Psoriatic Arthritis: a Pilot study to Stratify biologic therapies (PSAPS)

Roshan Amarasena,  Jan Herman Kuiper,  Oksana Kehoe

Funded by RJAH Hospital Charitable Fund

Psoriatic arthritis (PsA) is a chronic immune-mediated disease characterised by widespread musculoskeletal inflammation and is the major comorbidity associated with psoriasis. The prevalence of psoriatic arthritis in the UK is estimated to be around 0.1% to 0.3% of the total population, according to the National Institute for Health and Clinical Excellence (NICE).  It affects men and women equally and its incidence peaks between the ages of 30 and 55 years. PsA can significantly impair a person’s quality of life and cause disability; both skin and joints can be affected and people with PsA report more ‘role limitation’ and body pain than people with rheumatoid arthritis.

People with PsA can cost up to £5000 per year to treat in the NHS without the cost of biologics. Biologics have transformed the treatment of Psoriatic Arthritis.  Therapy with anti-tumor necrosis factor (TNF)-α agents represents the first therapeutic choice for moderate and severe forms; however, more than 30% of  PsA patients experienced anti-TNFα failure, lack of efficacy, or adverse events.  Additional studies directly comparing different biological drugs and assessing the efficacy of treatment strategies specific for PsA are urgently needed.

The aim of the PSAPS study is to investigate whether the most effective choice of biologic therapy for patients with PsA might be guided by synovial fluid analysis in combination with blood inflammatory markers. We would like to answer an important question whether synovial fluid analysis in combination with blood inflammatory markers can identify the 30% patients-non-responders to anti-TNF therapy.