Delayed diagnosis of psoriatic arthritis (PsA) remains a significant challenge, often leading to worse functional outcomes for patients, according to a recent study by Simon Grant.
Irish research has highlighted a concerning trend: patients with PsA experience an average delay of one year between disease onset and their first rheumatological assessment, with some cases extending to two years. The study also linked late diagnoses to an increased risk of developing joint damage and worse health outcomes, underscoring the importance of timely intervention.
Studies have shown that early diagnosis, particularly within the first year of symptoms, is crucial for achieving better clinical outcomes, suggesting there may be a “window of opportunity” for intervention that could improve long-term health prospects.
A new international initiative, the HIPPOCRATES project (Health Initiatives in Psoriasis and Psoriatic Arthritis Consortium for European States), aims to address this issue by advancing research into early PsA diagnosis. The project combines data from 27 institutions across 11 countries—Belgium, Denmark, Germany, Ireland, Italy, the Netherlands, Spain, Sweden, Switzerland, the UK, and the US—with the goal of fostering future breakthroughs in the management of PsA.
Four Research Streams
The HIPPOCRATES project is divided into four key research streams. The first is focused on developing a reliable diagnostic tool that can identify early signs of PsA through blood biomarkers, distinguishing it from other forms of arthritis. The consortium also aims to refine imaging techniques to detect early joint damage and use advanced statistical methods to create a diagnostic algorithm.
The second stream targets the development of a test to identify psoriasis patients at risk of progressing to PsA, enabling earlier intervention. Stream three focuses on identifying biomarkers that predict the progression of PsA. The fourth stream employs artificial intelligence to analyze large datasets to determine which patients respond best to specific treatments.
Progress and Early Findings
Though the HIPPOCRATES project is still in its early stages, the consortium has made significant progress. A late-breaking abstract submitted to the American College of Rheumatology’s upcoming meeting highlights the identification of specific proteins that differentiate psoriasis patients with no musculoskeletal issues from those with early signs of PsA and those with established PsA.
Professor Oliver FitzGerald, co-lead of the consortium and a researcher at University College Dublin’s Conway Institute for Biomedical and Biomolecular Research, expressed optimism about the project’s trajectory. “We’ve conducted a multiomic analysis of blood samples, and the good news is that there appear to be proteins that clearly distinguish between psoriasis and PsA, as well as between psoriasis and early musculoskeletal symptoms,” he said.
By the end of this year, the team expects to have analyzed most of their datasets and is aiming to test a biomarker panel on a larger scale. FitzGerald hopes that, by the project’s conclusion, the team will have identified a candidate biomarker that could be validated in larger cohorts and eventually used in routine clinical practice.
The HIPPOCRATES Prospective Observational Study (HPOS)
A crucial component of the HIPPOCRATES project is the HIPPOCRATES Prospective Observational Study (HPOS), which aims to recruit 25,000 patients with psoriasis across 16 European countries, including Ireland. Launched in the UK in July 2023, the study has since expanded to Ireland, Greece, Portugal, and Poland, with more countries expected to join soon. Each participating country has set a target of 2,000 participants, and as of now, 3,600 people have been recruited.
“This study is incredibly important. We are following patients with psoriasis over time to identify who will go on to develop PsA,” Professor FitzGerald explained. “Ireland has played a significant role in this effort, and we are close to reaching our target of 2,000 participants.”
HPOS targets adults with psoriasis who do not yet have a PsA diagnosis. Participants are managed through an online platform, where they provide dynamic consent and complete questionnaires at six-month intervals. If a participant screens positive for PsA, they are encouraged to seek medical review. Data collected includes patient-reported outcomes and bio-samples, which are gathered using self-administered finger-prick kits from those at higher risk of developing PsA.
Encouraging Participation in Ireland
In Ireland, approximately 1,900 participants have been enrolled, and Professor FitzGerald is encouraging more psoriasis patients without PsA to join the study. “We’re still seeking participants, and physicians can play a key role by directing their patients to the study website,” he said, urging people to visit www.hpos.study for more information and enrollment.
Revolutionizing PsA Management
If successful, the HIPPOCRATES project could significantly transform how PsA is diagnosed and treated. By identifying psoriasis patients at risk of developing PsA, the project could lead to earlier interventions, potentially preventing the disease altogether. In addition, the project aims to create a more personalized approach to treatment, selecting the most effective therapies for each patient based on their individual profile.
Professor FitzGerald envisions a future where, in 10 years’ time, the management of PsA will be radically different, with more precise and targeted treatments tailored to the specific needs of patients. “We hope to shift from a one-size-fits-all approach to a more individualized, precision medicine model for PsA treatment,” he concluded.
As the HIPPOCRATES project progresses, the research team remains optimistic that their findings will lead to groundbreaking advancements in the early diagnosis and treatment of psoriatic arthritis.
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