Defining Difficult-to-Treat and Complex-to-Manage Psoriatic Arthritis

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.

• 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

• 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

• Explore the full scope of this initiative on the GRAPPA D2T PsA Project Page.

• Visit our Website for more information.

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