Psoriatic Arthritis Research
NYU Langone’s Division of Rheumatology conducts basic, translational, and clinical research on psoriatic arthritis in order to better manage this complicated condition.
Jose U. Scher, MD, Soumya M. Reddy, MD, and Julia Manasson, MD, lead the research program. Both Dr. Scher and Dr. Reddy served on the panel that wrote the 2018 American College of Rheumatology’s first-ever psoriatic arthritis treatment guidelines.
In addition, Dr. Scher is an active member of the U.S. Food and Drug Administration (FDA) Arthritis Advisory Committee, which advises the federal agency on new arthritis medications. To add to the field’s recent therapeutic advances, the advisory committee has helped secure the approval of lower-cost, biosimilar drugs for psoriatic arthritis and expand the range of available options for patients.
Our research program’s physician–scientists conduct psoriatic arthritis clinical trials, as well as investigate several lines of research in the laboratory setting.
Psoriatic Arthritis Center Research
Many new psoriatic arthritis drugs have received FDA approval. In response, researchers in our Psoriatic Arthritis Center use our blend of translational and clinical research expertise to help physicians and patients make informed choices about which options are best for them. An extensive and expanding patient database, a biobank, and a growing roster of experts help Psoriatic Arthritis Center researchers reveal pathogenic mechanisms and refine therapeutic strategies.
Preventing Psoriatic Arthritis Cohort
Data collected from the Preventing Psoriatic Arthritis Cohort are helping Psoriatic Arthritis Center researchers better understand the disease. For example, scientists have found that about one third of patients with psoriasis eventually develop psoriatic arthritis. Our researchers are following people with psoriasis over time to determine which clinical, immunologic, and environmental factors may influence this outcome.
About 35 percent of the center’s patients with psoriatic arthritis have a first-degree relative with psoriasis but not psoriatic arthritis. This crucial observation led the center researchers to ask why some patients progress to psoriatic arthritis and others do not. Access to the first-degree relatives helps us pursue answers.
In addition, center researchers are tracking changes in joint and blood immune cells and in microbes present in the gut and skin at the time of arthritis disease progression in order to identify possible prevention targets. Through a recent National Institutes of Health (NIH) grant, researchers are exploring whether microbes may trigger psoriasis or arthritis and how the microbiome’s suite of drug-metabolizing enzymes may alter a patient’s response to conventional therapy or predict a regimen’s effectiveness.
Comorbidities and Psoriatic Arthritis
Dr. Scher and Dr. Reddy are co-investigators on an NIH-funded study led by the multicenter Psoriatic Arthritis Research Collaborative to determine whether less conventional clinical data on comorbidities, such as fatigue and certain patient-reported outcomes, can be incorporated into clinical trials. The project benefits from the Psoriatic Arthritis Center patient database, which has already helped NYU Langone researchers describe several significant comorbidities.
Notably, one in three women seen at the Psoriatic Arthritis Center takes medication for anxiety or depression. Attention deficit disorder is another comorbidity the researchers have identified. Both observations may be highly relevant to medication adherence, given that half of all patients with inflammatory arthritis stop their prescribed biologic therapy within the first six months. Researchers are studying whether controlling such comorbidities is beneficial in psoriatic arthritis treatment or helps with adherence to arthritis drugs.
Psoriasis and Psoriatic Arthritis Clinics Multicenter Advancement Network
An external partnership with the Psoriasis and Psoriatic Arthritis Clinics Multicenter Advancement Network (PPACMAN) enables our scientists to investigate whether a collaborative approach to patient care, such as the one available to patients with psoriatic arthritis at the multidisciplinary NYU Langone Orthopedic Center, yields more benefits than the prevailing standard of care. This joint effort with 10 other institutions and foundations in the United States and Canada also supports the development of a combined longitudinal database.
The Microbiome and Psoriatic Arthritis
Our researchers are developing a better understanding of the connection between the microbiome and psoriatic arthritis.
Differences in the Skin Microbiome
Dr. Manasson studies the skin microbiome of patients with psoriatic arthritis. She and her colleagues compare healthy subjects with patients who have only psoriasis of the skin and patients who have both psoriasis of the skin and psoriatic arthritis to identify differences along the disease spectrum. The overall goal is to determine why some patients with psoriasis go on to develop psoriatic arthritis while others never progress. Although many factors are likely at work, the research aims to determine whether differences in the skin microbiome might play a role. The research benefits from skin and stool samples from patients with psoriatic arthritis from Dr. Scher’s large and well-organized sample repository.
The Gut Microbiome’s Impact on Treatments
A separate project explores whether gut microbes modulate clinical treatments. This may help explain why the effectiveness of medications such as oral methotrexate varies among patients who have psoriatic arthritis. Preliminary evidence suggests that the makeup of a patient’s gut microbiome before methotrexate therapy may help predict response. The accumulating knowledge of how such drugs are metabolized by intestinal flora could provide similar insights into new-onset rheumatoid arthritis, which shares many of the same treatments.
Commensal Bacteria’s Effect on Skin and Joints
In another approach to studying the microbiome and its relationship with psoriatic arthritis, researchers are feeding commensal bacteria or their metabolites to lab animals and assessing the impact on their skin and joints.
The Division of Rheumatology has more than 100 years of experience conducting translational research of immune-mediated inflammatory diseases like psoriatic arthritis. The Psoriatic Arthritis Translational Registry and Biorepository, established in 2003, currently collects longitudinal clinical data and biospecimens from patients with psoriasis and psoriatic arthritis. The Microbiome Center for Rheumatology and Autoimmunity (MiCRA), created in 2009, studies the role of skin and gut microorganisms in rheumatoid arthritis, and has recently expanded to study the human microbiome’s role in psoriatic arthritis.
Our scientists are currently working on the identification of biomarkers (such as blood proteins, cells, and molecules) that predict whether an individual patient can respond to new psoriatic arthritis therapies or experience drug toxicity. Ongoing projects include research collaborations to identify biomarker profiles of arthritic disease susceptibility, with the ultimate goal to better understand the personalized response to biologic agents and disease progression.
Understanding Interleukin-17 Pathology
Among our many basic and translational research efforts, scientists study the pathology of interleukin-17 (IL-17) cytokine overproduction in animal models and examine how blocking the molecules released by proinflammatory Th17 cells may provide relief to patients.
By clarifying the anticytokine mechanism of new monoclonal antibodies targeting the IL-17 pathway, researchers hope to create a basis for physicians to recommend promising medications to specific patients with psoriatic arthritis, while considering potential side effects in the intestine.
For more information about our psoriatic arthritis research program, please contact firstname.lastname@example.org.