanaugh ·

    Nature Reviews Rheumatology 09/2015; DOI:10.1038/nrrheum.2015.129 · 9.85 Impact Factor
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    ABSTRACT: As patients with rheumatoid arthritis (RA) receive treatment with anti-tumour necrosis factors over several years, it is important to evaluate their long-term safety and efficacy. The objective of this study was to examine the safety and benefits of certolizumab pegol (CZP)+methotrexate (MTX) treatment for almost 5 years in patients with RA. Patients who completed the 24-week Rheumatoid Arthritis Prevention of Structural Damage (RAPID) 2 randomized controlled trial (RCT; NCT00160602), or who were American College of Rheumatology (ACR) 20 non-responders at Week 16, entered the open-label extension (OLE; NCT00160641). After ≥6 months treatment with CZP 400 mg every two weeks (Q2W), dose was reduced to 200 mg Q2W, the approved maintenance dose. Safety data are presented from all patients who received ≥1 dose CZP (Safety population, n=612). Efficacy data are presented to Week 232 for the intent-to-treat (ITT, n=492) and Week 24 CZP RCT Completer (n=342) populations, and through 192 weeks of dose-reduction for the Dose-reduction population (patients whose CZP dose was reduced to 200 mg, n=369). Radiographic progression (modified total Sharp score change from RCT baseline >0.5) to Week 128 is reported for the Week 24 CZP Completers. In the RCT, 619 patients were randomized to CZP+MTX (n=492) or placebo+MTX (n=127). Overall, 567 patients (91.6%) entered the OLE: 447 CZP and 120 placebo patients. Of all randomized patients, 358 (57.8%) were ongoing at Week 232. Annual drop-out rates during the first four years ranged from 8.4–15.0%. Event rates per 100 patient-years were 163.0 for adverse events (AEs) and 15.7 for serious AEs. Nineteen patients (3.1%) had fatal AEs (incidence rate=0.8). Clinical improvements in the RCT were maintained to Week 232 in the CZP Completers: mean Disease Activity Score 28 (Erythrocyte Sedimentation Rate) change from baseline was −3.4 and ACR20/50/70 responses 68.4%/47.1%/25.1% (non-responder imputation). Similar improvements observed in the ITT were maintained following dose-reduction. 73.2% of CZP Completers had no radiographic progression at Week 128. In patients with active RA despite MTX therapy, CZP was well tolerated, with no new safety signals identified. CZP provided sustained improvements in clinical outcomes for almost 5 years. Trial registration, NCT00160602 and NCT00160641. Registered 8 September 2005.
    Arthritis Research & Therapy 09/2015; 17(1). DOI:10.1186/s13075-015-0767-2 · 3.75 Impact Factor
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    ABSTRACT: Objectives: The aim of this study was to establish consensus for potential remission criteria for use in clinical trials of gout. Methods: Experts (n=88) in gout from multiple countries were invited to participate in a web-based questionnaire study. Three rounds of Delphi consensus exercises were conducted using SurveyMonkey® followed by a discrete choice experiment using 1000Minds®. The exercises focused on identifying domains, definitions for each domain and the timeframe over which remission should be defined. Results: There were 49 respondents (56% response) to the initial survey with subsequent response rates ranging from 57% to 90%. Consensus was reached for the inclusion of serum urate (98% agreement), flares (96%), tophi (92%), pain (83%) and patient global assessment (93%) of disease activity as measurement domains in remission criteria. Consensus was also reached for domain definitions including serum urate (< 0.36mM), pain (<2 on a 10-point scale) and patient global assessment (<2 on a 10-point scale), all of which should be measured at least twice over a set time interval. Consensus was not achieved in the Delphi exercise for the timeframe for remission with equal responses for six months (51%) and one year (49%). In the discrete choice experiment, there was a preference towards 12 months as a timeframe for remission. Conclusion: These consensus exercises have identified domains and provisional definitions for gout remission criteria. Based on the results of these exercises, preliminary remission criteria are proposed with domains of serum urate, acute flares, tophus, pain and patient global assessment. These preliminary criteria now require testing in clinical datasets. This article is protected by copyright. All rights reserved.
    Arthritis Care and Research 09/2015; DOI:10.1002/acr.22741 · 4.71 Impact Factor
  • Tristan Boyd · Arthur Kavanaugh ·
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    ABSTRACT: The introduction of highly effective therapies and clearly defined targets has altered the treatment paradigm in psoriatic arthritis (PsA). Validated classification criteria and outcome measures specific to PsA have helped standardize a therapeutic approach to this heterogeneous disease that affects multiple clinical domains. This article discusses the importance of early intervention using a treat-to-target strategy; emerging evidence for tight control based on minimal disease activity criteria; disease considerations specific to PsA (prognostic markers, biomarkers, subclinical disease, comorbidities); and new treatment strategies to deal with refractory disease (eg, tumor necrosis factor inhibitor switching and use of novel disease-modifying therapies) and controlled disease (eg, tapering or discontinuing biologic therapy).
    Rheumatic Disease Clinics of North America 08/2015; 41(4). DOI:10.1016/j.rdc.2015.07.011 · 2.69 Impact Factor
  • Source
    Arthur Kavanaugh · John J Cush ·

    The Journal of Rheumatology 08/2015; 42(8):1357-1358. DOI:10.3899/jrheum.150566 · 3.19 Impact Factor
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    ABSTRACT: Objective: To evaluate the long-term effectiveness and safety of 10 years of adalimumab (ADA) treatment in DMARD-refractory RA patients and to analyse efficacy based on RF status and baseline disease duration. Methods: DE020 was a multicentre, phase 3, open-label continuation study. Adult RA patients who received s.c. ADA (40 mg every other week or monthly) in one of four early assessment studies could receive ADA for ≤10 years in DE020. Assessments included the 28-joint DAS with CRP (DAS28-CRP), Simplified Disease Activity Index (SDAI), HAQ Disability Index (HAQ-DI) and safety as events per 100 patient-years. Results: Of 846 enrolled patients, mean age at baseline was 55.6 years, 78.1% were women, mean disease duration was 11.7 years and 27.0% were RF(-). Among 286 (33.8%) patients who completed 10 years of ADA, 168/236 (71.2%) achieved DAS28-CRP ≤3.2, 101/238 (42.4%) achieved HAQ-DI <0.5 and 90/241 (37.3%) achieved DAS28-CRP ≤3.2 plus HAQ-DI <0.5. DAS28-CRP- or SDAI-based remission was observed in 135/236 (57.2%) and 70/236 (29.7%) patients, respectively. Effectiveness outcomes were similar regardless of RF status. Higher proportions of patients with shorter vs longer baseline disease duration (≤2 vs >2 years) achieved HAQ-DI <0.5 (60.6% vs 39.5%; P = 0.023) and DAS28-CRP ≤3.2 plus HAQ-DI <0.5 (58.1% vs 32.5%; P = 0.006). Adverse events (317.2 events per 100 patient-years) during ADA exposure were consistent with the expected safety profile for TNF inhibitors. Conclusion: ADA led to sustained clinical and functional responses in the 33.8% of treatment-refractory RA patients who completed 10 years of treatment. Patients with shorter disease duration achieved better outcomes, highlighting the need for early treatment. No unexpected safety findings were observed. Trial registration:,, NCT00195650.
    Rheumatology (Oxford, England) 07/2015; DOI:10.1093/rheumatology/kev249 · 4.48 Impact Factor
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    ABSTRACT: Interleukin 17A is a proinflammatory cytokine that is implicated in the pathogenesis of psoriatic arthritis. We assessed the efficacy and safety of subcutaneous secukinumab, a human anti-interleukin-17A monoclonal antibody, in patients with psoriatic arthritis. In this phase 3, double-blind, placebo-controlled study undertaken at 76 centres in Asia, Australia, Canada, Europe, and the USA, adults (aged ≥18 years old) with active psoriatic arthritis were randomly allocated in a 1:1:1:1 ratio with computer-generated blocks to receive subcutaneous placebo or secukinumab 300 mg, 150 mg, or 75 mg once a week from baseline and then every 4 weeks from week 4. Patients and investigators were masked to treatment assignment. The primary endpoint was the proportion of patients achieving at least 20% improvement in the American College of Rheumatology response criteria (ACR20) at week 24. Analysis was by intention to treat. This study is registered with, number NCT01752634. Between April 14, and Nov 25, 2013, 397 patients were randomly assigned to receive secukinumab 300 mg (n=100), 150 mg (n=100), 75 mg (n=99), or placebo (n=98). A significantly higher proportion of patients achieved an ACR20 at week 24 with secukinumab 300 mg (54 [54%] patients; odds ratio versus placebo 6·81, 95% CI 3·42-13·56; p<0·0001), 150 mg (51 [51%] patients; 6·52, 3·25-13·08; p<0·0001), and 75 mg (29 [29%] patients; 2·32, 1·14-4·73; p=0·0399) versus placebo (15 [15%] patients). Up to week 16, the most common adverse events were upper respiratory tract infections (four [4%], eight [8%], ten [10%], and seven [7%] with secukinumab 300 mg, 150 mg, 75 mg, and placebo, respectively) and nasopharyngitis (six [6%], four [4%], six [6%], and eight [8%], respectively). Serious adverse events were reported by five (5%), one (1%), and four (4%) patients in the secukinumab 300 mg, 150 mg, and 75 mg groups, respectively, compared with two (2%) in the placebo group. No deaths were reported. Subcutaneous secukinumab 300 mg and 150 mg improved the signs and symptoms of psoriatic arthritis, suggesting that secukinumab is a potential future treatment option for patients with this disorder. Novartis. Copyright © 2015 Elsevier Ltd. All rights reserved.
    The Lancet 06/2015; 386(9999). DOI:10.1016/S0140-6736(15)61134-5 · 45.22 Impact Factor
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    ABSTRACT: To evaluate the efficacy and safety of ustekinumab through 2years in adult patients with active psoriatic arthritis (PsA). A total of 615 adult patients with active PsA were randomized to placebo, ustekinumab 45mg, or ustekinumab 90mg, at wks0, 4, and every 12 weeks through wk88 (last dose). At wk16, patients with <5% improvement in both tender/swollen joint counts entered blinded early escape (placebo to 45mg, 45mg to 90mg, 90mg to 90mg). All remaining placebo patients crossed over to ustekinumab 45mg at wk24. Clinical efficacy measures included: ≥20% improvement in the American College of Rheumatology criteria (ACR20), 28-joint count disease activity score using C-reactive protein (DAS28-CRP), and ≥75% improvement in psoriasis area and severity index (PASI75). Radiographic progression was evaluated using the van der Heijde-modified Sharp (vdH-S) score. At week100, ACR20, DAS28-CRP moderate/good response, and PASI75 rates ranged from 56.7%-63.6%, 71.9%-76.7%, and 63.9%- 72.5%, respectively, across treatment groups. In both ustekinumab groups, the median percent improvement in dactylitis and enthesitis was 100% at wk100. The mean changes in vdH-S from week52-100 were similar to those observed from wk0-52 in the ustekinumab groups. Through week108, 70.7% and 9.7% of patients had an AE or SAE, respectively. The rates and type of AEs were similar between the dose groups. Clinical and radiographic benefits from ustekinumab treatment were maintained through wk100 in PSUMMIT 1. No unexpected safety events were observed; the safety profile of ustekinumab in this population was similar to that previously observed in psoriasis patients treated with ustekinumab. This article is protected by copyright. All rights reserved. © 2015, American College of Rheumatology.
    06/2015; DOI:10.1002/acr.22645
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    ABSTRACT: Background Bone damage, including localized as well as generalized osteoporosis is a well known consequence of the inflammatory arthritides such as rheumatoid arthritis (RA). Psoriatic arthritis (PsA) can be characterized by bone destruction but also new bone formation. In PsA, the literature on osteoporosis is inconclusive and scarcer than in RA. Objectives To explore if PsA patients are at increased risk of having reduced bone mineral density (BMD) at hip and/or lumbar spine. Methods Consecutive patients from an outpatient clinic fulfilling CASPAR criteria for PsA were enrolled. We excluded PsA patients with only axial manifestation without peripheral arthritis. All patients underwent a thorough examination according to an extensive protocol. Data collection included demographics, clinical and laboratory disease measures, treatments, and previous fracture history. BMD was measured at spine (L1-4) and hip (femoral neck and total hip) by dual energy X-ray absorptiometry (DXA, Lunar Prodogy). Calibration of the DXA machine was stable during the whole measurement period. BMD was expressed as g/cm2, Z-score and T-score. The percentage of patients with T-score ≤ -2.5 SD (WHO osteoporosis definition) and with Z-score ≤ -1.0 SD was calculated. Appropriate descriptive statistics was applied for continuous and categorical variables. Results Patient characteristics among the 141 examined PsA patients (men 50.4%): mean (SD) age 52.5 (9.9) years, body mass index (BMI) 28.3 (4.4) kg/m2, disease duration 8.9 years (6.8) and current smoker 17.0%. Median (range) 68 tender joint count was 6.0 [0-55], 66 swollen joint count 0 [0-6] and CRP 2.0 [0-63] mg/dl. Mean (SD) DAS28 was 3.2 (1.2), ESR 15.9 (11.9) mm/hr, MHAQ 0.44 (0.40) and pain and fatigue on visual analogue scale 35.1 (23.5) and 45.7 (32.4) mm respectively. Biologic DMARDs were used by 33.3%, synthetic DMARDs by 56.7% and glucocorticosteroids by 9.9%. Only 11.3% of patients were using calcium and vitamin D supplementation and 2.1% antiresorptive osteoporosis treatment. Low energy fracture was reported in 8.9% of the patients. In the table below mean (SD or 95%CI) bone density values expressed as BMD, Z-score and T-score and percentage of patients with T-score ≤ -2.5 SD and Z-score ≤ -1.0 SD (by definition 16% in the reference population) is displayed. As shown the proportion of patients with Z-score ≤ -1.0 SD was comparable with the 16% seen in the reference population database. Conclusions The proportion of PsA patients with osteoporosis in our study was low. Overall BMD was comparable to that from normative bone density reference values. Disclosure of Interest G. Haugeberg Grant/research support from: Unrestricted Grant from Pfizer, B. Grandaunet: None declared, H. Høiberg: None declared, A. Diamantopoulos: None declared, A. Kavanaugh: None declared
    Annals of the Rheumatic Diseases 06/2015; 74(Suppl 2):352.2-352. DOI:10.1136/annrheumdis-2015-eular.2795 · 10.38 Impact Factor
  • L. C. Coates · A. F. Kavanaugh · P. J. Mease · C. T. Ritchlin ·
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    ABSTRACT: At the 2014 annual meeting of the Group for Research and Assessment of Psoriasis and Psoriatic Arthritis (GRAPPA), members discussed an update of their previous treatment recommendations published in 2009. Domain subcommittees representing the different aspects of psoriatic arthritis (PsA) had been reconvened in 2013 and a new group was formed that focused on PsA comorbidities and associated conditions. A combined literature review was completed in February 2013 followed by individual group literature reviews and analyses. Articles from each of these subcommittees were published in 2014, updating the evidence for individual therapies in PsA. At their 2014 annual meeting, GRAPPA members discussed their plans for a summary article on treatment recommendations, finalized the Grading of Recommendations Assessment, Development and Evaluation (GRADE)-formatted recommendations for individual drugs within the domain subcommittees, and presented these for debate. Modifications to the GRAPPA grid were also discussed in breakout groups and presented to the full membership. At the GRAPPA meeting adjacent to the 2014 American College of Rheumatology meeting, a new GRAPPA treatment schema was proposed to replace the original GRAPPA grid. Each domain subcommittee discussed treatment algorithms based on their GRADE recommendations for inclusion in the final treatment recommendations article, which will be submitted in 2015.
    The Journal of Rheumatology 06/2015; 42(6):1052-1055. DOI:10.3899/jrheum.150132 · 3.19 Impact Factor

  • Annals of the Rheumatic Diseases 06/2015; 74(Suppl 2):1165.3-1166. DOI:10.1136/annrheumdis-2015-eular.4653 · 10.38 Impact Factor

  • Annals of the Rheumatic Diseases 06/2015; 74(Suppl 2):1169.2-1169. DOI:10.1136/annrheumdis-2015-eular.5190 · 10.38 Impact Factor

Publication Stats

11k Citations
1,737.10 Total Impact Points


  • 2003-2015
    • La Jolla Institute for Allergy & Immunology
      • Division of Cell Biology
      لا هویا, California, United States
  • 2000-2015
    • University of California, San Diego
      • • Division of Rheumatology, Allergy and Immunology
      • • Division of Immunology and Allergy
      San Diego, California, United States
  • 2014
    • University Center Rochester
      Рочестер, Minnesota, United States
  • 2009
    • National University (California)
      San Diego, California, United States
  • 2008
    • CSU Mentor
      Long Beach, California, United States
    • Goethe-Universität Frankfurt am Main
      Frankfurt, Hesse, Germany
  • 2007
    • University of California, San Francisco
      San Francisco, California, United States
  • 2006
    • University of San Diego
      San Diego, California, United States
  • 2004
    • Stanford University
      • Division of Immunology
      Palo Alto, California, United States
  • 1991-2004
    • University of Texas Southwestern Medical Center
      • • Division of Rheumatic Diseases
      • • Department of Internal Medicine
      Dallas, Texas, United States
  • 1994-1998
    • University of Texas at Dallas
      Richardson, Texas, United States