Patient Involvement in Outcome Measures for Psoriatic Arthritis

  • William Tillett
  • Ade Adebajo
  • Mel Brooke
  • Willemina Campbell
  • Laura C. Coates
  • Oliver FitzGerald
  • Laure Gossec
  • Philip Helliwell
  • Sarah Hewlett
  • Jana James
  • Patricia Minnock
  • Aisling Reast
  • Dennis O’Sullivan
  • Maarten de Wit
  • Neil McHugh
Part of the following topical collections:
  1. Topical Collection on Psoriatic Arthritis


Psoriatic arthritis (PsA) is a heterogeneous inflammatory arthritis with a varied clinical phenotype. There has been considerable international collaboration over recent years to develop and prioritise appropriate disease domains and outcome measures to capture all aspects of this complex disease. It has been recognised that patient-reported measures and physician assessments are complementary and, when used together, allow an improved reflection of disease burden. Taking this concept one step further, the experience in rheumatoid arthritis has demonstrated benefits of incorporating the patient perspective in the development of outcome measures. We report a systematic review demonstrating (1) that there has been little incorporation of the patient perspective in the development of outcome measures and domains in PsA, (2) the proceedings from the preliminary patient involvement in outcome measures for PsA (PIOMPSA) meetings, and (3) a proposed roadmap for improving patient involvement.


Psoriatic arthritis Outcome measures Assessment Disease activity Patient-reported outcomes Patient involvement PIOMPSA OMERACT 


Compliance with Ethics Guidelines

Conflict of Interest

Meetings were supported through unrestricted educational grants from Pfizer and Abbvie Laboratories.

Laure Gossec received EULAR funding for the PsAID study.

Ade Adebajo, Mel Brooke, Willemina Campbell, Laura C. Coates, Oliver FitzGerald, Philip Helliwell, Sarah Hewlett, Jana James, Patricia Minnock, Aisling Reast, William Tillett, Dennis O’Sullivan, Maarten de Wit, and Neil McHugh declare that they have no conflict of interest.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.


Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

  1. 1.
    Mease PJ. Measures of psoriatic arthritis: Tender and Swollen Joint Assessment, Psoriasis Area and Severity Index (PASI), Nail Psoriasis Severity Index (NAPSI), Modified Nail Psoriasis Severity Index (mNAPSI), Mander/Newcastle Enthesitis Index (MEI), Leeds Enthesitis Index (LEI), Spondyloarthritis Research Consortium of Canada (SPARCC), Maastricht Ankylosing Spondylitis Enthesis Score (MASES), Leeds Dactylitis Index (LDI), Patient Global for Psoriatic Arthritis, Dermatology Life Quality Index (DLQI), Psoriatic Arthritis Quality of Life (PsAQOL), Functional Assessment of Chronic Illness Therapy-Fatigue (FACIT-F), Psoriatic Arthritis Response Criteria (PsARC), Psoriatic Arthritis Joint Activity Index (PsAJAI), Disease Activity in Psoriatic Arthritis (DAPSA), and Composite Psoriatic Disease Activity Index (CPDAI). Arthritis Care Res. 2011;63 Suppl 11:S64–85.CrossRefGoogle Scholar
  2. 2.
    Gladman DD, Mease PJ, Strand V, et al. Consensus on a core set of domains for psoriatic arthritis. J Rheumatol. 2007;34(5):1167–70.PubMedGoogle Scholar
  3. 3.
    Taylor WJ. Preliminary identification of core domains for outcome studies in psoriatic arthritis using Delphi methods. Ann Rheum Dis. 2005;64 Suppl 2:ii110–2.PubMedCentralPubMedGoogle Scholar
  4. 4.•
    Palominos PE, Gaujoux-Viala C, Fautrel B, et al. Clinical outcomes in psoriatic arthritis: a systematic literature review. Arthritis Care Res. 2012;64(3):397–406. A systematic review demonstrating great heterogeneity in the reporting of outcomes in PsA clinical trials and the need for consensus on the reporting of PsA domains. CrossRefGoogle Scholar
  5. 5.
    Berkanovic E, Hurwicz ML, Lachenbruch PA. Concordant and discrepant views of patients’ physical functioning. Arthritis Care Res Official J Arthritis Health Prof Assoc. 1995;8(2):94–101.CrossRefGoogle Scholar
  6. 6.
    Studenic P, Radner H, Smolen JS, et al. Discrepancies between patients and physicians in their perceptions of rheumatoid arthritis disease activity. Arthritis Rheum. 2012;64(9):2814–23.PubMedCrossRefGoogle Scholar
  7. 7.•
    Dandorfer SW, Rech J, Manger B, et al. Differences in the patient’s and the physician’s perspective of disease in psoriatic arthritis. Semin Arthritis Rheum. 2012;42(1):32–41. A study demonstrating the discrepancies between physician and patient perspectives of PsA. PubMedCrossRefGoogle Scholar
  8. 8.
    Gladman DD. Consensus exercise on domains in psoriatic arthritis. Ann Rheum Dis. 2005;64 Suppl 2:ii113–4.PubMedCentralPubMedGoogle Scholar
  9. 9.
    Kirwan JR, Fries JF, Hewlett SE, et al. Patient perspective workshop: moving towards OMERACT guidelines for choosing or developing instruments to measure patient-reported outcomes. J Rheumatol. 2011;38(8):1711–5.PubMedCrossRefGoogle Scholar
  10. 10.
    Kirwan JR, Fries JF, Hewlett S, et al. Patient perspective: choosing or developing instruments. J Rheumatol. 2011;38(8):1716–9.PubMedCrossRefGoogle Scholar
  11. 11.
    de Wit M, Abma T, Koelewijn-van Loon M, et al. Involving patient research partners has a significant impact on outcomes research: a responsive evaluation of the international OMERACT conferences. BMJ. 2013;3(5). doi: 10.1136/bmjopen-2012-002241.
  12. 12.••
    de Wit MP, Berlo SE, Aanerud GJ, et al. European League Against Rheumatism recommendations for the inclusion of patient representatives in scientific projects. Ann Rheum Dis. 2011;70(5):722–6. The EULAR recommendations for incorporating the patients’ perspective in scientific research developed by patient partners, rheumatologists and allied health professionals. PubMedCrossRefGoogle Scholar
  13. 13.
    Kirwan JR, Hewlett SE, Heiberg T, et al. Incorporating the patient perspective into outcome assessment in rheumatoid arthritis–progress at OMERACT 7. J Rheumatol. 2005;32(11):2250–6.PubMedGoogle Scholar
  14. 14.
    NIHR. Briefing notes for researchers: public involvement in NHS, public health and social care research. Eastleigh: Involve; 2012.Google Scholar
  15. 15.
    McKenna SP, Doward LC, Whalley D, et al. Development of the PsAQoL: a quality of life instrument specific to psoriatic arthritis. Ann Rheum Dis. 2004;63(2):162–9.PubMedCentralPubMedCrossRefGoogle Scholar
  16. 16.
    Stamm TA, Nell V, Mathis M, et al. Concepts important to patients with psoriatic arthritis are not adequately covered by standard measures of functioning. Arthritis Rheum. 2007;57(3):487–94.PubMedCrossRefGoogle Scholar
  17. 17.
    MacKenzie H, Thavaneswaran A, Chandran V, et al. Patient-reported outcome in psoriatic arthritis: a comparison of Web-based versus paper-completed questionnaires. J Rheumatol. 2011;38(12):2619–24.PubMedCrossRefGoogle Scholar
  18. 18.••
    Gossec LDWM, Heiberg T, Maccarone M, Balanescu A, Balint P, Dora Niedermayer D, et al. Elaboration and preliminary validation of the Psoriatic Arthritis Impact of Disease (PsAID) questionnaire. A 13-country EULAR initiative with involvement of patient research partners from each country. Madrid: EULAR; 2013. p. OP0111. The development and preliminary validation of the PsA impact of disease (PsAID) project. This novel measure has been developed in close collaboration with patient partners.Google Scholar
  19. 19.
    Hewlett S, Sanderson T, May J, et al. ‘I’m hurting, I want to kill myself’: rheumatoid arthritis flare is more than a high joint count–an international patient perspective on flare where medical help is sought. Rheumatology (Oxford). 2012;51(1):69–76.CrossRefGoogle Scholar
  20. 20.
    Healy PJ, Helliwell PS. Measuring dactylitis in clinical trials: which is the best instrument to use? J Rheumatol. 2007;34(6):1302–6.PubMedGoogle Scholar
  21. 21.•
    Bingham 3rd CO, Alten R, de Wit MP. The importance of patient participation in measuring rheumatoid arthritis flares. Ann Rheum Dis. 2012;71(7):1107–9. An editorial concisely describing the rational and evidence for incorporating the patient perspective in measuring rheumatoid arthritis flares. PubMedCrossRefGoogle Scholar
  22. 22.
    Blackmore MG, Gladman DD, Husted J, et al. Measuring health status in psoriatic arthritis: the Health Assessment Questionnaire and its modification. J Rheumatol. 1995;22(5):886–93.PubMedGoogle Scholar
  23. 23.
    Pincus T, Swearingen C, Wolfe F. Toward a multidimensional Health Assessment Questionnaire (MDHAQ): assessment of advanced activities of daily living and psychological status in the patient-friendly health assessment questionnaire format. Arthritis Rheum. 1999;42(10):2220–30.PubMedCrossRefGoogle Scholar
  24. 24.
    Husted JA, Gladman DD, Farewell VT, et al. Health-related quality of life of patients with psoriatic arthritis: a comparison with patients with rheumatoid arthritis. Arthritis Rheum. 2001;45(2):151–8.PubMedCrossRefGoogle Scholar
  25. 25.
    Husted JA, Gladman DD, Long JA, et al. A modified version of the Health Assessment Questionnaire (HAQ) for psoriatic arthritis. Clin Exp Rheumatol. 1995;13(4):439–43.PubMedGoogle Scholar
  26. 26.
    Husted JA, Tom BD, Farewell VT, et al. Description and prediction of physical functional disability in psoriatic arthritis: a longitudinal analysis using a Markov model approach. Arthritis Rheum. 2005;53(3):404–9.PubMedCrossRefGoogle Scholar
  27. 27.
    Husted JA, Tom BD, Farewell VT, et al. A longitudinal study of the effect of disease activity and clinical damage on physical function over the course of psoriatic arthritis: does the effect change over time? Arthritis Rheum. 2007;56(3):840–9.PubMedCrossRefGoogle Scholar
  28. 28.
    Leung YY, Tam LS, Kun EW, et al. Comparison of 4 functional indexes in psoriatic arthritis with axial or peripheral disease subgroups using Rasch analyses. J Rheumatol. 2008;35(8):1613–21.PubMedGoogle Scholar
  29. 29.
    Brodszky V, Pentek M, Balint PV, et al. Comparison of the Psoriatic Arthritis Quality of Life (PsAQoL) questionnaire, the functional status (HAQ) and utility (EQ-5D) measures in psoriatic arthritis: results from a cross-sectional survey. Scand J Rheumatol. 2010;39(4):303–9.PubMedCrossRefGoogle Scholar
  30. 30.
    Mease PJ, Woolley JM, Bitman B, et al. Minimally important difference of Health Assessment Questionnaire in psoriatic arthritis: relating thresholds of improvement in functional ability to patient-rated importance and satisfaction. J Rheumatol. 2011;38(11):2461–5.PubMedCrossRefGoogle Scholar
  31. 31.
    Kwok T, Pope JE. Minimally important difference for patient-reported outcomes in psoriatic arthritis: Health Assessment Questionnaire and pain, fatigue, and global visual analog scales. J Rheumatol. 2010;37(5):1024–8.PubMedCrossRefGoogle Scholar
  32. 32.
    Wolfe F, Michaud K, Pincus T. Development and validation of the health assessment questionnaire II: a revised version of the health assessment questionnaire. Arthritis Rheum. 2004;50(10):3296–305.PubMedCrossRefGoogle Scholar
  33. 33.
    Daltroy LH, Larson MG, Roberts NW, et al. A modification of the Health Assessment Questionnaire for the spondyloarthropathies. J Rheumatol. 1990;17(7):946–50.PubMedGoogle Scholar
  34. 34.
    Husted JA, Gladman DD, Farewell VT, et al. Validating the SF-36 health survey questionnaire in patients with psoriatic arthritis. J Rheumatol. 1997;24(3):511–7.PubMedGoogle Scholar
  35. 35.
    Taylor WJ, McPherson KM. Using Rasch analysis to compare the psychometric properties of the Short Form 36 physical function score and the Health Assessment Questionnaire disability index in patients with psoriatic arthritis and rheumatoid arthritis. Arthritis Rheum. 2007;57(5):723–9.PubMedCrossRefGoogle Scholar
  36. 36.
    Leung YY, Ho KW, Zhu TY, et al. Testing scaling assumptions, reliability and validity of medical outcomes study short-form 36 health survey in psoriatic arthritis. Rheumatology (Oxford). 2010;49(8):1495–501.CrossRefGoogle Scholar
  37. 37.
    Kvamme MK, Kristiansen IS, Lie E, et al. Identification of cutpoints for acceptable health status and important improvement in patient-reported outcomes, in rheumatoid arthritis, psoriatic arthritis, and ankylosing spondylitis. J Rheumatol. 2010;37(1):26–31.PubMedCrossRefGoogle Scholar
  38. 38.
    Shikiar R, Willian MK, Okun MM, et al. The validity and responsiveness of three quality of life measures in the assessment of psoriasis patients: results of a phase II study. Health Qual Life Outcomes. 2006;4:71.PubMedCentralPubMedCrossRefGoogle Scholar
  39. 39.
    Husted J, Gladman DD, Farewell VT, et al. Validation of the revised and expanded version of the Arthritis Impact Measurement Scales for patients with psoriatic Arthritis. J Rheumatol. 1996;23(6):1015–9.PubMedGoogle Scholar
  40. 40.
    Husted J, Gladman DD, Long JA, et al. Relationship of the Arthritis Impact Measurement Scales to changes in articular status and functional performance in patients with psoriatic arthritis. J Rheumatol. 1996;23(11):1932–7.PubMedGoogle Scholar
  41. 41.
    Duffy CM, Watanabe Duffy KN, Gladman DD, et al. The utility of the arthritis impact measurement scales for patients with psoriatic arthritis. J Rheumatol. 1992;19(11):1727–32.PubMedGoogle Scholar
  42. 42.
    Sokoll KB, Helliwell PS. Comparison of disability and quality of life in rheumatoid and psoriatic arthritis. J Rheumatol. 2001;28(8):1842–6.PubMedGoogle Scholar
  43. 43.
    Singh JA, Strand V. Health care utilization in patients with spondyloarthropathies. Rheumatology (Oxford). 2009;48(3):272–6.CrossRefGoogle Scholar
  44. 44.
    Healy PJ, Helliwell PS. Psoriatic arthritis quality of life instrument: an assessment of sensitivity and response to change. J Rheumatol. 2008;35(7):1359–61.PubMedGoogle Scholar
  45. 45.
    Nichol MB, Margolies JE, Lippa E, et al. The application of multiple quality-of-life instruments in individuals with mild-to-moderate psoriasis. PharmacoEconomics. 1996;10(6):644–53.PubMedCrossRefGoogle Scholar
  46. 46.
    Cauli A, Gladman DD, Mathieu A, et al. Patient global assessment in psoriatic arthritis: a multicenter GRAPPA and OMERACT study. J Rheumatol. 2011;38(5):898–903.PubMedCrossRefGoogle Scholar
  47. 47.
    Leung YY, Ho KW, Zhu TY, et al. Construct validity of the modified numeric rating scale of patient global assessment in psoriatic arthritis. J Rheumatol. 2012;39(4):844–8.PubMedCrossRefGoogle Scholar
  48. 48.
    Gladman DD, Inman RD, Cook RJ, et al. International spondyloarthritis interobserver reliability exercise–the INSPIRE study: II. Assessment of peripheral joints, enthesitis, and dactylitis. J Rheumatol. 2007;34(8):1740–5.PubMedGoogle Scholar
  49. 49.
    Fredriksson T, Pettersson U. Severe psoriasis–oral therapy with a new retinoid. Dermatologica. 1978;157(4):238–44.PubMedCrossRefGoogle Scholar
  50. 50.
    Louden BA, Pearce DJ, Lang W, et al. A Simplified Psoriasis Area Severity Index (SPASI) for rating psoriasis severity in clinic patients. Dermatol Online J. 2004;10(2):7.PubMedGoogle Scholar
  51. 51.
    Feldman SR, Fleischer Jr AB, Reboussin DM, et al. The self-administered psoriasis area and severity index is valid and reliable. J Invest Dermatol. 1996;106(1):183–6.PubMedCrossRefGoogle Scholar
  52. 52.
    Carlin CS, Feldman SR, Krueger JG, et al. A 50 % reduction in the Psoriasis Area and Severity Index (PASI 50) is a clinically significant endpoint in the assessment of psoriasis. J Am Acad Dermatol. 2004;50(6):859–66.PubMedCrossRefGoogle Scholar
  53. 53.
    Healy PJ, Helliwell PS. Measuring clinical enthesitis in psoriatic arthritis: assessment of existing measures and development of an instrument specific to psoriatic arthritis. Arthritis Rheum. 2008;59(5):686–91.PubMedCrossRefGoogle Scholar
  54. 54.
    Maksymowych WP, Mallon C, Morrow S, et al. Development and validation of the Spondyloarthritis Research Consortium of Canada (SPARCC) Enthesitis Index. Ann Rheum Dis. 2009;68(6):948–53.PubMedCrossRefGoogle Scholar
  55. 55.
    Gladman DD, Inman RD, Cook RJ, et al. International spondyloarthritis interobserver reliability exercise–the INSPIRE study: I. Assessment of spinal measures. J Rheumatol. 2007;34(8):1733–9.PubMedGoogle Scholar
  56. 56.
    Helliwell PS, Firth J, Ibrahim GH, et al. Development of an assessment tool for dactylitis in patients with psoriatic arthritis. J Rheumatol. 2005;32(9):1745–50.PubMedGoogle Scholar
  57. 57.
    Leung YY, Ho KW, Tam LS, et al. Evaluation of spinal mobility measurements in predicting axial psoriatic arthritis. Clin Rheumatol. 2011;30(9):1157–62.PubMedCrossRefGoogle Scholar
  58. 58.
    Fernandez-Sueiro JL, Willisch A, Pertega-Diaz S, et al. Evaluation of ankylosing spondylitis spinal mobility measurements in the assessment of spinal involvement in psoriatic arthritis. Arthritis Rheum. 2009;61(3):386–92.PubMedCrossRefGoogle Scholar
  59. 59.
    Taylor WJ, Harrison AA. Could the Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) be a valid measure of disease activity in patients with psoriatic arthritis? Arthritis Rheum. 2004;51(3):311–5.PubMedCrossRefGoogle Scholar
  60. 60.
    Fernandez-Sueiro JL, Willisch A, Pertega-Diaz S, et al. Validity of the bath ankylosing spondylitis disease activity index for the evaluation of disease activity in axial psoriatic arthritis. Arthritis Care Res. 2010;62(1):78–85.CrossRefGoogle Scholar
  61. 61.
    Eder L, Chandran V, Shen H, et al. Is ASDAS better than BASDAI as a measure of disease activity in axial psoriatic arthritis? Ann Rheum Dis. 2010;69(12):2160–4.PubMedCrossRefGoogle Scholar
  62. 62.
    Rich P, Scher RK. Nail Psoriasis Severity Index: a useful tool for evaluation of nail psoriasis. J Am Acad Dermatol. 2003;49(2):206–12.PubMedCrossRefGoogle Scholar
  63. 63.
    Aktan S, Ilknur T, Akin C, et al. Interobserver reliability of the Nail Psoriasis Severity Index. Clin Exp Dermatol. 2007;32(2):141–4.PubMedCrossRefGoogle Scholar
  64. 64.
    Cassell SE, Bieber JD, Rich P, et al. The modified Nail Psoriasis Severity Index: validation of an instrument to assess psoriatic nail involvement in patients with psoriatic arthritis. J Rheumatol. 2007;34(1):123–9.PubMedGoogle Scholar
  65. 65.
    Maejima H, Taniguchi T, Watarai A, et al. Evaluation of nail disease in psoriatic arthritis by using a modified nail psoriasis severity score index. Int J Dermatol. 2010;49(8):901–6.PubMedCrossRefGoogle Scholar
  66. 66.
    Gladman DD, Strand V, Mease PJ, et al. OMERACT 7 psoriatic arthritis workshop: synopsis. Ann Rheum Dis. 2005;64 Suppl 2:ii115–6.PubMedCentralPubMedGoogle Scholar
  67. 67.
    Mumtaz A, Gallagher P, Kirby B, et al. Development of a preliminary composite disease activity index in psoriatic arthritis. Ann Rheum Dis. 2011;70(2):272–7.PubMedCrossRefGoogle Scholar
  68. 68.
    FitzGerald O, Helliwell P, Mease P, et al. Application of composite disease activity scores in psoriatic arthritis to the PRESTA data set. Ann Rheum Dis. 2012;71(3):358–62.PubMedCrossRefGoogle Scholar
  69. 69.
    Nell-Duxneuner VP, Stamm TA, Machold KP, et al. Evaluation of the appropriateness of composite disease activity measures for assessment of psoriatic arthritis. Ann Rheum Dis. 2010;69(3):546–9.PubMedCrossRefGoogle Scholar
  70. 70.
    Schoels M, Aletaha D, Funovits J, et al. Application of the DAREA/DAPSA score for assessment of disease activity in psoriatic arthritis. Ann Rheum Dis. 2010;69(8):1441–7.PubMedCrossRefGoogle Scholar
  71. 71.
    Coates LC, Fransen J, Helliwell PS. Defining minimal disease activity in psoriatic arthritis: a proposed objective target for treatment. Ann Rheum Dis. 2010;69(1):48–53.PubMedCrossRefGoogle Scholar
  72. 72.
    Coates LC, Cook R, Lee KA, et al. Frequency, predictors, and prognosis of sustained minimal disease activity in an observational psoriatic arthritis cohort. Arthritis Care Res. 2010;62(7):970–6.CrossRefGoogle Scholar
  73. 73.
    Coates LC, Helliwell PS. Validation of minimal disease activity criteria for psoriatic arthritis using interventional trial data. Arthritis Care Res. 2010;62(7):965–9.CrossRefGoogle Scholar
  74. 74.
    Gladman DD, Tom BD, Mease PJ, et al. Informing response criteria for psoriatic arthritis. I: discrimination models based on data from 3 anti-tumor necrosis factor randomized studies. J Rheumatol. 2010;37(9):1892–7.PubMedCrossRefGoogle Scholar
  75. 75.
    Gladman DD, Tom BD, Mease PJ, et al. Informing response criteria for psoriatic arthritis (PsA). II: further considerations and a proposal–the PsA joint activity index. J Rheumatol. 2010;37(12):2559–65.PubMedCrossRefGoogle Scholar
  76. 76.
    Helliwell PS, Fitzgerald O, Fransen J, et al. The development of candidate composite disease activity and responder indices for psoriatic arthritis (GRACE project). Ann Rheum Dis. 2013;72(6):986–91.PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media New York 2014

Authors and Affiliations

  • William Tillett
    • 1
  • Ade Adebajo
    • 2
  • Mel Brooke
    • 3
  • Willemina Campbell
    • 4
  • Laura C. Coates
    • 5
    • 6
  • Oliver FitzGerald
    • 7
    • 8
  • Laure Gossec
    • 9
  • Philip Helliwell
    • 10
  • Sarah Hewlett
    • 11
  • Jana James
    • 12
  • Patricia Minnock
    • 13
  • Aisling Reast
    • 14
  • Dennis O’Sullivan
    • 7
  • Maarten de Wit
    • 15
  • Neil McHugh
    • 16
    • 17
  1. 1.Royal National Hospital for Rheumatic DiseasesBathUK
  2. 2.Faculty of Medicine, Dentistry and HealthUniversity of SheffieldSheffieldUK
  3. 3.ChippenhamUK
  4. 4.MarkhamCanada
  5. 5.Leeds Institute of Rheumatic and Musculoskeletal MedicineUniversity of LeedsLeedsUK
  6. 6.Leeds Musculoskeletal Biomedical Research UnitLeeds Teaching Hospitals NHS TrustLeedsUK
  7. 7.Department RheumatologySt Vincents University HospitalDublinIreland
  8. 8.Conway Institute of Biomolecular ResearchUniversity College DublinDublinIreland
  9. 9.AP-HP, Pitié Salpêtrière Hospital, Department of rheumatologyUniv Paris 06, GRC-UPMC 08 (EEMOIS)ParisFrance
  10. 10.Leeds Institute of Rheumatic and Musculoskeletal MedicineUniversity of LeedsLeedsUK
  11. 11.Department of Nursing and MidwiferyUniversity of the West of EnglandBristolUK
  12. 12.TorwbridgeUK
  13. 13.Our Lady’s HospiceUniversity College Dublin Rheumatology RehabilitationDublinIreland
  14. 14.The Pharmaceutical Society of IrelandDublinIreland
  15. 15.Department of Medical HumanitiesVU Medical CenterAmsterdamNetherlands
  16. 16.Royal National Hospital for Rheumatic DiseasesBathUK
  17. 17.Pharmacy and PharmacologyUniversity of BathBathUK

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