Management of psoriatic arthritis is increasingly focused on early identification of clinical, immunological, and tissue-based phenotypes that predict treatment response. However, there is also a role for lifestyle interventions to maintain a healthy weight, as supported by recommendations for people with inflammatory arthritis. The annual meeting of EULAR (European Union of Rheumatology Associations) set the stage for two groups to share new discoveries in these exciting fields.
Psoriatic arthritis is biologically heterogeneous and there is a lack of validated predictive biomarkers to select treatments. An oral abstract presentation on Wednesday 3 June at the 2026 EULAR Congress in London outlined the shift from disease-centered to tissue-centered care, with results from a real-world proof-of-concept study comparing the clinical effectiveness of a biopsy-driven treatment strategy to a standard approach based solely on clinical testing and laboratory evaluation in 35 patients with psoriatic arthritis. Synovial samples were evaluated and classified into three disease types: myeloid, lymphoid myeloid, and partially immune. Fifteen patients had myeloid CD117-positive synovial disease identified by immunohistochemistry and underwent a biopsy-driven strategy with biologics directed against IL-17, IL-23, or TNF. A matched control group of 20 patients was treated with biologics based on standard clinical judgment without biopsy guidance.
The primary clinical endpoint of low disease activity or remission was achieved in 68% of patients treated with biopsy, compared with only 45% of the control group. In patients with myeloid CD117-positive disease, the mean reduction in DAPSA at 6 months was significantly greater with IL-17 and -23 inhibitors compared with TNF inhibitors. Additionally, the quantitative burden of synovial inflammation was shown to influence treatment response. These findings suggest a biological basis for differential response to treatment and highlight the central role of the IL-17/23 axis in this subgroup.
”This real-world proof-of-concept study shows that a synovial biopsy treatment strategy is associated with improved clinical outcomes compared to standard clinical management in PsA.” said Simone Parisi on behalf of the research team in Turin, Italy, presenting the results of the study.These findings support a tissue-centered precision medicine approach in psoriatic arthritis and warrant confirmation in large prospective studies.”
Another new treatment strategy was presented by Lihi Eder, focusing on the role of diet, an area where current knowledge is limited. DIPSA is a multicenter randomized controlled trial of 92 patients with active psoriatic arthritis with a mean BMI of 33. This study was designed to assess whether a personalized dietary intervention can improve clinical outcomes compared to standard care. Participants were randomly assigned to either a Mediterranean diet, centered on a healthy food composition rich in olive oil and nuts, or a low-calorie diet aimed at weight loss and lower blood pressure, both with face-to-face consultation and telephone support from a nutritionist. The standard-of-care control group received a generic printed document containing non-personalized dietary advice.
All groups experienced modest and statistically significant weight loss compared to baseline by week 12, with no significant differences between the different approaches, although the primary endpoint was change in DAPSA. Here, DAPSA scores significantly decreased in the hypocaloric and control groups compared to baseline to week 24, with improvements seen in all groups by week 24, with no significant differences between groups. Improvements in pain, fatigue, and joint tenderness were observed in all arms.
Importantly, the magnitude of weight loss was significantly associated with improved clinical outcomes, independent of dietary intervention.
”These findings suggest that weight loss may be an effective adjunctive strategy to reduce residual disease activity in overweight and obese psoriatic arthritis patients, independent of the approach used.” said Lich Eder on behalf of his colleagues in Canada and the United States.
sauce:
European Union of Rheumatology Associations, EULAR
References:
- From disease-centered care to tissue-centered care in psoriatic arthritis: clinical impact of treatment stratification based on synovial biopsy. Presented at EULAR 2026. OP0071. Ann Rheum Dis 2026; DOI: 10.1136/annrheumdis-2026-eular.B.1257.
- Eder L et al. Dietary Intervention in Psoriatic Arthritis (DIPSA): A randomized controlled clinical trial. Presented at EULAR 2026. OP0070. Ann Rheumdis 2026; DOI: 10.1136/annrheumdis-2026-eular.B.545.
