Promising Advances, Key Gaps in Psoriatic Arthritis Research

In this bonus clip from The American Journal of Managed Care^®'s interview with Rebecca Haberman, MD, rheumatologist and associate director of the Psoriatic Arthritis Center at NYU Langone Health, she discusses promising areas of psoriatic arthritis research and key gaps that should be prioritized for further investigation.

Watch parts 1, 2, and 3 of the interview to learn about the objectives and findings of Haberman's study, "Racial and Ethnic Determinants of Psoriatic Arthritis Phenotypes and Disease Activity."

This transcript has been lightly edited for clarity; captions were auto-generated.

Transcript

What are the most promising areas of psoriatic arthritis research that could significantly improve patient care in the near future?

I think the most exciting thing, the thing that we're looking at, is precision medicine, so the idea of picking the right medication for the right person at the very beginning of the disease. Right now, the way we usually are treating psoriatic arthritis is we pick a medication based on the patient's comorbidities, what their disease looks like. We try it for 3 months, and if it doesn't work, we move on to the next one, which, again, we're really deciding just out of a clinical impression.

The problem with psoriatic arthritis is, if you're not treating it effectively, even within those first 6 months, you can develop joint damage. If we're not hitting the right medication first, you're creating this window where someone can be accumulating permanent damage to their joints.

Studies that are looking at how we choose the right medication to give that specific patient first, I think, is one of the most exciting areas of research, and that's being done in many different ways. There was a group out of Japan that, a couple of years ago, published a paper that looked at the different type of T-cells and then decided, based on that, which medication to give them, and those had a higher rate of response.

There are different groups using RNA transcriptomics, so all of these different strategies to try and figure out, can we do a blood test, for example, right at the beginning, and say, "This is the medication that you will respond to." I think that's one of the most exciting things.

I also think another exciting thing is preventing psoriatic arthritis. There are patients who develop psoriatic arthritis and psoriasis at the same time, but most patients, about 85%, develop psoriasis first and then psoriatic arthritis. Can we actually intervene in that window before they develop psoriatic arthritis to actually prevent disease, or intervene very, very early?

That can prevent the whole host of sequelae that someone can have when they have psoriatic arthritis. Those are 2, I think, of the most promising and exciting areas of research that are going on right now.

Conversely, what gaps in research do you believe should be prioritized for further investigation?

One of the big gaps, I think, is how we address psoriatic arthritis more holistically. By that I mean when we're treating patients with psoriatic arthritis, even if we're looking at the patient and they look like they have totally controlled disease, up to 50% of them continue to have residual symptoms, like pain, like fatigue, for example. Even if we're effectively treating their inflammation, if they're not getting improvement on these other areas, they're not having that improvement in quality of life, which we are striving for.

I think that we need more research into how we are addressing non-inflammatory pain, how we are addressing fatigue. There's also comorbidities, like obesity and depression, that come a lot with psoriatic arthritis and can worsen the disease. How are we addressing obesity? How can we address depression?

All of these together play into, really, quality of life for our patients. I do think we need a little bit more research and care, looking into those aspects of the disease, because only by addressing all these factors will we really be able to improve outcomes that are improved for the majority of our patients.