Conway Institute of Biomedical Research, University College Dublin, Dublin, 4, Ireland.
Department of Rheumatology, St. Vincent's University Hospital and Conway Institute for Biomolecular Research, University College Dublin, Elm Park, Dublin, 4, Ireland.
Clin Rev Allergy Immunol. 2018 Dec;55(3):271-294. doi: 10.1007/s12016-017-8630-7.
Psoriatic arthritis (PsA) is a form of inflammatory arthritis (IA) affecting approximately 0.25% of the population. It is a heterogeneous disorder associated with joint damage, disability, disfiguring skin disease and in severe cases, premature mortality. Inherently irreversible and frequently progressive, the process of joint damage begins at, or before, the clinical onset of disease. Early recognition and intervention is thus crucial to patient outcome. At disease onset, however, PsA often resembles other forms of arthritis-especially rheumatoid arthritis (RA). Despite the similarities between PsA and RA, their distinctive pathologies require different treatments. For example, drugs that are effective in RA may not be effective in PsA and can even cause adverse effects. Since there is no currently validated test for PsA, the diagnosis is often missed or delayed and this has functional consequences for the patient. In the context of PsA and RA, making an accurate diagnosis is not the only challenge faced by rheumatologists. Choosing an effective and safe medication to manage the disease is another significant challenge and currently approximately 40% achieve meaningful responses such as minimal disease activity status. For the patient, several months may be lost as a result of trial and error testing-meanwhile, irreversible joint damage may occur. Clearly, more effective clinical tests are urgently needed to improve personalised patient care in PsA. Specifically, there is need to develop minimally invasive tests predictive of diagnosis, response to treatment and radiographic progression. In this review, we examined the biomarker development process, highlighted the importance of qualifying unmet clinical needs and emphasised the challenges that impede biomarker studies. We have compiled a comprehensive list of potentially clinically relevant biomarkers in PsA and provided a summary of proteomic technologies that might usefully support additional biomarker research in PsA.
银屑病关节炎（PsA）是一种影响约 0.25%人群的炎性关节炎（IA）。它是一种与关节损伤、残疾、毁容性皮肤病相关的异质性疾病，在严重情况下还会导致过早死亡。该病具有内在的不可逆转性，且通常呈进行性发展，关节损伤过程始于疾病临床发作之前或之时。因此，早期识别和干预对于患者的预后至关重要。然而，在疾病发作时，PsA 通常类似于其他类型的关节炎——尤其是类风湿关节炎（RA）。尽管 PsA 和 RA 之间存在相似之处，但它们的病理特征不同，需要不同的治疗方法。例如，在 RA 中有效的药物在 PsA 中可能无效，甚至可能产生不良反应。由于目前尚无针对 PsA 的验证性测试，因此该病的诊断经常被忽视或延迟，这对患者的功能产生了影响。在 PsA 和 RA 的背景下，风湿科医生面临的不仅仅是做出准确的诊断。选择一种有效的、安全的药物来管理疾病也是另一个重大挑战，目前只有约 40%的患者能获得有意义的缓解，如达到疾病最小活动度状态。由于试验和错误测试，患者可能会因此失去数月的时间——与此同时，关节的不可逆损伤可能已经发生。显然，迫切需要更有效的临床测试来改善 PsA 患者的个性化治疗。具体来说，需要开发出能够预测诊断、治疗反应和影像学进展的微创性测试。在本综述中，我们研究了生物标志物的开发过程，强调了确定未满足的临床需求的重要性，并强调了阻碍生物标志物研究的挑战。我们整理了一份全面的 PsA 潜在临床相关生物标志物清单，并提供了支持 PsA 进一步生物标志物研究的蛋白质组学技术概述。
