Psoriatic disease--from skin to bone

Area of Science:

• Rheumatology and Immunology
• Dermatology

Background:

• Psoriatic arthritis (PsA) is a heterogeneous inflammatory joint disease.
• Distinguishing PsA from other spondyloarthropathies relies on clinical, histopathologic, immunogenetic, and imaging data.
• Historically, T lymphocytes were considered primary drivers, but emerging evidence points to monocyte-macrophages.

Purpose of the Study:

• To differentiate psoriatic arthritis from rheumatoid arthritis and other spondyloarthropathies.
• To elucidate the role of monocyte-macrophages in psoriatic arthritis pathogenesis.
• To explore the relationship between psoriatic disease manifestations and adverse cardiovascular/metabolic outcomes.

Main Methods:

• Analysis of clinical features, histopathology, immunogenetics, and musculoskeletal imaging.
• Investigation of the cellular players in joint and skin inflammation.
• Examination of genetic risk factors and patient outcomes.

Main Results:

• Psoriatic arthritis exhibits distinct characteristics from other spondyloarthropathies.
• Monocyte-macrophages play a crucial role in initiating and sustaining inflammation in psoriatic arthritis.
• Psoriatic arthritis can occur without skin psoriasis, indicating distinct disease pathways.
• Adverse cardiovascular and metabolic outcomes may be linked to inflammatory pathways involving monocytes and macrophages.

Conclusions:

• Psoriatic arthritis is a distinct entity from psoriatic skin disease.
• The term 'psoriatic disease' now encompasses systemic inflammation affecting joints, eyes, and gut.
• Activated monocytes and macrophages contribute to systemic inflammation and associated comorbidities in psoriatic disease.