Advances in precision medicine in imaging and therapeutic strategies for psoriatic disease

Abstract

Psoriatic disease, encompassing psoriasis (PsO) and psoriatic arthritis (PsA), affects approximately 2 % of the global population. In the majority of cases, skin alterations occur first, followed by musculoskeletal disorders. The transition from cutaneous to synovio-entheseal disease reflects a gradual immune-driven progression from localized to systemic manifestations in most cases. Subclinical or non-specific symptoms often precede demonstrable synovitis or enthesitis, which further delays diagnosis and increases the risk of irreversible structural damage. Despite the critical importance of early detection, established risk factors for PsA are largely nonspecific, presenting challenges for precision medicine. Key amongst these is the presence of arthralgia, which usually precedes PsA development but is also common in degenerative and biomechanical problems. Recent advancements, encompassing cutting-edge imaging modalities, hold the potential to facilitate earlier and more precise detection of PsA, while groundbreaking therapeutic innovations are redefining treatment paradigms and may further integrate advanced imaging into personalized therapeutic strategies. This review explores the molecular and clinical complexity of psoriatic disease, highlights the latest developments in imaging and treatment, and considers their potential to revolutionize patient outcomes. Novel strategies promise advances in precision medicine and may pave the way for customized interventions that not only enhance the diagnosis and prognosis of psoriatic disease but also refine therapeutic decision-making. Innovative imaging techniques are essential to distinguishing psoriatic disease-related pain from alternative causes such as osteoarthritis, thereby guiding treatment continuation and optimization.

Keywords: Biological DMARDs; Imaging; Precision medicine; Psoriasis; Psoriatic arthritis; Targeted-synthetic DMARDs; Treatment.