In this compelling episode of Inside GRAPPA, host Dr. Hanna Johnsson, a rheumatologist based in Scotland, leads an important conversation on one of the most pressing issues in psoriatic arthritis (PsA) care: what truly makes a case difficult to treat or complex to manage?
Dr. Johnsson is joined by two experts deeply embedded in the GRAPPA initiative to define these concepts:
- Dr. Fabian Proft, Head of the Division of Rheumatology at Charité Berlin, Germany, and long-time GRAPPA contributor.
- Dr. Shikha Singla, Assistant Professor of Medicine at the Medical College of Wisconsin, who brings firsthand experience from her combined rheum-derm clinic.
Together, they unpack the background, progress, and patient-centered approach of the Difficult-to-Treat (D2T) and Complex-to-Manage PsA Project.
✅ Highlights
- Clearer definitions aim to improve care for patients with persistent symptoms despite treatment
- “Difficult to treat” focuses on ongoing inflammation; “complex to manage” accounts for non-inflammatory factors
- A global literature review revealed inconsistent criteria in defining treatment challenges
- Surveys of clinicians and patients shaped a more inclusive, consensus-driven framework
- New definitions to be presented at EULAR—marking a major milestone in PsA research
⏱ Timestamps
- 00:00 – Introduction to the episode and today’s topic
- 00:36 – Guest introductions: Dr. Fabian Proft and Dr. Shikha Singla
- 01:00 – Fabian on the need for better definitions and understanding treatment failure
- 04:12 – Defining the terms: inflammation vs. non-inflammatory drivers of disease burden
- 05:15 – Why “complex to manage” is more appropriate than “difficult patient”
- 06:00 – How terminology shapes perceptions and supports more empathetic care
- 06:42 – Scoping literature review: methods and inconsistencies in existing definitions
- 07:57 – Healthcare provider survey: over 200 responses, strong support for two definitions
- 09:12 – Patient survey: nearly 600 responses and insights into global experiences
- 10:21 – Patient-reported challenges: joint pain, fatigue, medication side effects
- 11:54 – Cultural and social factors influencing patient experience
- 12:39 – The Delphi process and achieving expert consensus
- 13:15 – Project milestones: EULAR submission and upcoming publications
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