Table 2

Primary and secondary unmet scientific needs within psoriatic arthritis with regard to translational science, clinical science and therapeutic trials, and clinical care∗

Primary unmet needsSecondary 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.