PsA is a disease that often strikes young adults at the prime of their productive years and is associated with high work productivity loss. The mean annual direct cost of PsA in patients seen at my centre is $15,802, the cost being higher in those with severe disease. Delayed diagnosis and consequent inability to obtain appropriate treatment leads to worse joint damage and often long-term disability. The diagnosis of PsA is often delayed because current clinical assessment tools are subjective and rely considerably on physician judgment. These tools are unreliable in the hands of non-rheumatologists who usually are the front-line physicians coming into contact with patients. Currently no robust tools exist for the assessment of disease activity or for prognosis. My research targets clinical practices in diagnosis, evaluation and treatment of PsA. Using recent technological breakthroughs in ‘omics’ (proteomics, metabolomics, transcriptomics), bioinformatics, and augmented intelligence platforms and having access to a large cohort of well-phenotyped patients, I intend to develop tools to facilitate more efficient management of patients with PsA.
I envision developing innovative evaluation tools that physicians will use at initial point-of-contact with patients so that inflammatory arthritis and its associated comorbidities are identified early. Psoriasis along with its associated comorbidities– psoriatic disease– is especially suited for a collaborative approach since this relatively common skin disease is associated with musculoskeletal, gastrointestinal, ophthalmic, cardiovascular and psychiatric comorbidities. My strength in building well-fit collaborations will ensure comprehensive results. My focus is on early diagnosis, prognostication and treatment of PsA. Among the inflammatory arthritides, PsA provides a unique opportunity for early diagnosis and prognostication since most patients develop PsA either simultaneously with or after onset of psoriasis. I intend to evaluate psoriasis subjects as a target high-risk group to identify PsA; this strategy will be more efficient than screening the general population. My knowledge transfer and exchange (KTE) activities include conducting studies to define the current level of awareness of and practices relating to the diagnosis and referral of PsA and its comorbidities among clinicians and patients.
The specific goals of my research program over the next 5 years are to:
- develop a soluble biomarker-based screening tool for PsA
- identify biomarkers for joint damage in PsA
- identify mechanisms for persistent synovial inflammation in psoriatic joints
- identify novel drug targets for management of PsA
- establish community-based registry of patients with PsA.
My translational research endeavour aims to develop integrated identification and care pathways with targeted aggressive therapy to improve long-term PsA outcomes. Simultaneously, integrated KTE studies with patient-research partners, dermatologists and rheumatologists will focus on evaluating the barriers to identifying and stratifying PsA.
Future studies will evaluate clinical performance and cost-effectiveness of biomarker-based approaches to routine clinical evaluation. PsA has a significant economic impact; annual healthcare costs are considerable. Delayed diagnosis and disease severity is associated with higher costs. Early diagnosis and better treatment will prevent joint damage, reduce disability, limit comorbidities, and improve quality of life of more than a million Canadians suffering from psoriasis and PsA.
The University of Toronto Psoriatic Arthritis (PsA) Research Program located at Toronto Western Hospital has established large prospective cohorts of patients with psoriatic arthritis and psoriasis as well as healthy controls. Patients are well phenotyped with the collection of extensive clinical, laboratory and radiographic information on a longitudinal basis. Corresponding biologic specimens are routinely collected and banked. The PsA Program also includes a basic science laboratory consisting of 300 feet located on the 5th floor of the Krembil Discovery Tower allowing for extensive translational work in biomarker discovery and drug development.
The PsA Program is the coordinating centre for International Psoriatic Arthritis Research Team (IPART) and has been selected as the core facility for the BioDam project of the international Group for Research and Assessment of Psoriasis and Psoriatic Arthritis (GRAPPA) to identify biomarkers for damage in psoriatic arthritis.