Research Themes Inflammatory diseases From Psoriasis to Arthritis
The prevalence of psoriasis in the Dutch population is up to 3% and psoriasis is known to have grave impact on Quality of Life (QoL) and a substantial socio-economic impact. In 2016 the large disease burden of psoriasis was recognized by the WHO and they committed their efforts to fight this stigmatizing disease. About 30% of psoriasis patients develop Psoriatic Arthritis (PsA), a chronic inflammation of joints and entheses with substantial additional negative impact on quality of life and societal participation. In most patients the skin lesions precede the development of PsA by 10 years, making the skin a unique biomarker for PsA. However, PsA is markedly under-diagnosed by dermatologists, resulting in treatment delay. This delay in PsA diagnosis is the foremost important factor determining future well-being, joint integrity and functioning of PsA patients. The GRAPPA working group has declared that early detection of PsA is vital and requires serious improvement. Once referred to a rheumatologist, the treatment of PsA patients is still a challenge due to the heterogeneous nature of the disease. PsA involves at least five domains: arthritis, dactylitis, enthesitis, axial involvement, and skin and nail psoriasis. The care for PsA patients still has major gaps. Specific difficulties in the management of PsA are: (i) the disappointing results and lack of evidence of first-line treatment strategies that are still widely used; (ii) treatment of one disease domain does not necessarily mean clinical response in other domains. Current insight stresses the importance of incorporating the standardized evaluation of a wider array of disease domains in PsA patients not restricted to joint inflammation, which is current practice in most rheumatology outpatient clinics. Therefore, insight in the most effective first-line treatment regime for PsA and its different domains is needed. To target these omissions in current patient care, clinicians and scientists from our theme (rheumatologists, dermatologists, and immunologists working at Radboudumc and the Sint Maartenskliniek) collaborated to develop logistical structures between the partners to enhance patient care and research in psoriasis and PsA. We are now developing a new PsA screening algorithm necessary for the accurate early referral of psoriasis patients suspected to have PsA. By implementing standard evaluation of multiple disease domains and patient-reported outcomes and performing a clinical study comparing first-line anti-rheumatic treatment strategies, we will address the current knowledge gaps in the (early) treatment of PsA patients. Complementary to these efforts we will incorporate high-dimensional immunophenotyping in our research. We will research whether the platform can assist in stratifying psoriasis/PsA patients and aid treatment choices. Involved in this research are de Jong, Schalkwijk, Wenink, Koenen, Joosten, and Mahler.