Primary and secondary unmet scientific needs within psoriatic arthritis with regard to translational science, clinical science and therapeutic trials, and clinical care∗
| Primary unmet needs | Secondary unmet needs | |
| Translational science | Understanding how to use molecular imaging modalities to interrogate tissue pathophysiology, especially the enthesium Better understanding the effect of genetic markers, skin and gut microbiome patterns, metabolic syndrome and central sensitisation (fibromyalgia) on disease subtypes and their outcomes Further development of longitudinal, clinically well-characterised cohorts with appropriate imaging, tissue and fluid samples; improved data-sharing among investigators; these relate to inception cohorts as well as cohorts of patients with long-standing disease | Development of appropriate animal models for pathogenesis Understanding various mechanisms of pain, including central sensitisation Understanding the progression of skin psoriasis to that of associated arthritis. Understanding at the molecular level similarities or differences in inflammation between affected joints and skin |
| Clinical science and therapeutic trials | Standardisation of enthesitis and dactylitis measures Reliable and feasible imaging assessment of new bone formation Correlation of physical examination with advanced imaging (US, MRI) Testing the benefits and risks of scores that use multiple disease domains vs scores that use single domains for approval of drugs Understanding differential therapeutic effects on different clinical domains in PsA Further evaluation of combination therapies and strategic trials including the use of sequential therapies, controlled withdrawal, the treatment of early disease, and the treatment of monoarticular or oligoarticular disease Head-to-head comparison of therapies with different mechanisms of action | Development/validation of advanced imaging and other biomarkers including patient-reported outcomes to assess disease activity and clinical outcomes in the different clinical domains of PsA Use of NMR spectroscopy and other advanced imaging for metabolic syndrome Specific interventions related to microbiome |
| Clinical care | Standardisation in the characterisation and measurement of PsA clinical domains The development of a clinician-feasible measure(s) of PsA remission or low disease activity as a target of therapy. Developing better knowledge, communication and screening approaches (including the development of educational initiatives and cross-specialty clinics) for rheumatologists, dermatologists and primary care providers caring for patients with PsA to facilitate earlier diagnosis Improved clinical attention to PsA-related comorbidities, especially metabolic syndrome and central sensitisation | Use of serum and other types of biomarkers for diagnosis, disease severity categorisation and identifying structural damage The development of guidance regarding therapeutic choice based on patient factors, clinical presentations and ‘to be developed’ biomarkers |
*Sequence of needs within the table is random and is not meant to imply order of importance.
PsA, psoriatic arthritis.