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Psoriatic arthritis (PsA) occurs in up to 30% of patients with psoriasis, and usually follows the development of psoriasis by an average of 7 to 10 years. However, there is significant variability in the timing of transition from psoriasis to PsA, which contributes to delays in diagnosis and high rates of undiagnosed PsA.

At the American College of Rheumatology (ACR) virtual annual meeting, one study aimed to associated with the time to transition to PsA, while another looked to in patients with psoriasis.

In this third of four exclusive episodes, 番茄社区 brought together three expert leaders in the field, all from the Cleveland Clinic -- moderator M. Elaine Husni, MD, MPH, is joined by Leonard Calabrese, DO, and Anthony Fernandez, MD, PhD -- for a virtual roundtable discussion about these two related studies.

Following is a transcript of their remarks:

Husni: Welcome. Thanks for joining us on this virtual roundtable for ACR Convergence 2021. Today, I'm really honored to have my good friends and colleagues here, Lenny and Tony. I have asked them to provide their opinions regarding some exciting abstracts at this year's Convergence meeting around psoriatic arthritis.

I'd like to spend some time on abstracts regarding decreasing the time to diagnosis from psoriasis to psoriatic arthritis. As you know, there's usually been a 7- to 10-year lag between psoriasis to psoriatic arthritis, and this transition has always been really interesting to us; we were always trying to diagnose sooner.

So in this abstract, we talked about a transition to psoriatic arthritis -- what factors predict a shorter transition time from psoriasis to psoriatic arthritis. So this is actually done out of our center here at the Cleveland Clinic, and we took over 380 patients and we followed them regarding their age of onset of psoriasis and some predictors for them to transition to psoriatic arthritis. And what we found was that patients that were diagnosed with psoriasis who presented at a much older age actually had a significantly shorter amount of time compared to younger patients that got psoriasis.

So, Tony, I'd love to just have you reflect on what you think about maybe earlier screening strategies in older patients or not, or what other ways that we can get at this group faster.

Fernandez: Well, I think it's exciting work, Elaine, as expected from you. And so for me I think the first thing I think about is, why would this happen, why should older patients have a shorter time to progressing to psoriatic arthritis?

And the first thing I think about is that patients who are a little bit older may have comorbid diseases that contribute to a pro-inflammatory state. They may have more joint issues -- tendinitis, other things going on in the joints that also lend themselves to a pro-inflammatory state.

So for me I think it's not only screening, but trying to get to the heart of why is there this shorter progression, and is there something that we can do to intervene if we know those reasons underlying it, that may lengthen that period of time, or even prevent progression to psoriatic arthritis. So I think your data is really just opening up a box of a lot of questions that can be addressed to better understand why this would occur.

Husni: Really interesting. So Len, we also know that we are really in this omics technology, where we're really trying to do some deep immune profiling of these groups. And despite genetic analysis as well, we haven't really come closer to really understanding how we can pick up this transition earlier. Any thoughts on system biologies, any processes that you could think of that we really need to strive at to try to find -- are we even in the right direction? Maybe it's more environmental triggers in addition to our underlying that make a difference.

Calabrese: I mean I think that big data, omics, artificial intelligence at this point in time, are adding to our understanding of immuno-pathogenesis, and as you point out, genetic predisposition, extra social factors and this copious amount of data. But I think we're not ready for prime time. We have the same lack of precision in diagnosing early RA [rheumatoid arthritis] and early lupus, and we're just not there yet.

Husni: Yeah, so these abstracts are interesting but probably as Tony said, bring up more questions than answers. But exciting to think about.

Watch the first episode of the roundtable: Exploring the Potential of Guselkumab in Psoriatic Arthritis

Watch the second episode of the roundtable: TYK2 Inhibitors Show Efficacy in Psoriatic Arthritis

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