Junko Takeshita, M.D., Ph.D., MSCE, began the clinical research part of the symposium. She presented on addressing racial and ethnic health disparities in psoriasis. Health disparities exist for nearly every health condition, including psoriasis. In psoriasis, racial and/or ethnic disparities in disease burden, health care use, and treatment exist; however, there remains much to learn about disparities related to psoriasis. Further research will be critical to eliminating disparities in psoriatic disease outcomes, according to Dr. Takeshita.
Seemal Desai, M.D., FAAD, discussed psoriasis in skin of color. In individuals with darker skin types, clinical features of psoriasis include less prominent scaling by more violaceous discoloration and areas of hyperpigmentation. Dyschromia on other parts of the body can be more common, and there is potential for more cutaneous involvement. Dr. Desai urged health care providers to remember that atypical papulosquamous disorders in skin of color can be psoriasis and to keep in mind that cultural and access to care issues may be present in these populations. Related to the presentation by Dr. Takeshita, minority health disparities could affect treatment access. Additionally, geriatric patients require special treatment considerations.
Additional considerations when treating individuals with psoriatic disease are metabolic diseases and obesity. Alexis Ogdie, M.D., MSCE, presented on the impact obesity has on psoriatic disease, highlighting that metabolic disease and obesity are common and can influence treatment response. Data show that patients with PsA are obese years before their diagnosis and that obesity is associated with reduced function, more pain, and higher patient global assessment. However, modification of body weight can improve risk for PsA and that weight loss can improve therapy outcomes.
Michael Garshick, M.D., MS, next took to the podium to discuss in the intersection of psoriasis, inflammation, and cardiovascular risk. He showed evidence that the endothelium is damaged in psoriasis and the role of platelets in endothelial inflammatory activation. Furthermore, specific inflammatory transcripts are upregulated in the psoriasis endothelium. Investigations at New York University point toward specific mechanisms of accelerated atherosclerosis in psoriasis. There may even be a therapeutic benefit of aspirin in reducing vascular inflammation.
Seoyoung C. Kim, M.D., ScD, MSCE, discussed emulating trials with real-world data studies. Well designed and executed real-world data analysis can provide useful data for clinical or regulatory decision making. This can be important as the number of available treatments increase, and not all important and interesting questions can be answered with randomized clinical trials. A real-world data study design/analytic strategy can be largely similar to that of a randomly controlled trial except for the statistical approach to manage the lack of baseline randomization. Targeted trial frameworks can help to improve the clarity of a real-world data study design and improve data quality. However, substantial improvement in documentation/protocol registration and reporting are needed.
Wilson Liao, M.D., discussed the single cell omics of psoriatic disease. By using single cell omics, researchers can understand how distinct cell types may contribute to biology; this can be an advantage over bulk RNA-sequencing. Additionally, the heterogeneity and fluidity of cell types can be discovered. Dr. Liao discussed how diseased-driving cells may only constitute a small fraction of cells, including stromal cells. Additionally, the clonal enrichment of T cells suggests autoantigens may play a role.
Jose Scher, M.D., discussed the effects of the microbiome in psoriatic disease. He explained how some emerging data are implicating the human microbiome in disease pathogenesis in psoriatic disease. He further discussed multiomic platforms and how those could eventually lead to precision medicine strategies for drug efficacy and toxicity. He closed his discussion speaking about microbial features and targeted therapies as potential modulators of the progression from psoriasis to PsA.
The NPF Beverly Foster Lectureship was given by Mariana Kaplan, M.D., Chief of the Systemic Autoimmunity Branch and Deputy Scientific Director at NIAMS. Dr. Kaplan discussed the pathogenesis of systemic autoimmune diseases, specifically the neutrophil subsets and neutrophil extracellular traps (NETs). She discussed how NETS are a source of modified autoantigens and how they may promote pathogenic autoimmunity in predisposed hosts. Additionally, she explained that oxidation of nucleic acids appears to be an important pathogenic modification, which promotes type I IFN responses. Her talk closed discussing how targeting specific neutrophil subsets could contribute to the mitigation of vascular disease and end-organ damage in SLE as well as other autoimmune diseases.
Dr. Josef Penninger, M.D., Ph.D., discussed the discovery of ACE2 and how it may be used in the future to prevent and treat early SARS-CoV-2 infections. This is based on more than 2 decades of research that began with identifying how ACE2 functions and how it can protect from lung failure.
To inform the community about relevant research in other areas that may apply to psoriatic disease, speakers with varied expertise were included. Laura Donlin, Ph.D., spoke about autoimmune cellular cascades. She provided an overview of RA synovial subsets and macrophages before moving on to explaining findings from RA assays. She discussed how PsA tissues compared to RA, including related cellular findings. She closed her talk discussing research on immune checkpoint inhibitor (ICI)-arthritis and checkpoint therapy.
Nicole Ward, Ph.D., discussed how basic science can help to identify, treat, and prevent psoriatic disease comorbidities. After discussing how mouse models can be used to understand more about psoriasis pathogenesis, she spoke about how mouse models can be used to predict which psoriasis patients will develop PsA, identify novel human disease biomarkers, and whether they can be used to determine novel pathogenic pathways of PsA. Her talk ended with discussion about how personalized medicine and models could be used together to improve health outcomes.
Christopher Ritchlin, M.D., concluded the basic science portion of the presentations discussing the historical perspectives and future directions of PsA research and treatment. He explained that in the beginning there was limited PsA research and knowledge, and outcomes measurements were based on RA. He continued on, showcasing some of the more recent research. His talk closed discussing how the breadth of knowledge has expanded and all of the exciting advances that lie ahead.
The symposium is available in its entirety on-demand for people who were not able to join us in-person for the event.
Interested in receiving CME credit for viewing the on-demand content? Please email Samantha Koons at email@example.com for more information.