People with IA may suffer from pain of differing aetiologies and subtypes including nociceptive joint pain, neuropathic pain of carpal tunnel syndrome or nociplastic pain from concomitant fibromyalgia. Lack of precise measurement tools to identify nociplastic pain influences as a contextual factor potentially all outcomes in collected clinical trials as residual pain might impact various measurements in IA. The OMERACT 2025 pain SIG discussed, developing a scoping review from protocol, to identify an instrument to measure nociplastic pain in IA and a contextualised domain definition for nociplastic pain in IA. Stakeholder opinions were sought regarding pain in IA and the importance of identifying an instrument to measure nociplastic pain in IA. A total of twenty-four participants attending the OMERACT 2025 pain SIG session included a mix of patients, clinicians, researchers, methodologists, and industry representatives. Patient research partner (PRP), MC spoke about the impact of pain including different pain subtypes in IA. She recapped the results of OMERACT 2023 poll where participants, including PRPs, agreed that assessing different pain subtypes in IA was important to improve targeted treatments for pain. SK - a pain specialist- presented evidence supporting the presence and impact of nociplastic pain in different IA's including rheumatoid arthritis (RA), psoriatic arthritis (PsA) and axial spondylarthritis (AxSpA). Details of the scoping review protocol developed by the OMERACT Pain Working Group identifying candidate instruments for nociplastic pain assessment in IA was presented. Participants opinions were polled regarding their perspectives of the nociplastic pain definition and measurement. Polling showed clear agreement on advancing efforts to identify or develop an outcome measure for nociplastic pain. Most participants (86 %, 19/24) endorsed beginning with a systematic review of the existing literature to identify an appropriate validated instrument. Following a pain neuroscience education session five of the six (83 %) patient research partners (PRP) agreed they would be able to report the different pain types experienced in IA. Only one participant (1/24) agreed that the current IASP nociplastic pain definition is directly applicable to IA. Most participants (96 %) either disagreed or were uncertain, and over half (14/24) felt the definition likely requires contextualisation for IA. There was broad agreement that, in a substantial proportion of patients with inflammatory arthritis, nociplastic pain persists despite optimal treatment, is challenging to manage in routine clinical practice, and is associated with substantial patient suffering. The OMERACT meeting underscored the need for a standardized measure of nociplastic pain in inflammatory arthritis to refine eligibility criteria and support the development of stratified approaches in future clinical trials.

Epicardial fat as a cardiovascular risk factor in inflammatory arthritis.

Interleukin-23 inhibitors (IL-23i) are effective in psoriatic arthritis (PsA) in randomized trials; however, real-world data from Latin America remain limited. We described baseline characteristics and treatment line at IL-23i initiation, physician-reported reasons for selecting IL-23 inhibition, and pragmatic effectiveness and persistence at 6 and 12months in Argentina. Multicenter, observational, retrospective cohort study across seven Argentine sites. Adults with rheumatologist-diagnosed PsA initiating IL-23i (guselkumab or risankizumab) in routine care were included. Baseline demographics, disease duration, domains, key activity measures, prior advanced therapy lines, and physician-reported rationale were abstracted from records. Patients were assessed at ~ 6 and 12months. Primary outcome was physician-recorded minimal disease activity (MDA); persistence was remaining on IL-23i. Analyses were descriptive, with no inferential/predictive analyses due to sample size. Fifty-five patients were included (48% female; age 56 ± 11years). Mean PsA duration before IL-23i was 7.7 ± 5.8years and psoriasis duration 19 ± 11years. IL-23i was initiated as the 1st, 2nd, or ≥ 3rd advanced line in 26%, 34%, and 39%, respectively; prior TNF inhibitor exposure was 75% and IL-17 inhibitor exposure 25%. Domain involvement was frequent (peripheral 95%, skin 91%, nails 44%, enthesitis 43%, dactylitis 13%, axial 17%). Physicians selected IL-23i mainly for safety (73.9%) and expected skin efficacy (69.6%). MDA was achieved by 70% at 6months (90% persistence) and 75% at 12months (80% persistence). In Argentine routine care, IL-23 inhibition achieved high MDA rates with substantial 12-month persistence in complex, treatment-experienced PsA, supporting its pragmatic use in daily practice.

Robust evidence on the repair of radiographic damage in psoriatic arthritis (PsA) is limited. In this study, we determined the frequency of damage repair and identified its predictors. We performed biennial radiographic assessments of the hands and feet and graded them using the modified Steinbrocker score (mSS). Grades 0 and 1 were combined as a single state. We defined damage repair as a decrease in the joint-level mSS and summarized disease characteristics using descriptive statistics. We defined states based on the mSS and fitted multistate Markov models to estimate transition intensities and assess the impact of prognostic factors on damage repair. We included 674 patients with PsA (54.7% male), with a mean age of 44.4 years (SD 12.8) and a mean disease duration of 6.3 years (SD 8.0) at baseline (clinic entry). Over a total follow-up of 7,189.5 person-years, 428 patients (63.4%) developed at least one damaged joint (mSS ≥ 2), and 127 of them (29.7%) demonstrated evidence of repair in at least one joint. In total, 361 joints demonstrated radiographic improvement. Progression of damage was observed in patients prior to biologic DMARD therapy. Combination of methotrexate and biologic DMARDs was associated with a reduced progression rate for joint damage (RR = 0.48, 95% CI: 0.38-0.62) and an increased rate of damage repair (RR = 1.97, 95% CI: 1.13-3.45). Radiographic improvement consistent with damage repair is not infrequent in PsA. Concomitant treatment with biologic DMARDs and MTX is a predictor of slower radiographic progression and damage repair.

Despite the intention of international psoriasis treatment guidelines to cover all patients globally, disparities persist in the availability and accessibility of adequate therapy in many countries. The Global Healthcare Study on Psoriasis (GHSP) aims to study patient characteristics, disease impact, treatment accessibility and healthcare systems worldwide. This study provides a description and data analysis of 22 countries. The GHSP cohort was initiated in 2020, and the number of recruiting centres has gradually grown. Participants are recruited by dermatologists at reference centres worldwide. Data are collected using a standardised assessment questionnaire comprising 88 items, administered by trained experts. By 26 October 2024, cross-sectional data had been collected from 3950 psoriasis patients at 130 reference centres in 22 countries on six continents. The majority (55.7%) of patients were male, and the median (IQR) body mass index was 26.5 (23.7-30.1) kg/m2. The median (IQR) Psoriasis Area and Severity Index was 5.0 (2.0-11.4), and median (IQR) Dermatology Life Quality Index was 7.0 (2.0-14.0). Psoriatic arthritis was present in 20.2% of the patients and nail psoriasis in 36.7%. Additionally, 16.5% of patients were current smokers, and 26.4% reported regular alcohol consumption. By identifying inequalities, special patient populations and country-specific differences, the GHSP will guide the development of strategies to enhance psoriasis care on a global level. Future directions include expanding the study to additional countries and sites worldwide, while transitioning into a long-term global registry of skin diseases, including atopic dermatitis and hidradenitis suppurativa, termed 'Global Healthcare Registry on Skin Diseases'.

Background Psoriatic arthritis (PsA) often requires escalation from conventional synthetic disease-modifying antirheumatic drugs (csDMARDs) to biologic therapy (bDMARDs), yet biomarkers guiding treatment decisions remain limited. Anti-CD74 autoantibodies have shown diagnostic potential in axial spondyloarthritis, but their relevance in PsA is insufficiently characterized. Objective To evaluate whether IgA anti-CD74 levels are associated with treatment escalation in peripheral PsA (pPsA) and to characterize their relationships with clinical and immunological parameters. Methods Serum samples from 171 PsA (127 pPsA, 44 axial PsA [axPsA]), 43 non-rheumatic disease controls (NRD), and 43 rheumatoid arthritis (RA) patients were analyzed. IgA anti-CD74 levels were measured by enzyme-linked immunosorbent assay (ELISA). Patients were stratified by disease duration and treatment exposure. Correlation analyses, receiver operating characteristic (ROC) curves, and logistic regression models were performed. A prospective subgroup of 53 early pPsA patients was followed to assess treatment initiation. Results IgA anti-CD74 levels were elevated in PsA compared with NRD controls (median 13 vs. 6 U/mL, p < 0.0001), with similar levels in pPsA and axPsA and comparable values in RA, indicating an association with inflammatory disease rather than disease specificity. Anti-CD74 positivity (>15 U/mL) was observed in 31.5% of pPsA and 43.2% of axPsA versus 2.3% of NRD, independent of disease duration. Anti-CD74 levels were associated with treatment escalation in pPsA, with higher levels in bDMARD-treated patients (median 13.0 vs. 11.0 U/mL, p = 0.04). In multivariate analyses, anti-CD74 was independently associated with csDMARD (OR 1.113, p = 0.022) and bDMARD use (OR 1.052, p = 0.02). After false discovery rate (FDR) correction, anti-CD74 remained associated with serum IgA (q = 0.0008) and weakly with IgG (q = 0.0250), but not with C-reactive protein (CRP) or age. Longitudinal associations were not significant after FDR correction (csDMARD initiation: p = 0.047, q = 0.094; bDMARD initiation: p = 0.19, q = 0.1866), indicating these findings are exploratory. Conclusion IgA anti-CD74 levels are elevated in PsA and appear to reflect immunological activity not captured by CRP. Their independent association with treatment escalation in pPsA supports further evaluation as a biomarker candidate, although findings remain exploratory and require validation in larger longitudinal cohorts.

DAPSA scores reflect both articular and cutaneous involvement in psoriatic arthritis.

Cutaneous disease is a central component of psoriatic arthritis (PsA), contributing substantially to patient disease burden and influencing therapeutic choices. Beyond plaque psoriasis, specific phenotypes, including nail, scalp, palmoplantar, and inverse involvement, are relatively common in PsA and are frequently associated with greater functional limitation, impaired quality of life, and discordant responses to systemic therapy. Accurate identification of these manifestations is critical for diagnosis, risk stratification, and treatment optimization. This review provides a clinically oriented overview of the dermatologic spectrum of PsA, outlining epidemiology, pathogenic mechanisms linking the skin-joint axis, and the impact of skin disease on outcomes. We summarize evidence for topical therapies, conventional systemic agents, biologics targeting tumour necrosis factor alpha (TNFα), interleukin-17 (IL-17), and interleukin-23 (IL-23), targeted synthetic disease-modifying anti-rheumatic drugs (DMARDs), and emerging treatments, with attention to phenotype-specific considerations and multidisciplinary management. The implications of persistent skin activity in complex-to-manage PsA are also discussed. A domain-based, integrated approach to skin and joint care is required to achieve effective control both of musculoskeletal and cutaneous symptoms. Systematic evaluation and treatment of skin involvement should be considered a core component of PsA management rather than an ancillary concern.

Platelets are increasingly recognised as inflammatory mediators that influence leukocyte behaviour, yet their spatial organisation and contribution to psoriatic skin inflammation remain incompletely understood. Here, spatial transcriptomics was used to map platelet-leukocyte niches (PLNi) across inflammatory skin diseases, contrasting psoriasis (PsO) with atopic dermatitis (AD). PLNi were selectively expanded in PsO lesions, where platelet-neutrophil co-localisation defined transcriptionally active regions enriched for stress and inflammatory mediators. PsO and psoriatic arthritis (PsA) shared a convergent cellular profile in which platelet association occurred across immune lineages but was markedly increased in neutrophils, particularly within the epidermis. Epidermal PLNi showed coordinated spatial patterns of dendritic and T cell enrichment, with neutrophil-platelet niches correlating with both. Neutrophil-platelet regions displayed enhanced inflammatory activity and stronger dendritic- and T-cell activation signatures, becoming more frequent with disease severity and pointing to a role for epidermal platelet-neutrophil associations in amplifying psoriatic immune responses. Peripheral multiomic analysis revealed enhanced platelet-neutrophil coupling and increased neutrophil activation in PsA, consistent with the higher systemic inflammatory burden of the arthritic form of the disease. Altogether, these results establish platelet-neutrophil niches as spatial features linked to immune activation in psoriatic disease, with consistent platelet-neutrophil aggregation patterns in circulation. KEY MESSAGES: Platelet-neutrophil niches expand selectively in psoriatic lesions Epidermal niches align with dendritic and T-cell activation programs syndrome Niche prevalence correlates with psoriasis clinical severity Psoriatic arthritis shows systemic platelet-neutrophil coupling Findings outline a platelet-associated inflammatory axis in autoimmunity.

This study aims to characterize the burden and distinct patterns of chronic overlapping pain conditions (COPCs) multimorbidity in adults with autoimmune rheumatic diseases (ARDs). We analyzed 2008-2021 data from the Merative MarketScan Commercial Claims and Encounters Database, identifying 149,742 patients with ARD (ankylosing spondylitis, psoriatic arthritis, rheumatoid arthritis, Sjögren's disease, systemic lupus erythematosus, systemic sclerosis) using ICD-9/10-CM codes. We assessed COPC (e.g., fibromyalgia, chronic low back pain, migraine, irritable bowel syndrome, chronic fatigue syndrome, temporomandibular disorders, and pelvic pain conditions) prevalence, multimorbidity patterns, and pairwise co-occurrence frequencies, calculating observed/expected ratios and odds ratios. Of 149,742 ARD patients, 57.5% had ≥1 COPC, with 22.7% experiencing multiple conditions. Chronic low back pain (41.4%) and fibromyalgia (21.1%) were most prevalent. Women and individuals aged 31-50 showed the highest COPC prevalence. Many COPC pairs co-occurred more frequently than expected by chance (e.g., fibromyalgia and chronic low back pain: observed/expected ratio 1.35; migraine and chronic low back pain: 1.42). Strongly associated dyads included urologic chronic pelvic pain and vulvodynia (OR 10.46). A substantial burden and distinct multimorbidity patterns of COPCs exist among ARD patients, suggesting shared pathophysiological mechanisms. Routine COPC screening and targeted non-opioid multimodal interventions, especially for common dyads, are crucial for improved pain management and reducing opioid-related risks in this population.

Children with psoriasis can develop juvenile psoriatic arthritis. Musculoskeletal ultrasound is a helpful imaging modality in the early recognition of joint inflammation. This pilot study aims to describe clinical and subclinical joint and nail abnormalities in children with psoriasis. Children with psoriasis and healthy controls underwent ultrasound examination of various joints, entheses, and nails. Using a standard acquisition protocol, images were obtained in both B-mode and PD-mode. Differences between psoriasis and control groups were examined. Fifteen psoriasis patients who were not on systemic therapy and did not have clinical signs of arthritis and thirteen age- and sex-matched healthy controls were enrolled. While patients with psoriasis demonstrated subclinical synovitis in the finger, knee, and ankle joints more frequently than the control group (p = 0.047), no statistically significant difference was observed in the comparison of each specific joint. PD positivity was detected at the entheses in two patients with psoriasis and at three entheseal sites of two healthy children. Nail ultrasound examination demonstrated significantly thicker nail beds (1.6 vs. 1.4mm, p < 0.001) and more frequent abnormal nail structure (70% vs. 21.2%, p < 0.001) in the psoriasis group compared to control group while the thickness of the nail plate and nail matrix were similar. Type II nail morphology changes were the most frequently detected type according to the Wortsman classification. Positive PD-mode findings in the nail bed and nail matrix were more common in the control group (both p < 0.001). Among the psoriasis cohort, nails with abnormal exam findings had significantly thicker nail plate (0.4 vs. 0.35mm, p = 0.003) and nail bed (1.8 vs. 1.6mm, p = 0.006) measurements compared to nails with normal examination. Ultrasound is a useful tool for evaluating inflammatory joint and nail findings that may help delineate subclinical joint inflammation in children with psoriasis.

At the Group for Research and Assessment of Psoriasis and Psoriatic Arthritis (GRAPPA) 2025 congress, 2 major research initiatives in psoriatic disease were highlighted: (1) the Axial Involvement in Psoriatic Arthritis (AXIS) study, and (2) the GRAPPA consensus definitions for complex-to-manage psoriatic arthritis (C2M-PsA) and treatment-refractory PsA (TR-PsA). The AXIS study, jointly led by Assessment of SpondyloArthritis international Society (ASAS) and GRAPPA, aims to establish internationally accepted classification criteria for axial PsA. In its recently completed phase, 409 patients were recruited across 41 centers in 19 countries. A comprehensive imaging and clinical dataset were collected and analyzed. The next phase will construct and validate a PsA-specific classification instrument to support future research. In parallel, GRAPPA developed consensus definitions for C2M-PsA and TR-PsA through a transparent, multistakeholder process. C2M-PsA refers to patients with persistent symptoms despite appropriate treatment, often complicated by comorbidities or overlapping conditions. TR-PsA is defined by failure to respond to multiple therapies and by confirmed persistent inflammation. These definitions were endorsed by 95% of GRAPPA members and are supported by practical checklists for clinical use. These initiatives represent a significant advancement in PsA research, offering clinicians structured tools to improve patient stratification, guide treatment decisions, and enhance personalized care.

The Group for Research and Assessment of Psoriasis and Psoriatic Arthritis (GRAPPA) 2025 annual meeting, held in Bogotá, Colombia, featured soapbox presentations highlighting innovative approaches to psoriatic disease (PsD) care. Dr. Vasileios Charisis presented the Psoriatic Arthritis Inflammation Explained Through Multi-Source Data Analysis Guiding a Novel Personalised Digital Care Ecosystem (iPROLEPSIS) project, which applies digital phenotyping and explainable artificial intelligence to monitor psoriatic arthritis (PsA) using smartphone-based typing dynamics and hand motion tracking. Pilot data demonstrated high accuracy in detecting functional impairments, underscoring the potential of digital biomarkers for personalized disease management. Dr. Rodrigo García-Salinas reported consensus recommendations from the Red de Excelenciaen Artritis para la América Latina-Pan American League of Associations for Rheumatology (REAL-PANLAR) group to establish PsD Centers of Excellence (CoEs) in Latin America. Through a Delphi process, experts from 12 countries defined structural, process, and outcome standards, resulting in 2 adaptable models-optimal and model-designed to reduce diagnostic delays, enhance multidisciplinary collaboration, and improve outcomes. Dr. Juan Raul Castro-Ayarza summarized real-world evidence on biologic drug survival in Latin America, emphasizing fragmented data and variability across national cohorts. Findings from Venezuela, Brazil, Argentina, and Colombia revealed differences in treatment persistence and predictors of discontinuation, reinforcing the need for a standardized regional registry. Collectively, these initiatives demonstrate the value of digital health tools, region-specific care frameworks, and real-world evidence in advancing PsD management globally.

Key advances from the Group for Research and Assessment of Psoriasis and Psoriatic Arthritis (GRAPPA) pilot research grant program were presented at the GRAPPA 2025 annual meeting. Areas of study included hypoxia-inducible factor 1α (HIF1A) as a potential factor in psoriatic arthritis (PsA), plasma extracellular vesicle cytokines as potential biomarkers for predicting response to tumor necrosis factor inhibitors in PsA, bone properties and biomechanics in psoriatic disease (PsD), better understanding of differences in body composition in PsD, and the effect of sleep on PsD severity.

At the Group for Research and Assessment of Psoriasis and Psoriatic Arthritis (GRAPPA) 2025 Collaborative Research Network meeting in Bogotá, Colombia, experts in dermatology and rheumatology presented complementary perspectives on the future of psoriatic disease management. Dr. Andrew Blauvelt introduced innovative approaches to achieving long-term remission or a cure for psoriasis, focusing on early intervention and "knockout" therapies with high-dose interleukin 23 inhibitors. Dr. Philip Mease presented evolving concepts in difficult-to-treat and complex-to-manage psoriatic arthritis, emphasizing the need for formal definitions and the growing role of dual therapy strategies. This session reflected a shift toward a more personalized, proactive, and multidisciplinary strategy to address unmet needs in psoriatic disease.

Plain radiographs have been widely used in psoriatic disease (PsD) for diagnosis, classification, and monitoring of structural damage. However, with the emergence of other imaging modalities such as ultrasound, magnetic resonance imaging, and computed tomography, the necessity of plain radiographs in PsD is debatable. At the Group for Research and Assessment of Psoriasis and Psoriatic Arthritis (GRAPPA) 2025 annual meeting in Bogotá, Colombia, Drs. William Tillett and Arthur Kavanaugh were invited to debate the topic "Plain radiography in psoriatic disease: is it still necessary?" Each presented evidence-based arguments, incorporating multiple data sources, including clinical trials, to support their positions for and against the topic, respectively. This article summarizes their debate for the broader PsD community.

Inflammatory bowel disease and psoriasis as causal drivers of psychiatric disorders: A two-stage Mendelian randomization study grounded in the gut-brain-skin axis.

The Group for Research and Assessment of Psoriasis and Psoriatic Arthritis (GRAPPA) 2025 annual meeting, held in Bogotá, Colombia, opened with a dedicated trainee symposium that underscored the depth and breadth of emerging talent in psoriatic disease research. This report summarizes the 5 oral presentations and 17 posters encompassing basic, translational, clinical, and outcomes research projects. Together, these works illustrate not only the scientific rigor of the next generation of dermatology and rheumatology investigators but also GRAPPA's expanding global role in driving innovation and advancing the understanding and management of psoriatic diseases.

Biologic therapies are a major and growing driver of pharmaceutical expenditure globally, with tumor necrosis factor (TNF) inhibitors among the most widely used and costly biologics. In Australia, these therapies are funded through the Pharmaceutical Benefits Scheme (PBS), where biosimilars offer lower cost alternatives; however, the long-term public expenditure impact of TNF inhibitor biosimilars under regulated pricing systems has not been comprehensively quantified. We conducted a retrospective, population-level expenditure analysis using publicly available PBS Item Reports data from 2015 to 2025 to estimate PBS cost savings associated with the listing of adalimumab, etanercept, and infliximab biosimilars for inflammatory arthritis. Counterfactual scenarios were constructed to estimate expected expenditure in the absence of biosimilar entry, explicitly accounting for key PBS pricing mechanisms, including mandatory price reductions and price-disclosure cycles. Biosimilar listing was associated with cumulative PBS savings of AU$562.3 million over the study period. Etanercept biosimilar generated the largest absolute savings (AU$341.5 million; 23.7% reduction), whereas adalimumab biosimilars generated smaller relative savings (AU$195.3 million; 9.4% reduction), reflecting delayed biosimilar entry despite high utilization. Most savings accrued in rheumatoid arthritis, followed by ankylosing spondylitis and psoriatic arthritis. In conclusion, TNF inhibitor biosimilars were associated with substantial and sustained reductions in public medicine expenditure in Australia. The magnitude of savings varied markedly by molecule and was jointly determined by the timing of biosimilar entry and statutory pricing mechanisms, illustrating how regulated reimbursement systems shape realized biosimilar value.

Efficacy thresholds allow interpretation of randomised clinical trials (RCTs) and establishment of treatment targets. To assess the need for more personalised treatment goals, minimal clinically important improvement (MCII) thresholds in psoriatic arthritis (PsA) clinical and patient-reported outcome measures were determined by treatment history and baseline disease activity. This post hoc analysis pooled data from 3 RCTs in participants with active PsA receiving guselkumab every 8 week (Q8W), or placebo with W24 transition to guselkumab Q8W. MCII thresholds for clinical Disease Activity Index for PsA (cDAPSA), PsA Disease Activity Score (PASDAS), and patient-reported assessments of arthritis and psoriasis, pain, fatigue, and physical function were determined using established distribution-based methods in participant subgroups defined by prior tumour necrosis factor inhibitor (TNFi) treatment and baseline cDAPSA and PASDAS disease activity (high vs moderate). In this pooled RCT population, estimated MCII thresholds for all examined measures were consistent across TNFi-experienced and biologic-naïve cohorts. However, the determined cDAPSA, but not PASDAS, MCII was more stringent among participants with high vs moderate baseline disease activity. Guselkumab-treated participants had greater odds of achieving MCII thresholds vs placebo as early as W8, irrespective of prior TNFi and baseline cDAPSA and PASDAS disease activity, supporting the known-groups validity of the estimated thresholds. Estimated MCII thresholds were consistent regardless of prior TNFi but greater for participants with higher baseline joint disease activity, indicating disease severity may impact perceived PsA improvement. These findings may aid in setting more personalised goals in shared decision‑making and treat-to-target strategies, and RCT interpretation.