Psoriatic arthritis affects up to 40% of people with psoriasis and is associated with several comorbidities such as obesity and diabetes, cardiovascular diseases, osteoporosis, depression, and anxiety. It is difficult to diagnose because of its diverse symptoms manifesting of arthritis of the spine and limbs (axial and peripheral arthritis), inflammation where tendons or ligaments are joined to bone (enthesitis), swelling of fingers or toes (dactylitis), skin and nail changes. Currently, patients are treated with standard medication such as Non-Steroidal Anti-Inflammatory Drugs, glucocorticoids and conventional Disease-Modifying Anti-Rheumatic Drugs (methotrexate, sulfasalazine, leflunomide) to relieve inflammation and pain. When patients respond poorly or fail to respond to these standard treatments, they switch to biologic drugs such as TNFi, IL-23/12 inhibitors, IL-17 inhibitors, JAK/STAT inhibitors and PDE-4 inhibitors. However, these treatments are expensive and are not effective in around 50% of the cases. It is important to find potential predictors of the response to TNFi to help clinicians choosing the most appropriate biologic drug. This will save money for the NHS and improve the quality of life of patients more quickly. These predictors could be provided by clinical data and simple blood test analysis and will not be too demanding for the patients. The aim of this project is to study specific potential predictors and verify if they can give significant outcome for a better choice of treatment. We will look at (1) blood markers such as Human Serum Albumin (HSA), inflammation markers and immune cell profile, (2) the presence of comorbidities, particularly diabetes and obesity (metabolic syndromes), cardiovascular diseases, osteoporosis, depression, and anxiety, as well as associated medication, which could have an impact on response to treatment, and (3) the lifestyle of the patients in term of smoking, alcohol, diet habits, and physical exercises, and their body fat/muscle composition. We estimate that 24 months will be necessary to conduct this study.
We hope this study will help clinicians to choose more appropriate treatments for patients with PsA. Each patient is different in term of physiology, comorbidity, concomitant medication and lifestyle, and our study will give clinicians data on which they can rely to make better decision.
