Research agenda for PsA
| Theme | Research questions |
|---|---|
| Diagnosis | Defining screening strategies for PsA among psoriasis patients: is screening needed and if so, how and when? |
| Diagnosing PsA versus RA with concomitant psoriasis | |
| Prognosis | Defining prognostic factors related to the risk of progressive disease, structural damage and bad functional outcome in early (and established) PsA |
| Predicting response to treatment (predicting response to NSAID, to DMARD, to biological agents) | |
| Assessment of spinal disease: defining the similarities and differences with ankylosing spondylitis | |
| Defining disease severity | |
| Pathophysiology | Defining the relationship between inflammation and structural damage in PsA |
| Exploring juvenile PsA: is it different from adult-onset PsA? | |
| Identification of new therapeutic targets | |
| Biomarkers | Determining biomarkers related to damage, prognosis and treatment response |
| Treatment strategy | Defining and evaluating the utility of tight control strategies in PsA |
| Assessing efficacy and safety of combinations of DMARD and of DMARD with biological agents | |
| Evaluating the need for early treatment in PsA: who should be treated with DMARD? When to treat with DMARD? | |
| Outcomes | Patient-reported outcomes in PsA (which ones are important?), composite patient-reported scores in PsA, fatigue in PsA |
| Defining treatment targets | |
| Defining (residual) active disease | |
| Defining remission and predictors of remission | |
| Synthetic DMARD | Need for more RCT with DMARD (eg, methotrexate) to obtain more data on efficacy and toxicity |
| Assessing efficacy and safety of combination therapy of synthetic DMARD | |
| Need for DMARD studies in MRI-positive early axial PsA | |
| Biological agents | Efficacy of combining DMARD with biological agents, compared with biological monotherapy and DMARD monotherapy |
| Defining the best indication for biological agents, when to start? | |
| Defining the optimal duration of biological therapy, including addressing biological agent discontinuation (need for respective controlled trials) | |
| Assessing the possibility of maintenance therapy with lower doses of biological agents | |
| Assessing the efficacy and toxicity of new biological agents (including more data on ustekinumab, tocilizumab, abatacept, rituximab) | |
| Through registry-based studies, assessing the safety of biological agents in PsA | |
| Systemic glucocorticoids | Assessing the risk of skin flares related to systemic glucocorticoids and in particular at low doses |
| Assessing the benefit/risk ratio of long term glucocorticoid therapy | |
| Assessing the efficacy and toxicity of intramuscular glucocorticoids in PsA | |
| Other systemic treatments | Assessing the efficacy of miscellaneous drugs, for example, oral vitamin D73 74 |
| Local treatments | Radiation synovectomy: evaluating its efficacy in monoarthritis of the knee |
| Comorbidities | Understanding the risk of cardiovascular disease in PsA and the modification of such risk according to disease activity and therapy |
| Assessing the risk and consequences of metabolic syndrome in PsA | |
| Addressing tolerated consumption of alcohol in PsA in particular when treating by methotrexate | |
| Imaging | Defining the optimal use of radiographic scores |
| Evaluating the usefulness of MRI and ultrasonography, as well as developing scoring techniques for these imaging modalities |
DMARD, disease-modifying antirheumatic drug; NSAID, non-steroidal anti-inflammatory drug; PsA, psoriatic arthritis; RA, rheumatoid arthritis; RCT, randomised controlled trial.