One in three people with psoriasis will develop psoriatic arthritis, yet doctors cannot predict who or how to stop it. This fellowship tackles two linked problems. First, there is no way to identify which psoriasis patients will progress to arthritis, so prevention is impossible. Second, once diagnosed, no evidence-based strategy exists for combining or sequencing the growing number of available drugs. The researcher leads a European study of 25,000 people with psoriasis, using digital biomarkers to build prediction tools and design prevention trials. For established disease, they will co-design a national platform trial that tests treatment sequences and precision medicine approaches, embedding research directly into NHS clinics. If successful, this work could transform psoriatic arthritis care. Prediction tools would allow early intervention to prevent joint damage. A flexible trial platform would generate rapid, real-world evidence on which drug combinations work best for which patients, reducing disability and streamlining NHS treatment pathways. The model could then extend to other chronic diseases, making routine care a site of continuous learning rather than delayed evidence.
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Research question What is the best strategy for predicting and preventing the transition from psoriasis to PsA management of PsA (James Lind Priority Setting Partnership priorities) Background Psoriatic arthritis (PsA) affects up to one-third of people with skin psoriasis and is the second commonest form of inflammatory arthritis causing significant pain, radiographic joint damage and disability. Currently we cannot predict which patients will develop arthritis and we cannot intervene in this 'at-risk' stage to potentially prevent arthritis. After diagnosis, there are no evidence-based treatment strategies on how to combine, sequence and personalise treatment to control arthritis despite increasing numbers of available drugs to treat PsA. Aims and objectives This fellowship aims to optimise care of psoriatic disease by: Leading a European online study of people with psoriasis to develop prediction tools for arthritis and design studies to prevent development of PsA Developing a co-designed national pragmatic platform treatment trial in PsA leveraging available drugs to deliver better patient care Utilising modern research methods within NHS systems to minimise the burden of research, supporting inclusion of underserved groups, and embedding research within NHS clinics supporting changes in NHS care delivery Developing a national network of researchers supporting pragmatic studies in rheumatology addressing key unmet needs and providing rapid implementation. This project and associated training plan will support my personal objective to become an international leader of novel, digitally supported, clinical research embedded into, and supporting, routine NHS care in rheumatology and beyond. Methods - pre-PsA I will develop prediction tools for development of PsA using the HIPPOCRATES Prospective Observational Study (HPOS), a prospective European psoriasis cohort of 25,000 people with embedded digital biomarkers which I lead. This will allow me to co-design European studies aiming to prevent progression to PsA with lifestyle or medication interventions. Methods - Early and established PsA I will develop a sequential multiple assignment randomised trial platform study for PsA addressing treatment strategy, including Co-design workshops and surveys of people living with PsA (including underserved communities) and their clinicians to select outcome measures including remote, digital biomarkers collecting detailed, objective health data with minimal burden. Statistical modelling using MONITOR study data to address use of remote outcome measures and the impact of variable follow-up times introduced by current NHS outpatient service redesign. Co-design workshops to design and prioritise interventions for trials including initial treatment algorithms and investigation of sequencing, comparison, and precision medicine approaches to biologics. Co-design of 2 interventional studies ready for submission Timelines Nine-month set up. 9-month co-development of core sets and outcomes followed by 9-month focus on interventions. In parallel, 24-month statistical modelling using MONITOR data. Year 3, the cohort opens. Year 4/5, design of two interventional studies. Anticipated impact and dissemination This platform will transform PsA rheumatology research streamlining international efforts to optimise treatment strategy and inform treatment recommendations. Co-design processes and protocols will be published and publicised in lay form with patient organisations such as Psoriasis Association. This model can then be translated to other chronic disease areas.
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