Research agenda for PsA
| Theme | Research questions |
|---|---|
| Diagnosis | Defining screening strategies for PsA among patients with psoriasis: is screening needed and if so, how and when? Diagnosing PsA versus RA versus OA with concomitant psoriasis Can we define criteria for early diagnosis of PsA? |
| Prognosis | Defining prognostic factors related to risk of progressive disease, structural damage and bad functional outcome in early (and established) PsA Predicting response to treatment (predicting response to NSAIDs, to csDMARDs, to the different bDMARDs, to tsDMARDs) Assessment of spinal disease: defining the similarities and differences with spondyloarthritis Defining disease severity |
| Pathophysiology | Defining the relationship between inflammation and structural damage in PsA Exploring juvenile PsA: is it different from adult-onset PsA? Elucidation of the modes of action of ustekinumab and IL-17 inhibition Identification of new therapeutic targets Pathogenetic pathways leading to arthritis, dactylitis, enthesitis, axial disease and skin disease; similarities and differences Genetics of PsA |
| 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 csDMARDs compared with csDMARD monotherapy (with and without low dose glucocorticoids) Assessing efficacy and safety of combinations of csDMARDs with biologics compared with biologics monotherapy Comparing efficacy and safety of methotrexate versus biological monotherapy versus their combination in early PsA Evaluating the need for early treatment in PsA: who should be treated with csDMARDs? When to start treatment with DMARDs? Switching and cycling between drugs |
| Outcomes | Patient reported outcomes in PsA Fatigue in PsA Defining treatment targets Defining (residual) active disease and low disease activity Defining remission and predictors of remission and validating existing remission definitions How does remission and especially sustained remission relate to long-term functional and structural outcomes and how does this compare to low disease activity or moderate/high disease activity? What is an acceptable residual disease activity in PsA? Is reaching remission more favourable in terms of outcomes (structure, function, etc) than reaching low disease activity or minimal disease activity? Evaluating which components should be comprised in composite measures for PsA How long can treatment with csDMARDs be delayed without structural penalty? |
| csDMARDs | Comparative effectiveness research regarding csDMARDs alone and in comparison with bDMARDs How efficacious is methotrexate in PsA? Assessing efficacy and safety of combination therapy of csDMARDs |
| bDMARDs and tsDMARDs | Efficacy of combining csDMARDs with bDMARDs, compared with bDMARD monotherapy and to csDMARD monotherapy Comparison of apremilast with methotrexate and bDMARDs Defining the best indication for bDMARDs, when to start? Defining the optimal duration of biological therapy, including addressing bDMARD discontinuation Assessing the possibility of maintenance therapy with lower doses of bDMARDs (dose reduction) Is loss of good treatment state upon reduction or withdrawal of bDMARDs regainable upon reinstitution of the bDMARD? Head-to-head trials of agents with different molecular targets in csDMARD-failures and TNFi-failures (including study of TNFi versus new biological agents) Head-to-head trials of apremilast against methotrexate Head-to-head trials of apremilast against biologicals Structural data for apremilast Data for the new drugs on enthesitis, dactylitis and axial disease Comparative safety of bDMARDs in PsA Is there a window of opportunity in PsA with induction therapy using bDMARDs? Comparative effectiveness: head-to-head trials of apremilast versus secukinumab versus TNFis versus ustekinumab Strategic trials aiming at remission or low disease activity Drug tapering in remission |
| 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 |
| Comorbidities | More knowledge on cardiovascular disease in PsA and links with disease activity 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 for PsA Which factors are related to bony appositions in PsA? |
bDMARD, biological DMARD; csDMARDs, conventional synthetic DMARDs, such as methotrexate, sulfasalazine, or leflunomide; DMARD; DMARD, disease-modifying antirheumatic drug; NSAIDs, non-steroidal anti-inflammatory drugs; PsA, psoriatic arthritis; RA, rheumatoid arthritis; TNFi, tumour necrosis factor inhibitor; tsDMARD, targeted synthetic DMARD.