A groundbreaking study designed to detect early signs of psoriatic arthritis (PsA), or arthritis related to having the psoriasis condition, has announced encouraging initial findings from its Irish cohort of patients. The results of the ongoing study, known as HPOS, by a team of researchers at University College Dublin, in partnership with the University of Oxford, were revealed as Psoriasis Awareness Month draws to a close.
Of the approximately 1,500 participants who have so far registered for HPOS and completed the online Psoriasis Epidemiology Screening Tool (PEST), one in four (25 per cent) showed evidence of possible arthritis. While these participants would previously have been diagnosed with psoriasis, they were unaware of potentially having psoriatic arthritis too.
Researchers are hoping to use the findings from the study to develop diagnostic tests to better determine which psoriasis patients may develop psoriatic arthritis to prevent irreversible joint damage before it occurs, diagnose it earlier or predict disease progression.
The study continues to be open at www.hpos.study to anyone over 18 years who has been diagnosed with psoriasis, unless already diagnosed with psoriatic arthritis.
Debilitating Symptoms
Psoriasis is a skin condition that affects at least 73,000 people1 across Ireland, causing flaky, scaly and itchy pink/red patches on the skin. For one-third of patients, psoriasis can predispose them to developing the inflammatory disease, psoriatic arthritis2. For most people, psoriasis develops around ten years before psoriatic arthritis3 with symptoms including joint pain, nail changes, swelling of the fingers and toes, morning stiffness in the back, and pain in the heels or tennis elbow.
The HPOS study is part of a European Project, “HIPPOCRATES”, and aims to recruit 25,000 people across Europe. Taking place completely online, participants are asked questions about their psoriasis and other medical conditions, any musculoskeletal symptoms that they may have, treatments they are receiving, and details of their lifestyle.
Initial Findings
The PEST test asks participants a series of five questions. A positive response to three or more questions saw participants being advised to make an appointment to see their GP for further investigation, potentially including blood tests, imaging, and referral to a consultant rheumatologist.
When asked the series of five questions, the responses for Irish patients with psoriasis was as follows:
· Joint pain: when asked if they had ever had a swollen joint or joints, two in five (41%) respondents said yes
· GP interaction: when asked if their doctor had ever told them that they had arthritis, one in six (17%) said yes
· Finger and toe nails: when asked if their finger or toe nails had holes or pits, one in three (34%) said yes
· Heel pain: when asked if they have ever experienced pain in their heel, one in three (32%) said yes
· Swollen fingers and toes: when asked if they have ever had a finger or toe that was completely swollen and painful for no apparent reason, one in four (28%) said yes
Predicting the Future
Consultant rheumatologist and study co-lead, Prof. Oliver FitzGerald, comments:
“This study aims to find ways to identify which patients with psoriasis are likely to go on to develop psoriatic arthritis by developing a simple blood test that would catch the disease before there are any obvious symptoms. In this way, we hope to be able to intervene at a much earlier stage to prevent the disease from actually occurring by modifying risk factors or by offering preventative therapies. This study’s initial findings underscore the importance of patient participation in building a comprehensive understanding of the early warning signs of psoriatic arthritis. I would encourage any person with psoriasis, who is over 18 years of age, and who has not been diagnosed with psoriatic arthritis, to take part. It could be the difference between an early diagnosis and prompt action, or a delayed diagnosis and significant joint damage.”
The HIPPOCRATES project is funded by the Innovative Medicines Initiative 2 Joint Undertaking (JU), which receives support from the European Union’s Horizon 2020 research and innovation programme and the EFPIA. The research is also supported by Novartis, UCB, AbbVie, Bristol-Myers Squibb, and Pfizer.
