Application of newly proposed GRAPPA and EULAR criteria in a longitudinal cohort identified progressively smaller groups of patients with early psoriatic arthritis who experienced persistently worse patient-reported outcomes.
To evaluate the frequency of patients with early psoriatic arthritis meeting the GRAPPA and EULAR criteria for complex-to-manage and difficult-to-manage disease.
Approach:
Study Design: Retrospective analysis of data from the Dutch Southwest Early Psoriatic Arthritis cohort, involving 885 newly diagnosed, disease-modifying antirheumatic drug-naïve patients.
Criteria Application: The 2025 GRAPPA and EULAR definitions for complex-to-manage, treatment-refractory, difficult-to-manage diseases were applied to the cohort.
Follow-Up: Patients were followed for a mean of 40 months to assess outcomes.
Key Findings:
20% of patients met the GRAPPA-C2M definition, while only 4% met the EULAR-D2M and EULAR-TR definitions, and 1% met the GRAPPA-TR definition.
The GRAPPA-C2M criteria identified patients earlier in the disease course compared to EULAR definitions.
Patients meeting any of the definitions reported worse long-term patient-reported outcomes, including greater disability and pain, and were more likely to be female, have a higher body mass index, longer symptom duration, greater skin involvement, and enthesitis at baseline.
Interpretation:
Limitations:
Criteria were applied retrospectively using observational data.
Some criteria were assessed using proxy measures.
Generalizability may be limited as all patients were enrolled at Dutch clinical centers.
