How can patients at risk of developing PsA be identified and why is this important?

Plaque psoriasis (PsO) is an immune-mediated inflammatory skin disease that affects around 2–3% of the global population.¹ Up to one third of patients with PsO develop psoriatic arthritis (PsA),² a chronic inflammatory condition characterized by diverse clinical manifestations, including dactylitis, enthesitis, peripheral synovitis, and axial involvement.^3,4 Therefore, early recognition of PsA is crucial and may lead to improved clinical outcomes.⁴

The PsOPsA Hub spoke with Laure Gossec, Sorbonne Université and Pitié-Salpêtrière, Paris, FR. We asked, How can patients at risk of developing PsA be identified and why is this important? She discussed the risk of progression to PsA in patients with PsO, the potential impact of early intervention on disease outcomes, and the current treatment landscape for early PsA.

Key Learnings

Identification of patients with PsO at risk of developing PsA

• Around one third of patients with PsO will develop PsA.
• Risk factors for PsA include obesity, nail involvement, and family history of PsA; of these, obesity is the only modifiable factor, making weight management important in patients with PsO.

The impact of early treatment on PsA outcomes

• The aim of pre-PsA treatment is to intercept and modify disease progression, in order to maximize quality of life (QoL), and avoid structural damage.
• The European Alliance of Associations for Rheumatology (EULAR) criteria facilitate identification of a population of patients with PsO who are at risk of developing PsA in clinical trials.
• Results from the ongoing PAMPA randomized clinical trial (NCT05004727), investigating guselkumab for preventing the onset of PsA in patients at high risk, are not yet available; however, observational data suggest that biologic therapies, such as interleukin (IL)-17 and IL-23 inhibitors, appear to be effective in preventing the onset of PsA by up to 80%.
• Early intervention of PsA has the potential to improve clinical prognosis by reducing pain and enhancing QoL, while also preventing progression to polyarticular disease which is predictive of structural damage and long-term functional impairment.

The current treatment landscape for early PsA

• Treatment guidelines for very early PsA are currently lacking; however, all therapies approved and recommended for established PsA can be used in early disease, including conventional synthetic disease-modifying antirheumatic drugs (DMARDs); targeted synthetic DMARDs (such as Janus kinase (JAK) inhibitors and phosphodiesterase 4 (PDE4) inhibitors); and biologics (such as TNF inhibitors, IL-17 inhibitors, and IL-23 inhibitors).
• For patients with early PsA or oligoarticular disease, which is common presentation in early PsA, a less aggressive approach with conventional synthetic DMARDs may be appropriate, in line with EULAR recommendations.
• Use of apremilast, a PDE4 inhibitor, in very early PsA can modify the natural history of the disease and reduce progression to polyarticular disease compared with placebo, as shown in the FOREMOST trial (NCT03747939).

This educational resource is independently supported by UCB. All content was developed by SES in collaboration with an expert steering committee. Funders were allowed no influence on the content of this resource.