Psoriatic disease

Psoriatic arthritis (PsA) is a chronic immune-mediated form of arthritis that occurs in some patients with psoriasis. This Primer reviews the epidemiology and pathophysiology of PsA and highlights the challenges in diagnosis and advances in treatment. In addition, the authors discuss the quality of life of patients and outstanding questions in the field.

Psoriatic arthritis is a chronic immune-mediated disease with heterogeneous clinical features. This PrimeView highlights the mechanisms of psoriatic arthritis and accompanies the Primer article by Fitzgerald and colleagues.

In this Consensus Statement, an expert panel from the Psoriasis and Psoriatic Arthritis Clinics Multicenter Advancement Network (PPACMAN) recommends terminology for defining specific subgroups of individuals during the preclinical and early clinical phases of psoriatic arthritis to be used in research studies.

In this Review, the authors discuss how new approaches, including imaging, tissue analysis and omics technologies, could be applied to identify patients with a poor prognosis and to predict response to treatment, thus enabling precision medicine and improving outcomes in psoriatic disease.

Data from clinical trials of novel targeted therapies for psoriatic arthritis and other autoimmune diseases, which have produced sometimes surprising results, can inform our understanding of the immunopathogenesis of these diseases and help to identify the most relevant therapeutic targets.

An improved understanding of the transition from psoriasis to psoriatic arthritis (PsA) and the identification of those patients with psoriasis at increased risk of PsA transition are major unmet needs and important for the design of preventive trials.

Here, Ho and Kupper detail how T cell responses are generated and maintained in skin. They discuss how the various subsets of skin-resident T cells — including memory and innate-like populations — contribute to inflammatory skin disorders.

This Review considers the unique anatomy of the cutaneous immune system. The authors explain how both protective and pathological immune responses are shaped in the skin, its associated appendages (such as hair follicles and sweat glands) and skin-associated lymphoid tissues.

Kabashima and colleagues review inflammatory skin disorders by discussing the pathogenesis of atopic dermatitis and psoriasis.

Psoriasis is a chronic, immune-mediated disease that can severely affect patient quality of life. Various kinds of skin manifestations are possible; psoriatic arthritis is a common but underdiagnosed comorbidity. Treatments for psoriasis include topical agents, phototherapy and systemic and biologic agents.

Psoriasis is a chronic, immune-mediated disease characterized by cutaneous manifestations (often red, scaly plaques) and rheumatological complications (psoriatic arthritis). This PrimeView highlights the pathological mechanisms that lead to psoriatic lesions, in particular, the altered immune responses.

The results of several retrospective studies have reported that systemic treatment in patients with psoriasis reduces the risk of incident psoriatic arthritis (PsA). Although encouraging from a prevention perspective, such studies are limited in their ability to provide a conclusive understanding of PsA risk, preventing a clear picture from emerging.

Results of the SELECT-PsA 1 trial suggest the selective Janus kinase inhibitor upadacitinib shows promise for the treatment of psoriatic arthritis.

Interest in therapies for psoriatic arthritis (PsA) has increased in response to recognition that many patients remain undiagnosed and are inadequately treated. In 2020, advances in PsA treatments have included phase III trials of an IL-23 inhibitor, head-to-head trials of IL-17 inhibition against TNF inhibition and updated EULAR treatment guidelines.

Dactylitis is diffuse inflammation of the digits and is so closely associated with psoriatic arthritis that it can be used as an outcome measure of it. In this Opinion article, the authors describe how imaging modalities and scoring systems combined with data from animal models can be used to understand the underlying anatomy and immunopathogenesis of dactylitis.

A crucial role for glucose metabolism has been identified in wound repair and in the pathogenesis of chronic inflammatory skin diseases, indicating that targeting metabolism is an approach for treating psoriasis.

Some patients with psoriatic arthritis are refractive to one biologic therapy but not to others, and a strategy for selecting the right therapy for each patient is needed. The findings of a new study highlight the potential benefit of stratifying patients by their immunophenotype to select the optimal biologic to use.

A new publication by the GRAPPA–OMERACT group provides recommendations and a useful framework for physicians on the use of composite measures and treatment targets in psoriatic arthritis. However, these recommendations highlight the need for more research in order to improve patient care and health-related quality of life.

The deubiquitinase A20 is a potent inhibitor of NF-κB signaling pathways. Ma and colleagues identify distinct roles for A20 ubiquitin-binding ZF4 and ZF7 domains, which exhibit different phenotypes upon mutation, but play synergistic roles in regulating inflammatory responses.

Innate lymphoid cells (ILCs) can exhibit considerable plasticity. Humbles and colleagues identify a subpopulation of ILC2s in humans that can convert to proinflammatory ILC3s with implications for human skin diseases.

Approximately 30% of psoriasis patients develop psoriatic arthritis (PsA) and early diagnosis is crucial for the management of PsA. Here, Patrick et al. develop a computational pipeline involving statistical and machine-learning methods that can assess the risk of progression to PsA based on genetic markers.