Unlock PsA: Stratifying the Impact of Psoriatic Arthritis in Children and Adults

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Aim of the project: to uncover groups of people with psoriatic arthritis (PsA) who have different treatment needs. Background: Remission rates in PsA are low with many people still having symptoms years after they are diagnosed. Treatments for early PsA tend to be given in the same order even if peoples' diseases look different, with the first 'disease-modifying drug' being methotrexate in most cases. There might be groups of people who have the same combinations of problems and whose lives are impacted in the similar ways by PsA. These groups may need different treatments like starting with a different drug or earlier physiotherapy. Because PsA is so varied and complicated, the groups may not be obvious to doctors and can only be found using new methods in artificial intelligence. This project will use these methods to figure out how many groups of PsA there are, what experiences people in each group have, and create a tool to figure out which group they belong to right at the start of their disease journey. This will help pick the best treatments from different areas of healthcare and understand if treatments should be the same if people's PsA started in childhood or adulthood. Methods and approach: Children and adults with newly-diagnosed PsA will be included from six studies across Europe and Canada. The studies collect information from a diagnosis of PsA over time on personal characteristics, disease, and its impact on everyday life. New methods in artificial intelligence will find groups of people who share PsA impacts at diagnosis and in the year after starting methotrexate. This will help pinpoint which groups might need to have different treatments from different areas of healthcare early on. The project will then look for groups of PsA that are shared between people whose disease started in childhood versus adulthood. This could lead to a greater range of treatments for people whose disease started in childhood and shorter times to the right treatment across ages. Patient involvement in the design and conduct of the study: Patient partner involvement comes from children, young persons and parent groups (Your Rheum, CLUSTER champions, SNAC, CCAA) and from adults with PsA (Research User Group, BritPACT). A priority research area was to figure out which groups of people with PsA should have different treatments right after they are diagnosed. These groups have then helped plan this project moving forward, with which experiences should be studied, adding response to methotrexate as a key project aim, and the importance of comparing PsA in childhood versus adulthood. There are five involvement focus groups planned through the project, to figure out the best way to share the findings (focus groups 1 & 5), develop the statistical models (focus groups 2, 3 & 4), interpret the results (focus groups 2, 3 & 4), give feedback and celebrate involvement (workshop 5). Expected benefits for people with PsA: Treatment choices driven by different types of PsA. More certainty about how people's disease will progress and more confidence in the treatments picked for them. A new tool will predict how well methotrexate will work for PsA physical features alongside pain, quality of life and other symptoms. People who would benefit from methotrexate could be offered this drug earlier, and those whose disease only responds in certain areas, or whose quality of life does not improve after taking methotrexate could be given other treatment options at an earlier stage such as different anti-rheumatic drugs, physiotherapy, occupational therapy or psychology to prevent the impacts of disease. This would shorten the time to remission and decrease the burden of disease, as well as lower side-effects from unnecessary medications. Finally, children and young people with PsA could be offered a greater range of treatments if this project finds PsA has the same patterns whether it starts in childhood or adulthood.