Clinical Research Fellow, Department of Rheumatology, Addenbrooke's Hospital, Cambridge, UK.
Consultant Rheumatologist, Department of Medicine, University of Cambridge, Cambridge, UK.
Best Pract Res Clin Rheumatol. 2021 Jun;35(2):101693. doi: 10.1016/j.berh.2021.101693. Epub 2021 Jun 5.
Psoriatic arthritis (PsA) is a chronic inflammatory arthritis with a highly variable clinical presentation that does not have a validated molecular or imaging test, making accurate diagnosis a challenge. Consequences of diagnostic delay include irreversible joint damage and significant morbidity. Over the past few decades, there have been major advances in the understanding and treatment of PsA, leading to more targeted therapies. However, there is no current method to predict optimal treatment strategy to achieve minimal disease activity and prevent medication-related adverse events in the management of early disease. PsA is also associated with other comorbidities that include metabolic syndrome and psychosocial burden; two areas that are often unaddressed in the clinical setting and have associated sequelae. This chapter focuses on key domains of unmet needs, which include diagnostic challenges, delay in diagnosis, prognostication systems and stratified medicine approaches and precision medicine strategies for established and emerging therapies.
银屑病关节炎（PsA）是一种慢性炎症性关节炎，临床表现高度多变，目前尚无经过验证的分子或影像学检测方法，因此准确诊断具有挑战性。诊断延迟的后果包括关节不可逆损伤和显著的发病率。在过去的几十年中，人们对 PsA 的认识和治疗取得了重大进展，从而产生了更有针对性的治疗方法。然而，目前尚无方法可以预测最佳治疗策略，以实现早期疾病管理中的最小疾病活动度并预防与药物相关的不良事件。PsA 还与其他合并症相关，包括代谢综合征和心理社会负担；这两个领域在临床环境中常常未得到解决，并存在相关的后遗症。本章重点介绍未满足需求的关键领域，包括诊断挑战、诊断延迟、预后系统以及分层医学方法和针对现有和新兴疗法的精准医学策略。
