The landscape has improved dramatically in the treatment of psoriasis and, although significant progress has been made in psoriatic arthritis (PsA), achieving equivalent outcomes has proven to be challenging for clinicians, researchers, and patients alike. Yet, based on the success seen in dermatology, there is considerable optimism that breakthroughs in rheumatology are on the horizon.
“If we were successfully able to discern the pathways that help us control the cutaneous component of psoriatic diseases, we can potentially do the same in PsA,” said Jose U. Scher, MD, the Steere Abramson Professor of Medicine and Director, New York University (NYU) Colton Center for Autoimmunity and the NYU Psoriatic Arthritis Center at NYU Grossman School of Medicine. “It is problematic because we don’t know who with psoriasis will develop synovial, axial and/or entheseal disease.”
During the Sunday, October 26, session Shifting the Spotlight: New Horizons in the Diagnosis and Management of Psoriatic Arthritis, Dr. Scher and others will discuss some of the challenges and opportunities associated with addressing early onset PsA. The session will take place from 4:15–5:15 p.m. in Room W375B of McCormick Place. On-demand access to recorded presentations will be available to registered attendees of ACR Convergence following the annual meeting through October 31, 2026.
Dr. Scher and his team are trying to shift the paradigm for PsA. If it is a part of psoriasis, then they want to stop PsA altogether — even before it begins.
“We are working to identify the molecular features, mainly immune-mediated, but also from the metabolic and cardiovascular systems and others, that can contribute to the transition,” Dr. Scher said.
Statistical data indicate that patients with psoriasis who are on biologic therapies tend to have less progression to PsA.
“Animal studies support the fact that if you modulate the inflammatory process in the skin alone, you can also prevent the transition,” Dr. Scher explained. “So, one idea is to aggressively treat psoriasis with whatever means necessary.”
In psoriatic disease, the production of new bone formation structures is mainly the residue of inflammation, “a genie that we cannot necessarily put back into the bottle,” he noted.
That means that physicians have to address the diagnosis as early as possible, an occurrence that depends on many factors, such as education, the referral processes, access to care, and communication between dermatology and rheumatology.
“All of which we have been pursuing in the field,” Dr. Scher said.
But even that may not be enough.
That is because the likelihood of a patient with a new psoriatic arthritis diagnosis to achieve remission after the first-line regimen (typically a biologic) is about 25%, compared with 80% for a dermatology patient.
“How do we address this gap? Psoriasis is linear, PsA is not linear,” Dr. Scher said.
Clinical trials have described combination therapy to be safe and more effective in cancer, for example, and also inflammatory bowel disease, he said. Colitis data show that a combination of anti-tumor necrosis factor (TNF) with interleukin-23 inhibition leads to remission in a larger proportion of patients compared to either biological alone with an acceptable safety profile. The same may be true in PsA.
Through public-private partnerships like the National Institutes of Health (NIH) Accelerating Medicines Partnership in Autoimmune and Immune Mediated (AMP AIM) diseases, as well as the Psoriasis & Psoriatic Arthritis Clinics Multicenter Advancement Network (PPACMAN), Dr. Scher and colleagues are studying the disease through the understanding of immunoendotypes with the goal of repurposing existing drugs that target associated pathways. The group is leveraging artificial intelligence (AI) for predictive modeling, employing remote monitoring and wearables, and exploring personalized therapies to improve outcomes in PsA.
Alexis Ogdie, MD, Professor of Medicine and Epidemiology at the University of Pennsylvania and Deputy Director of the Penn Center for Clinical Epidemiology and Biostatistics, will discuss new and forthcoming therapies for managing PsA.
Don’t Miss a Session
If you weren’t able to make it to a live session during ACR Convergence 2025 — or you want to revisit a session from the annual meeting — make plans to watch the replay. All registered participants receive on-demand access to scientific sessions after the meeting through October 31, 2026.