Spondyloarthritis & psoriatic arthritis
Frequency of complex-to-manage, difficult-to-manage and treatment-refractory psoriatic arthritis: applying the 2025 Group for Research and Assessment of Psoriasis and Psoriatic Arthritis (GRAPPA) and EULAR definitions in a real-world longitudinal psoriatic arthritis (PsA) cohort
Authors' conclusion
Approximately 20% of patients with early PsA fulfilled the GRAPPA-C2M criteria, representing the earliest and broadest subgroup, while 4% met EULAR-D2M/EULAR-TR and 1.2% GRAPPA-TR definitions.
Study context
- Population
- Newly diagnosed, DMARD-naïve patients with PsA in the Dutch Southwest Early Psoriatic Arthritis cohort, 2013–2023newly diagnosed PsA
- Participants
- 885 participants
- Exposure
- GRAPPA-C2M vs EULAR-D2M vs EULAR-TR vs GRAPPA-TR
- GRAPPA-C2Mn = 179
- EULAR-D2Mn = 37
- EULAR-TRn = 34
- GRAPPA-TRn = 11
- Outcome
- Frequency of complex-to-manage (C2M), difficult-to-manage (D2M) and treatment-refractory (TR) PsA per 2025 GRAPPA and EULAR definitions
- Follow-up
- During
Methodological detailsreal-world, longitudinal, Kaplan-Meier time-to-event analyses, linear mixed-effects models
- Real-world
- Longitudinal
- Kaplan-Meier time-to-event analyses
- Linear mixed-effects models
Main finding
As reported in the abstract
Fulfilment of definition
Observational data: associations, not effects.
Further findings
Long-term HAQ-DI scores (linear mixed-effects models)
| β (95% CI) | |
|---|---|
| GRAPPA-C2MConsistently worse long-term PROs | 0.17 (0.10–0.24) |
| GRAPPA-TRConsistently worse long-term PROs | 0.37 (0.22–0.51) |
| EULAR-D2MConsistently worse long-term PROs | 0.36 (0.20–0.48) |
| EULAR-TRConsistently worse long-term PROs | 0.40 (0.25–0.55) |
Baseline characteristics
- Female sex, higher body mass index (BMI), longer symptom duration, presence of enthesitis and greater skin involvement differed with meeting definitions at baseline
Original publication
Frequency of complex-to-manage, difficult-to-manage and treatment-refractory psoriatic arthritis: applying the 2025 GRAPPA and EULAR definitions in a real-world longitudinal PsA cohort. RMD Open. Published 23 June 2026. doi:10.
Composed by AI from the published abstract and checked against it. How Briefs are made →