A TEAM of researchers at University College Dublin (UCD) is urging people with psoriasis across Ireland to sign up for a new study examining their risk of developing psoriasis-related arthritis or psoriatic arthritis.
Psoriasis is a skin condition that affects at least 73,000 people across Ireland, causing flaky, scaly and itchy pink/red patches on the skin. For a third of patients, psoriasis can predispose them to developing psoriatic arthritis, an inflammatory disease primarily affecting the joints of the hands and feet, which causes pain, swelling, stiffness and joint damage.
The UCD research team, which has partnered with the University of Oxford, is aiming to recruit 2,000 people across Ireland, out of a total of 25,000 across Europe, to the study. The research is supported by the Innovative Medicines Initiative together with AbbVie, Bristol-Myers Squibb, Novartis, Pfizer, and UCB.
The research aims to better determine which psoriasis patients may develop psoriatic arthritis in order to prevent it before it occurs.
It will also inform wider research efforts to diagnose the condition earlier or predict disease progression, to develop new diagnostic tests, and to pioneer personalised therapies to avert permanent, disabling joint damage.
Anyone over 18 who has been diagnosed with psoriasis, except those already diagnosed with psoriatic arthritis, can take part in the study. Participants will be asked about their psoriasis and other medical conditions, any musculoskeletal symptoms arising, treatments they are receiving, and details of their lifestyle.
Taking place completely online, participants complete questionnaires every six months over a three-year period. Some may be sent a home blood sampling kit to provide a finger-prick blood sample to assist in developing a tool to identify those at higher risk of developing arthritis. Register at www.hpos.study
Consultant Rheumatologist and study co-lead, Professor Oliver FitzGerald, said: “Psoriasis is a huge issue for so many people in Ireland and those suffering the additional burden of psoriatic arthritis can also endure joint pain, fatigue, anxiety and depression.
“Unfortunately, right now, we don’t know which patients with psoriasis will go on to develop psoriatic arthritis and which will not. There is also no test to properly diagnose it. But it is important that it be recognised promptly as each day left untreated leads to poorer outcomes. Also, while we have some good treatments, we don’t have a good way of being completely sure which is the right one for which patient. By identifying biomarkers associated with psoriatic arthritis, our aim is to develop a blood test to identify it prior to the development of any symptoms. Ultimately, if we can develop ways of better identifying which patients will develop arthritis, we may be able to prevent it through risk factor modification and preventative therapies.
I would encourage anyone over 18 who is eligible to register their interest and invest in their own care. Not only will it benefit them in providing ongoing monitoring of their condition, and an early diagnosis of psoriatic arthritis should it arise, it could also spell the end of the condition for other patients both now and into the future.
Five Things to Know About Psoriasis and Psoriatic Arthritis
1. A skin condition. Psoriasis is a chronic, genetic condition, which leads to skin plaques or raised patches on the body. There are different types but the most common involves plaque psoriasis affecting about 90% of patients. It is brought on by irregularities in the body’s immune system and arises from an increase in the rate at which skin cells are produced and shed from the skin. It tends to run in families, while being overweight is a risk factor for its development too. It may also be triggered by environmental factors, including infections such as strep throat, injury to the skin, certain medications, heavy drinking, smoking and stress. Psoriasis affects women and men equally, and generally develops in young adolescents (age 16-22) or in adulthood (average 33 years of age). It is not contagious or the result of poor hygiene.
2. Range of treatments. Unfortunately, there is no cure for psoriasis yet, but it can be controlled. No single medication is effective for everyone affected and patients may be prescribed a number of different treatments. These include topical creams and ointments, phototherapy, which is a form of artificial ultraviolet light, medications or injections, and biologic treatments which target specific parts of the immune system. Self-care is key and it is important to look at other lifestyle factors such as stopping smoking, avoiding excess alcohol consumption, maintaining a healthy weight, eating a healthy diet, undertaking regular exercise and having risk factors such as high blood pressure and cholesterol checked regularly.
3. Risk of other conditions. Unfortunately, people with more severe psoriasis - about 9,000 people in Ireland - are more likely to have other health issues. Ask a doctor about any potential risk for heart disease, stroke, type 2 diabetes, depression and psoriatic arthritis.
4. Psoriatic arthritis. This is a chronic, inflammatory form of arthritis associated with psoriasis. Symptoms include joint pain, swelling of the fingers and toes, nail changes, morning stiffness in the back, and pain in the heels or tennis elbow.
For most, psoriasis develops around ten years before psoriatic arthritis, while about one in six will develop joint problems first, or both skin and joint problems simultaneously. Treatments are available to reduce pain and inflammation, and to prevent long-term joint damage. Other interventions include: physiotherapy to help maintain muscle strength; occupational therapy guidance to reduce strain and prevent further damage to affected joints; podiatry advice on footwear to help keep the foot in the best alignment position; and dietary support on food choices when weight loss is important to reduce extra strain on joints.
5. Five questions to ask yourself. People with psoriasis who have not been diagnosed with psoriatic arthritis should answer what is known as the Psoriasis Epidemiology Screening Tool, or PEST, questionnaire annually.
If your answer is yes to three of these five questions, then you should seek a referral to a rheumatologist:
Have you ever had a swollen joint or joints?
Has a doctor ever told you that you have arthritis?
Do your finger nails or toenails have holes or pits?
Have you had pain in your heel?
Have you had a finger or toe that was completely swollen and painful for no apparent reason?
To download the Irish Skin Foundation’s comprehensive booklet ‘What you need to know about psoriasis?’, see www.irishskin.ie/psoriasis
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