Research agenda for PsA
| Theme | Research questions |
| Responsibility | Role of the rheumatologist vs other specialists in the management of PsA. |
| Diagnosis | Defining screening strategies for PsA among patients with psoriasis: is screening needed, and if so in which populations, how and when? Criteria for early diagnosis of PsA, including predictors for the development of PsA in patients with skin psoriasis. Diagnosis of axial involvement. |
| 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. |
| 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. Pathogenetic pathways leading to arthritis, dactylitis, enthesitis, tenosynovitis, tendinitis, axial disease and skin disease; similarities and differences. Genetics of PsA. |
| Phenotypes | Entheseal PsA: overlap with widespread pain syndrome and role of imaging in the diagnosis. Axial PsA: definition and role of imaging in the diagnosis. |
| Biomarkers | Determining biomarkers related to early diagnosis, damage, prognosis and treatment response. |
| Treatment strategy | 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 vs biological monotherapy vs 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. Therapeutic drug monitoring to optimise cost and to support switching between bDMARDs within the same class or to a different mode of action. Efficacy in oligoarticular rather than in polyarticular disease. Efficacy in axial disease. Strategy trials. |
| Outcomes | Composite scores in PsA and assessment of treatment outcomes. Usefulness of separate assessment of multiple scores limited to some specific domains in PsA. Axial involvement in PsA. Fatigue in PsA. |
| csDMARDs | Efficacy of methotrexate in PsA, including for enthesitis. Efficacy of csDMARDs for dactylitis. Efficacy and safety of combination therapy of csDMARDs. Strategy of csDMARDs before bDMARDs/tsDMARDs. |
| bDMARDs and tsDMARDs | Efficacy of combining csDMARDs with bDMARDs, compared with bDMARD monotherapy and with csDMARD monotherapy. Comparison of apremilast with methotrexate. Timing to start bDMARDs. Duration of biological therapy, including addressing bDMARD dose reduction or discontinuation. Head-to-head trials. Structural data for apremilast. How to identify the right bDMARD for the right patient phenotype. Comparative safety of bDMARDs in PsA. Differential effects of bDMARDs on comorbidities such as metabolic syndrome. |
| Systemic glucocorticoids | Assessing the risk of skin flares related to systemic glucocorticoids and in particular at low doses. Assessing the benefit to risk ratio of long-term glucocorticoid therapy. |
| Switches | Strategies after failures of bDMARDs other than TNFi. Repeat switching within a bDMARD class. |
| Comorbidities | Cardiovascular disease and metabolic syndrome in PsA and links with disease activity. Alcohol in PsA in particular when treating with methotrexate. Cardiovascular risk and DMARDs in PsA. |
bDMARDs, biological disease-modifying antirheumatic drugs; csDMARDs, conventional synthetic disease-modifying antirheumatic drugs; DMARDs, disease-modifying antirheumatic drugs; NSAIDs, non-steroidal anti-inflammatory drugs; PsA, psoriatic arthritis; TNFi, tumour necrosis factor inhibitor; tsDMARDs, targeted synthetic disease-modifying antirheumatic drugs.