Learning hub

Over onze consortium partners Vasilis Charisis Signal Processing & Biomedical Technology Unit (SPBTU) – Aristotle University of Thessaloniki Position Principal researcher focusing on the development of digital biomarkers and their translation into healthcare tools and interventions. What is your role in iPROLEPSIS? Scientific and Technical Coordinator. What are your main activities in the project? I manage the project's day-to-day operations and scientific coherence, driving the timely delivery of outcomes. Our team (SPBTU) is pioneering the use of AI and digital biomarkers from everyday smart devices to create predictive models for PsA symptoms. We are also developing a dedicated mobile app that supports patients by improving sleep patterns using binaural beat technology. What is your motivation? My motivation is rooted in a long-standing commitment to improving chronic disease management through accessible, non-invasive technology. In iPROLEPSIS, I am driven to apply advanced AI and biomedical engineering principles to address the significant challenges faced by PsA patients. We aim to create tangible, personalized digital tools that not only predict disease flares early but actively enhance patients' quality of life, ensuring our cutting-edge research delivers real clinical benefits. Coordination Clinical Experts Data Science Software Development Ethics, Legal and Exploitation Dissemination and Communication

Over onze consortium partners Konstantinidis Dimitrios CERTH Position Postdoctoral researcher What is your role in iPROLEPSIS? Researcher and technical developer What are your main activities in the project? I am mainly involved in the research activities of CERTH, concerning psoriatic nail detection and classification, range-of-motion assessment through the execution of active video tests and nutrition and physical activity recommendations. What is your motivation? I am deeply passionate about artificial intelligence and deep learning, with a strong interest in uncovering hidden patterns within data that can lead to highly accurate and reliable predictions. I find great satisfaction in developing advanced machine learning techniques to transform data into innovative solutions that contribute to real-world progress. Nikos Melanitis Ainigma Position Data Scientist What is your role in iPROLEPSIS? Data Scientist, Digital health and predictive modelling What are your main activities in the project? To design and implement novel approaches for improved management of PsA, through personalized models that warn patients for high risk of PsA exacerbation (flare). What is your motivation? To be part of the digital innovation in Health, enabling better disease management and personalised, precision medicine. Kosmas Dimitropoulos CERTH Position Principal Researcher (Researcher of Grade B’) What is your role in iPROLEPSIS? Principal Investigator for CERTH What are your main activities in the project? I am mainly involved in the research activities of CERTH, concerning psoriatic nail detection and classification, range-of-motion assessment through the execution of active video tests and nutrition and physical activity recommendations. What is your motivation? I am deeply motivated by the intersection of Artificial Intelligence and healthcare. I aspire to contribute to research that applies deep learning techniques to personalized medicine, enabling more accurate, data-driven, and patient-specific approaches to diagnosis and treatment. Eleni Vasileiou Signal Processing & Biomedical Technology Unit (SPBTU) – Aristotle University of Thessaloniki (AUTH) Position Research assistant working on digital health technologies and AI-enabled healthcare tools What is your role in iPROLEPSIS? AI Researcher & Data Scientist | Digital health and predictive modelling What are your main activities in the project? My main activities focus on developing digital, passively captured indicators that support risk prediction and monitoring models for psoriatic arthritis. I work on digital phenotyping of inflammatory symptoms with an emphasis on tracking motor manifestations using smart devices and wearables. This involves designing methods to analyze data from daily living activities – such as sleep, walking, and hand movements – to capture subtle physiological and behavioral changes associated with disease onset and progression. These efforts aim to identify key drivers of psoriatic arthritis and support personalized models for disease risk, progression prediction, and inflammation monitoring. What is your motivation? I am deeply motivated by the potential of digital health technologies to bring a more human and data-informed approach to healthcare. By combining AI with continuous, real-world data, we can reveal patterns often hidden in traditional clinical assessments. What drives me is the belief that these insights can empower both patients and clinicians to make earlier and more informed decisions, ultimately improving health outcomes and quality of life. My goal is to contribute to a future where technology enhances understanding, prevention, and personalized care for chronic conditions. Coordination Clinical Experts Data Science Software Development Ethics, Legal and Exploitation Dissemination and Communication

Over onze consortium partners Gail Heritage University of Oxford Position Senior Research Manager What is your role in iPROLEPSIS? UK PDPID coordinating center Manager What are your main activities in the project? UK Study manager What is your motivation? Contribution to clinical research to enhance patient experiences and disease outcomes. Francesca Levi-Schaffer The Hebrew University of Jerusalem, Israel Position Professor What is your role in iPROLEPSIS? Researcher What are your main activities in the project? To try to understand the passage from psoriasis to psoriatic arthritis by evaluating in skin biopsies vascularization, mast cell presence and to correlate this with involved joint vascularization What is your motivation? I would like to discover the connections between skin and joints and find a drug/s that can inhabit this progression Laura Coates Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford Position NIHR Research Professor What is your role in iPROLEPSIS? Lead for WP5 (clinical studies) What are your main activities in the project? I oversee all of the clinical studies within the consortium. What is your motivation? I am a rheumatologist who has worked in research in psoriatic arthritis for around 20 years. My interest is in improving outcomes for people living with psoriatic arthritis and I believe that work in this project can help us to predict, monitor and understand the disease better in day to day clinics. Coordination Clinical Experts Data Science Software Development Ethics, Legal and Exploitation Dissemination and Communication

Over onze consortium partners Kristina Leipuviene SmartSol SIA Position Project manager What is your role in iPROLEPSIS? Dissemination/Communication lead What are your main activities in the project? Leading and planning communication and dissemination activities. SmartSol team also supports networking and clustering with stakeholders. What is your motivation? As leaders of WP6, SmartSol aims to increase awareness of iPROLEPSIS and make it accessible to everyone. We focus on sharing information, raising awareness about psoriatic arthritis, and making a lasting impact through thoughtful planning and engagement with the public. Coordination Clinical Experts Data Science Software Development Ethics, Legal and Exploitation Dissemination and Communication

Over onze consortium partners Dr. Ioannis Drivas DIADIKASIA BUSINESS CONSULTING SYMVOULOI EPICHEIRISEON AE (DBC) Position Principal researcher focusing on the development of digital biomarkers and their translation into healthcare tools and interventions. What is your role in iPROLEPSIS? Project Manager What are your main activities in the project? As Project Manager, I coordinate all iPROLEPSIS-related activities assigned to DBC. What is your motivation? My motivation stems from a strong commitment to upholding ethical and legal standards in research while maximizing the impact and real-world use of the iPROLEPSIS results. Coordination Clinical Experts Data Science Software Development Ethics, Legal and Exploitation Dissemination and Communication

Over onze consortium partners Francisco Cardoso PLUX Position Software Developer What is your role in iPROLEPSIS? Monitoring Engineer What are your main activities in the project? I define SLIs/SLOs, design telemetry (metrics, logs, traces), build alerts and dashboards, run incident response/postmortems, and align data retention and security with compliance. What is your motivation? I’m motivated by making complex systems trustworthy. Turning real-time signals into fast decisions that reduce downtime and protect participants and data. Hugo Humberto Plácido da Silva PLUX Position Founder & Chief Innovation Officer What is your role in iPROLEPSIS? Principal Investigator representing PLUX. What are your main activities in the project? Internal management of the project at the board/administration level. Our team is making substantial contributions to the development of digital biomarkers (dBMs) that can be acquired using a smart belt. Furthermore, we are responsible for the iPROLEPSIS system orchestration, verification, and monitoring. What is your motivation? Psoriatic Arthritis (PsA) is a highly conditioning disease that currently affects a significant number of patients globally. Existing assessment and management methods are mostly bound to a clinical setting, involving complex protocols, therefore only of limited access to patients. For as long as I can remember, my work has been centered around purpose-driven innovations in the healthcare space; the possibility to explore novel dBMs as a way of improving the lives of PsA patients constitutes a once-in-a-lifetime opportunity and purpose like none other. Sofia Balula Dias Faculdade de Motricidade Humana Position Principal Investigator representing FMH partner What is your role in iPROLEPSIS? As Principal Investigator, I lead the design and development of a serious games-based intervention tool specifically tailored to support individuals living with Psoriatic Arthritis. What are your main activities in the project? Our multidisciplinary team is leading the development of the iPROLEPSIS serious games application to support Psoriatic Arthritis patients. Through co-creation with patients and collaboration across research, clinical, and design fields, we’re tailoring game mechanics and biofeedback features to meet real needs and preferences. Our work involves prototyping, testing, and refining therapeutic content designed to improve mobility, support pain management, reduce stress, and promote self-management, ultimately contributing to a more holistic and patient-centered approach to chronic care. What is your motivation? I am driven by the opportunity to improve the lives of PsA patients through non-pharmacological, technology-driven interventions. Serious games present an innovative and empowering method for symptom management and patient engagement. To date, there are no serious games specifically tailored to the needs of individuals with PsA, making this work both timely and impactful. Rodrigo Duarte Braga PLUX Position Research Collaborator What is your role in iPROLEPSIS? Systems Engineer What are your main activities in the project? I coordinate system orchestration, verification, and monitoring. I also lead the Smartbelt's technical development, from data acquisition and processing device data to building machine learning models. What is your motivation? Tackling complex challenges and developing innovative solutions and medical devices that create tangible value. Sérgio Lopes da Fonseca PLUX Position Project Manager What is your role in iPROLEPSIS? PLUX’s contribution to iPROLEPSIS management. What are your main activities in the project? Aligning timelines, deliverables, and resources across partners. I manage work-package commitments, budget and risks, and represent PLUX in steering and technical meetings to keep decisions action-oriented and on schedule. What is your motivation? To turn research into deployable, user-centred solutions. I’m driven by projects that measurably improve clinical workflows and patient outcomes—while creating a clear path from prototype to scalable product. iPROLEPSIS is a chance to do all three: integrate wearable biosignals seamlessly, prove value in real settings, and accelerate European med-tech competitiveness. Coordination Clinical Experts Data Science Software Development Ethics, Legal and Exploitation Dissemination and Communication

Learning hub Explore resources to help you understand and manage psoriatic arthritis. Learning hub Key Facts Handbook News Feed Quizzes Search RSS News Feed Psoriatic Arthritis articles within Nature Reviews Rheumatology Journal of Psoriasis and Psoriatic Arthritis National Psoriasis Foundation

Learning how to live with psoriatic arthritis might feel like a challenge. But understanding your diagnosis can help you take control of your health. Learning hub Explore resources to help you understand and manage psoriatic arthritis. Handbook Learning hub Key Facts Handbook News Feed Quizzes Search Handbook 1 Psoriatic Arthritis Handbook Understanding Psoriatic Arthritis h1.1 What is psoriatic arthritis? Psoriatic arthritis is a type of arthritis linked with psoriasis, a chronic skin and nail disease. Psoriasis causes red, scaly rashes and thick, pitted fingernails. Psoriatic arthritis is characterized by joint swelling (inflammation), pain and stiffness and can affect any peripheral joint such as fingers, toes, knees and/or spine. It also affects the insertion of tendons or ligaments in bones (enthesitis). Between 20-40% of people with the skin condition psoriasis will develop psoriatic arthritis (1, 2). Symptoms affecting their joints tend to develop 5 to 10 years after psoriasis is diagnosed but it can occur at any time (3). Currently, it is not clear why some people with psoriasis develop psoriatic arthritis while others do not. The arthritis of psoriatic arthritis comes in 3 forms: oligoarticular arthritis that affects 4 or less peripheral joints (e.g., joints in the fingers, toes, knees); polyarticular arthritis that involves 5 or more peripheral joints on both sides of the body; and axial arthritis that affects the joints of the spine including the sacroiliac joint (where the spine connects to the pelvis). Some people may develop psoriasis after or at the same time as symptoms of psoriatic arthritis present themselves (4). In rare cases, people may have psoriatic arthritis and never have any noticeable symptoms of psoriasis. Psoriatic arthritis and psoriasis are chronic inflammatory conditions that are caused by a fault in the immune system. Our immune system protects us from infection and illness. See related Key Facts section What causes psoriatic arthritis? While psoriatic arthritis can occur at any age, most people present their first signs and symptoms at 30-50 years. Psoriatic arthritis is most likely to be diagnosed within the first ten years of the psoriasis diagnosis (3). Psoriatic arthritis affects both sexes equally. However, the manifestations in terms of severity and impact of the disease differ between sexes. Men are more likely to have involvement of the bones in the spine (axial arthritis) and radiographic damage in the spine and peripheral joints (e.g., fingers, knees and toes), whereas women are more likely to experience impaired quality of life and severe limitations in function (5). Researchers are not sure why some people develop psoriatic arthritis. It is thought that certain genes inherited from parents and grandparents can make a person more likely to develop psoriatic arthritis (6–8). h1.2 In people with a higher genetic predisposition to develop psoriatic arthritis, the condition can be triggered by environmental factors, such as: an infection (9); an accident or injury (10, 11); being overweight (12); smoking (13, 14). Psoriasis and psoriatic arthritis are not contagious. You cannot catch psoriasis or psoriatic arthritis from other people. See related Key Facts section What are the symptoms of psoriatic arthritis? Psoriatic arthritis symptoms usually develop slowly, that is, many people are unaware that they are developing psoriatic arthritis (Figure 1). Although symptoms can develop suddenly in rarer cases. Some of the main symptoms include (15): pain in one or more joints; swelling in one or more joints; stiffness in one or more joints that lasts for 30 minutes or longer. These symptoms are caused by inflammation and can affect any joint in the body. See Figure 2 for the most commonly affected joints. See related Key Facts section h1.3 Psoriatic arthritis can cause pain and swelling in the entheses, that is, places in the body where tendons and ligaments connect to the bones (15). When the entheses become inflamed it is known as enthesitis. Enthesitis pain can spread along a wider area than joint pain. It frequently occurs at the back of the heel or on the bottom of the foot, which can make standing or walking difficult. Affected areas feel tender to touch even when just a small amount of pressure is applied. The knees, hips, elbows and chest can also be affected by enthesitis. Many people with psoriatic arthritis have swollen fingers or toes, a condition that is known as dactylitis (15) (Figure 1). It most commonly affects one or two fingers or toes at a time. Psoriatic arthritis can also cause small round dents in fingernails and/or toenails, a condition known as pitting. The nails can change colour, become thicker, or even lift away from your finger (15). People living with psoriatic arthritis may feel very tired (fatigued) and some may have a low-grade fever. Fatigue does not get better with rest. Psoriatic arthritis symptoms may come and go. A period of increased inflammation and worsening of other symptoms is called a flare. A flare can last for days or months See related Key Facts section h1.5 How is psoriatic arthritis diagnosed? A timely and accurate diagnosis is an important step for optimising care and improve long-term health outcomes (16). If you have been diagnosed with psoriasis in the past, and symptoms of arthritis (e.g., painful or swollen joints) have started more recently, you may have developed psoriatic arthritis. However, the symptoms of psoriatic arthritis can look like other health conditions. Make sure to see your healthcare provider for a diagnosis. The doctor you see first may depend on whether you have previously been diagnosed with psoriasis. If you develop symptoms of arthritis your primary care or skin doctor should refer you to a rheumatologist – a doctor who specialises in joint conditions – for an assessment. Tell your doctor if you have a history of psoriasis and/or psoriatic arthritis in your family. CURRENTLY, NO SINGLE TEST CAN CONFIRM PSORIATIC ARTHRITIS (15). A diagnosis will be made based on your medical history, symptoms, and a physical examination by your doctor. Your doctor may order X-rays or other types of imaging, such as ultrasound scans and magnetic resonance imaging (MRI), to look for changes to your bones and joints. Imaging studies will help your doctor determine the type and pattern of joint involvement, which can also help them distinguish between arthritis types. Blood tests, such as erythrocyte sedimentation rate and C-reactive protein, can help to identify inflammation. Your doctor may also order tests for rheumatoid factor and the anti-CCP antibody to rule out rheumatoid arthritis and HLA-B types to look for your genetic predisposition to spondylarthritis. See related Key Facts section h1.4 See related Key Facts Previous page Next page

Learning hub Explore resources to help you understand and manage psoriatic arthritis. Learning hub Key Facts Handbook News Feed Quizzes Search Psoriatic Arthritis Handbook Intimacy, Reproductive Health and Family Life Handbook How will psoriatic arthritis affect me? RELATIONSHIPS AND SEX Psoriatic arthritis can present a number of challenges in a relationship, namely: reduce your enjoyment of sex and other activities you share with your partner; affect your mood and self-esteem; impact your ability to contribute to household and family related duties; lead to financial worries if your condition affects your ability to work. Although your relationship may change because of psoriatic arthritis, you should remember that most couples go through phases in their relationship that are more or less positive, depending on a number of factors such as stress, work-life balance, or other health conditions. See related Key Facts section h4.1 h4.3 Talking to your partner about any changes or challenges you may be facing is a great way to improve communication in the relationship and arrive at solutions to please both of you. If you are not in a relationship and worry about how your condition may affect your prospects of finding a romantic partner, especially if you have visible signs of the condition, keep in mind that most relationships develop gradually and that shared interests are more important than physical considerations. While sex will not make your psoriatic arthritis worse, it can sometimes be painful when you move an affected joint. Besides the physical aspect, psoriatic arthritis may decrease your sex drive, affect your self- confidence, or make you feel less attractive. Psoriatic arthritis can sometimes lead to a dry vagina, and thus to uncomfortable sex. If this is the case, water-based lubricants can help you and/or your partner. Oil-based lubricants may irritate your skin or damage condoms. To help you overcome difficulties with sex, you should: talk openly with your partner about your physical and/or emotional concerns; keep active as physical exercise can help you strengthen your muscles and support your joints; take painkillers approximately one hour before having sex to minimise pain; try different positions and use cushions, pillows, or furniture to support your body; remember that there are multiple ways to achieve sexual satisfactions, such as kissing, caressing, mutual masturbation, oral stimulation, or even sex aids such as vibrators. See related Key Facts section FERTILITY, PREGNANCY, AND BREASTFEEDING If you are planning to start a family, you should discuss your treatment plan with your rheumatologist, as some medications are not safe in pregnancy. It is completely normal to feel concerned about the effect of your condition on your ability to start a family. People with arthritis may take slightly longer to become pregnant. It is best to try for a baby when your condition is not very active. There is a genetic contribution to psoriatic arthritis, that is, the presence of certain genes makes a person more likely to develop the condition. However, this is not a strictly hereditary condition. There are many factors involved in the development of psoriatic arthritis, not just the genes inherited from parents. Therefore, in the vast majority of cases the chances of passing it on to your children are relatively low. FERTILITY In women, there is no evidence to support that psoriatic arthritis affects fertility (51). However, a recent study indicated that untreated inflammatory arthritis, such as psoriatic arthritis, may decrease male fertility (52). In both women and men, fertility does decrease with age or may be affected by other health conditions. h4.2 Therefore, some people living with psoriatic arthritis will need fertility treatments. If your psoriatic arthritis is under control, there should be no problem to initiate fertility treatments. Discuss any plans for fertility treatments with your rheumatologist. They can offer specific advice, review your treatment plan, and liaise with the medical team responsible for your fertility treatment. See related Key Facts section PREGNANCY AND BREASTFEEDING Discuss your plans to start a family with your rheumatologist so that your treatment plan can be adjusted. If you become pregnant unexpectedly, talk to your rheumatologist as soon as possible. All women get aches and pains during pregnancy. As the baby grows, you may feel additional strain on some of your joints, especially on your hips and knees. While there is not a lot of information on the effects of pregnancy in psoriatic arthritis, studies have shown that the majority of women living with rheumatoid arthritis experience some form of symptom improvement during pregnancy. However, some women will have a flare after giving birth. Psoriatic arthritis usually does not affect delivery and you can still give birth through your vagina. If you are considering a caesarean, you should discuss this with your doctors (rheumatologist and obstetrician). It may be necessary to stop some of your medications before the surgery. You should continue anti-rheumatic drugs that are safe in pregnancy during pregnancy and breastfeeding. This will reduce your chances of any complications during pregnancy and will make flares less likely after giving birth. Many mothers feel sad, tearful, or anxious in the first two weeks after having a baby. However, if these symptoms last for longer or start later on, you may have post-natal depression, which affects 1 in 10 women after giving birth. It is important to seek medical help if you feel this way. See related Key Facts section h4.4 Remember that you are not alone. If you need extra support, please speak to your GP or Health Visitor. More information can be found below: NHS Mental Health Services https://www.nhs.uk/nhs-services/mental-health-services/ NHS Postnatal Depression https://www.nhs.uk/mental-health/ conditions/post-natal-depression/overview/ Be kind to your joints and your mind. See related Key Facts Previous page Next page

Learning how to live with psoriatic arthritis might feel like a challenge. But understanding your diagnosis can help you take control of your health. Learning hub Explore resources to help you understand and manage psoriatic arthritis. Learning hub Key Facts Handbook News Feed Quizzes Search Psoriatic Arthritis Handbook Living with Psoriatic Arthritis Handbook How will psoriatic arthritis affect me? WORK Work can provide a sense of purpose, identity, achievement, and a supportive social network, contributing positively to your emotional and physical wellbeing. While your condition may pose some challenges, people living with psoriatic arthritis can continue to work as long as their profession does not exacerbate their symptoms and worsen their health. People with certain health conditions have defined rights set out in law, designed to protect them against direct and indirect discrimination in the workplace. Your employer is legally obligated to make “reasonable accommodations” to your working environment and practices to ensure your condition does not prevent you from doing your job to the best of your ability and in a comfortable and safe environment. h3.1 In the European Union, the definition of reasonable accommodation at work was introduced by Article 5 of the Employment Equality Directive (Directive 2000/28/EC): “shall take appropriate measures, where needed in a particular case, to enable a person with disability to have access to, participate in, or advance in employment, or to undergo training, unless such measures would impose a disproportionate burden on the employer.” This directive has been transposed into national law in all EU member states. Research has shown that people who need workplace accommodations and effectively use them are more likely to keep a job and stay productive than those who do not use workplace accommodations (39). However, asking for workplace accommodations can be difficult. You may be concerned about being treated differently and negative reactions from your supervisor(s) or colleague(s). For this reason, you may prefer to negotiate informal workplace accommodations rather than seeking formal accommodations. Some of these accommodations may include those supported by the American College of Sports Medicine guidelines for physical activity and public health (40) and the ISO 11226 standard , https://www. iso.org/standard/25573.html , which defines joint limits to safeguard musculoskeletal health. By aligning workplace practices with these scientifically supported guidelines, employers and healthcare professionals can better accommodate the needs of their employees, fostering an inclusive and supportive work environment. Some examples follow: Recommendation #1: Avoid working for prolonged periods in the same position, whether sitting or standing. During the work shift: a continuous period of time in the standing position should not exceed 1 hour; the total time spent in a standing position should not exceed 4 hours; continuous sitting should be limited to 2 hours; when periods are dedicated to holding meetings, the duration of which should be reasonable, consideration should be given to the possibility of having them while standing or walking (41). Recommendation #2: Take frequent breaks throughout the shift. Please note that he definition of “breaks” must consider the following characteristics: Frequency: number of breaks/interruptions during the working day; Duration: micro-breaks (less than 2 minutes); short breaks (typically those that occur in the morning or afternoon, lasting between 7 and 10 minutes); or long breaks (meal breaks); and Type: passive or resting and active (including stretching or walking) (42). Thus, in an 8-hour working day, a worker should take at least a 7–10-minute break after consecutive 90-minute work periods. Recovery periods can include moments of rest or the performance of any other task to recover the muscle groups that have been worked. Within a period of at least 90 minutes, a worker should enjoy at least 30 seconds after 20 minutes of work. Both recommendations aim to address the prolonged exposure to low-intensity static load by limiting the duration of this exposure. These interventions help to alleviate fatigue and pain symptoms in the short-term, and to prevent work-related musculoskeletal injuries in the long-term. Active breaks add value; however, they do not replace the need to introduce diversity in the intensity of the mechanical load, such as rotational planes suited to the job’s demands (43). Please note that these recommendations refer to low-intensity, physically demanding tasks. Other recommendations apply to high-intensity tasks, such as those involving manual force. Recommendation #3: Physical changes to workstations work surfaces (desks) that allow alternation between standing and sitting, alone or combined with a training and information program for workers, reduce sitting time by approximately 60 minutes per working day (in the medium term, i.e., up to 3-12 months). This change in physical working conditions can bring about a behavioural change, with repercussions in an average reduction of 82 minutes in total sitting time per day (at and away from work) and in the average duration of consecutive periods of sitting (57 minutes) (42, 44). Even though workplace adaptations are consigned in the law, many people living with rheumatic and musculoskeletal diseases report a lack of understanding from their employer(s), colleague(s), and workplace doctor(s). You have options and rights; it is important to understand them and fully explore all available alternatives. If you are unsure about your rights in the workplace, please get in touch with your HR or occupational health department. More information can be found below: The Advisory, Conciliation and Arbitration Service. (ACAS) https://www.acas.org.uk/reasonable-adjustments If you require workplace adaptations, please talk to your assistant doctor about the difficulties you have been feeling and request reports to present to your employer and/or workplace doctor. See related Key Facts section SLEEP Pain, anxiety, and side effects of the medication can make it more difficult for a person with psoriatic arthritis to fall asleep and stay asleep throughout the night. In fact, about 40% of people living with psoriatic arthritis report sleep difficulties (45). Good sleep hygiene habits may help to improve sleep: develop a regular sleep routine, that is, go to bed and get up at a similar time each day; avoid caffeine, alcohol, and large meals before you go to bed; if you smoke, try to stop smoking, or at least do not smoke close to bedtime; a warm bath before bedtime may help ease pain and stiffness; listen to soothing music or sounds before going to bed; avoid watching TV and using computers, tablets, or smartphones in your bedroom; make sure your bedroom is dark, quiet, relaxing, and at a comfortable temperature. h3.2 The impact of exercising before bedtime can vary among individuals. It is essential to listen to your body, establish a consistent routine, and pay attention to how evening workouts affect your sleep patterns. If you have specific concerns about your sleep or exercise routine, it is also advisable to consult with a healthcare professional or a fitness expert. Pros: Improved sleep quality: For some people, engaging in moderate-intensity exercises a few hours before bedtime may promote better sleep quality. It can help reduce stress and anxiety, leading to a more relaxed state conducive to sleep. Body temperature regulation: Exercise increases body temperature, and the subsequent drop in temperature after exercise can signal the body that it is time to sleep. This mimics the natural temperature drop that occurs during the evening. Establishing a routine: Regular exercise, regardless of the time of day, can contribute to better sleep quality. Establishing a consistent exercise routine is often more important than the specific time of day. Cons: Stimulating effect: For some people, intense exercise close to bedtime may have a stimulating effect, making it more challenging to wind down and fall asleep. Body temperature: While the drop in body temperature after exercise can promote sleep, exercising too close to bedtime may disrupt the body’s natural cooling process, potentially interfering with sleep. Individual variability: People respond differently to exercise timing. Some may find that late-night workouts do not impact their sleep, while others may experience difficulties. Recommendations: Timing matters: Try to finish exercising at least 2-3 hours before bedtime to allow your body temperature to return to normal and your adrenaline levels to decrease. Listen to your body: Pay attention to how your body responds to evening workouts. It might be a good fit for you if it helps you relax and improves your sleep. Experiment: Everyone is different. Experiment with varying timings of exercise to see what works best for you. If evening workouts negatively impact your sleep, consider shifting them earlier. Moderation is key: Intense or vigorous exercise close to bedtime might be more likely to interfere with sleep. Opt for moderate-intensity activities in the evening (47). Nearly 50% of patients living with psoriatic arthritis report high levels of fatigue (five or higher on a 10-point scale) and consider fatigue a high-ranking problem, after joint pain and before skin issues (48). See related Key Facts section FATIGUE Problem solving, planning, prioritising, and pacing may help you cope better with your fatigue: PROBLEM SOLVING Identify factors / tasks / chores / activities that are contributing to your fatigue; Think about solutions that could help minimise the impact of these factors/tasks/chores/ activities. PLANNING Plan the tasks/chores/activities you want to complete in a day or week; Make sure to include activities that you enjoy and can improve your mood/wellbeing; Do not beat yourself up if you cannot stick to the plan. PRIORITISING Organise your tasks/chores/activities by order of importance. PACING Do not use your energy all in one go; Break the planned tasks/chores/activities into smaller portions that can be spread out over the course of a day, a week or even longer. See related Key Facts section EMOTIONAL WELLBEING Living with psoriatic arthritis can take a toll on your mental health (49, 50). You need to treat mental health symptoms as seriously as physical symptoms. Poor mental health can cause your psoriatic arthritis to flare, increase pain and fatigue, negatively affect your work and personal relationships, and limit your ability to manage your overall health. If you feel sad, hopeless, and lose interest in things you used to enjoy, talk to your doctor, and let your loved ones know what you are going through. Your doctor may redirect you to useful mental health services such as cognitive behavioural therapy (CBT) and/or they may prescribe you an antidepressant. h3.3 h3.4 Remember that you are not alone. If you need extra support, we are here to help you: NHS Mental Health Services https://www.nhs.uk/nhs-services/mental-health-services/ VERSUS ARTHRITIS / Psoriatic arthritis https://versusarthritis.org/ +44 800 520 0520 Be kind to your joints and your mind. See related Key Facts section See related Key Facts Previous page Next page

Learning how to live with psoriatic arthritis might feel like a challenge. But understanding your diagnosis can help you take control of your health. Learning hub Explore resources to help you understand and manage psoriatic arthritis. Learning hub Key Facts Handbook News Feed Quizzes Search Psoriatic Arthritis Handbook Handbook Handbook Understanding Psoriatic Arthritis Handbook Sections What is psoriatic arthritis? What causes psoriatic arthritis? What are the symptoms of psoriatic arthritis? How is psoriatic arthritis diagnosed? Read Sections Living with Psoriatic Arthritis Handbook Sections Work Sleep and fatigue Emotional wellbeing Read Sections Managing Psoriatic Arthritis Handbook Sections How is psoriatic arthritis treated? Non-pharmacological treatments Self-care and lifestyle Read Sections Intimacy, Reproductive Health and Family Life Handbook Sections Relationships and sex Fertility, pregnancy, and breastfeeding Read Sections Psoriatic Arthritis Handbook Handbook

Learning how to live with psoriatic arthritis might feel like a challenge. But understanding your diagnosis can help you take control of your health. Learning hub Explore resources to help you understand and manage psoriatic arthritis. Learning hub Key Facts Handbook News Feed Quizzes Search Psoriatic Arthritis Handbook Managing Psoriatic Arthritis: Treatments and Lifestyle Handbook Handbook 2 How is psoriatic arthritis treated? While there is no cure for psoriatic arthritis, there are multiple drug treatment options that work to control the disease and its symptoms (3). Drug treatments specific for psoriatic arthritis focus on: DRUG TREATMENTS slowing down the progression of the condition; reducing inflammation; relieving pain; treating skin symptoms; keeping joints as mobile as possible. For most people, treatment for psoriatic arthritis will involve trying several different medications. Since many people with psoriatic arthritis have psoriasis, managing the condition can seem like treating two diseases. Some treatments work on both diseases, while others work mainly on the arthritis or skin problems. Every person diagnosed with psoriatic arthritis is different. Doctors recommend certain treatments depending on: how many and which parts of the body are affected; how severe the disease is; drug allergies and other health conditions; current medication use. Many times, people with psoriatic arthritis may need to take more than one drug at the same time to control the disease – this is called combination therapy. Combination therapy can allow for lower doses of each individual drug to be used. During flares, additional medications may be added temporarily or for the longer term.It is important to be involved in shared-decision making with your doctor(s) and adhere to the treatment plan. You should communicate any issues with medications, such as side effects or difficulty adhering to the treatment plan, so that effective steps can be taken to address the problem(s). TREATMENT FOR THE ARTHRITIS The over-the-counter and prescription medicines for psoriatic arthritis include: non-steroidal anti-inflammatory drugs (NSAIDs); steroid medication (corticosteroids); disease modifying anti-rheumatic drugs (DMARDs). See related Key Facts section h2.1 Non-steroidal anti-inflammatory drugs (NSAIDs) NSAIDs can help relieve pain and reduce inflammation, but they might not be enough to treat symptoms of psoriatic arthritis (9). There are two types of NSAIDs: traditional NSAIDs, such as ibuprofen, naproxen, and diclofenac; COX-2 inhibitors, such as celecoxib and etoricoxib. Like all medicines, NSAIDs can have side effects. Your doctor will take precautions to reduce the risk of side effects by prescribing the lowest dose necessary to control your symptoms for the shortest time possible. NSAIDs can sometimes affect the stomach and intestines, causing digestive problems such as indigestion and stomach ulcers (17). A medication called a proton pump inhibitor (PPI), such as omeprazole or lansoprazole, may also be prescribed to help protect the stomach. Chronic treatment with NSAIDs can also increase the risk of heart attacks, strokes, and other heart problems (17). Please, let your doctor know if there are risk factors that may increase your overall risk, for example, smoking, high blood pressure, high cholesterol, diabetes, or a family history of heart disease. Some people have found that taking NSAIDs made their psoriasis symptoms worse. Inform your doctor if this happens to you. Steroid medication (corticosteroids) Like NSAIDs, corticosteroids can help reduce inflammation and pain (18). If you have a single painful and/or swollen joint, your doctor may inject the medication directly into the joint. The effect can last from a few weeks to several months. However, having too many steroid injections in the same joint(s) can damage the surrounding tissue and, thus, your doctor will usually not recommend more than three injections per year. When lots of joints are inflamed, corticosteroids can be taken as a tablet, or as an injection into the muscle. However, doctors are cautious about this because corticosteroids can cause side effects, such as weight gain and osteoporosis, increased risk of infection and cardiovascular events, if used for long periods of time. Because of these side effects, your doctor will prescribe you the lowest dose necessary to control your symptoms for the shortest time possible. Psoriasis can flare up when you stop using oral corticosteroids. Disease modifying anti-rheumatic drugs (DMARDs) DMARDs are powerful medications that reduce inflammation and can stop psoriatic arthritis from getting worse (19). DMARDs can help prevent damage to your joints. Many DMARDs will treat both psoriasis and psoriatic arthritis. Because this type of medicine treats the cause of your condition and not the symptoms, it can take up to three months before you feel an effect. Therefore, it is important to keep taking the medication, even if it does not seem to be working at first. Like all drugs, DMARDs can have some side effects. While DMARDs can be very effective, these medications reduce the activity of the immune system (immunosuppressants) and raise the risk of an infection. However, it is important to remember that not treating psoriatic arthritis could lead to permanent bone and joint damage. There are three types of DMARDs as described in Table 1. Table 1: Types of disease modifying anti-rheumatic drugs. Traditional Traditional DMARDs (csDMARDs) have been used the longest and have a broad immune- suppressing effect. These medicines are usually taken by mouth. Example: methotrexate, sulfasalazine. Biologic Biologic DMARDs (bDMARDs) disrupt key steps in the inflammatory process and generally work more quickly than traditional DMARDs. These drugs are usually injected. Example: adalimumab, etanercept. Targeted Like biologic DMARDs, targeted DMARDs (tsDMARDs) block key steps in the inflammatory process. These medications are usually taken by mouth. Example: tofacitinib. TREATMENT FOR THE PSORIASIS The over-the-counter and prescription medicines for psoriasis include: topical medications made from vitamin D, derivatives of vitamin A, salicylic acid, coal tar or corticosteroids; phototherapy that uses ultraviolet light (UVB) may be prescribed to treat and lessen skin rashes. Only your doctor should prescribe phototherapy, do not try to use sunlight or sunlamps to treat your skin on your own; some DMARDs and biological therapies used for arthritis can also help the psoriasis. VACCINES If you have psoriatic arthritis, you may have a higher risk of infection and infections may be more severe (20). This can be due to the arthritis itself or its treatment. Psoriatic arthritis, which caused by a fault of the immune system, can make you more vulnerable to infections. In addition, some of the drugs utilised to treat psoriatic arthritis (e.g., DMARDs and/ or steroids) dampen down the immune system, that is, they act as immunosuppressants, which can also make you more prone to infection. An increased risk of infection due to a medical condition and/or drugs is called immunosuppression. Your rheumatologist can provide guidance based on your age and your risk for getting certain infectious diseases (e.g., COVID-19, flu, pneumonia, shingles, or hepatitis B). Vaccines are safe and can help you avoid serious infections. See related Key Facts section Non-pharmacological treatments NON-PHARMACOLOGICAL TREATMENTS Drugs are not the only way to treat or manage the symptoms of psoriatic arthritis. There are many things you can do, alongside taking prescribed medication, that can improve your life quality by lessening pain and inflammation, and improving your overall health. YOUR VOICE MATTERS Your experiences – how your therapies are working, what side affects you are experiencing, how your symptoms are affecting you, what challenges you are facing in your daily life due to psoriatic arthritis – are very important pieces of information. This information is called patient-reported outcomes (PROs) and it may be collected via a questionnaire prior to your rheumatology appointment. PROs can help your doctor assess the impact of your disease and better evaluate your treatment plan. These questionnaires can also help you self-manage your condition. Some of the questionnaires your rheumatologist may use are: PSAID (Psoriatic Arthritis Impact of Disease): measures the impact of your disease on your physical and psychological health; VAS (Visual Analogue Scale): a simple tool to track and measure your pain; IPAQ (International Physical Activity Questionnaire): measures the types of intensity of physical activity and sitting time that people do as part of their daily lives; HAQ (Health Assessment Questionnaire): measures your physical function and disability due to arthritis; FACIT-F (Functional Assessment of Chronic Illness Therapy - Fatigue): measures your fatigue that is caused by the arthritis; WPAI (Work Productivity and Activity Impairment): measures impairments in work and activities; HADS (Hospital Anxiety and Depression Scale): measures the levels of anxiety and depression; PsAQoL (Psoriatic Arthritis Quality of Life): measures the quality of life in people with psoriatic arthritis; EQ-5D (EuroQol-5 Dimensions): measures quality of life in relation to 5 dimensions – mobility, usual activities, self-care, pain and discomfort, and anxiety and depression; SF-36 (Short Form-36): measures quality of life and covers 8 domains of health – physical functioning, physical role, pain, general health, vitality, social function, emotional role, and mental health. So, if your doctor or nurse asks you to fill out a questionnaire, please take the time to do it and be honest! PHYSICAL AND OCCUPATIONAL THERAPY Inflammation of joints and soft tissues can often lead to extreme pain, immobility, and dysfunction. Additionally, the arthritis can lead to difficulty in daily activities in the home and workplace. Physical and occupational therapy can help you get moving safely and effectively. Physical therapy is the most impactful if you are experiencing (21): loss of motion due to inflammation in the shoulder, wrist, hand, knee, or foot; severe enthesitis or dactylitis; inflammatory back pain. Physical therapy will focus on (21): improving mobility and restore the use of affected joints; increasing muscle strength to support the joints; maintaining fitness; preserving the ability to perform daily activities. Occupational therapy can also be helpful, especially if you are experiencing difficulties with everyday activities. See related Key Facts section h2.3 Occupational therapy can help you maximise your ability to participate in daily activities. Strategies include the use of assistive devices (e.g., braces, splints), and movement modification to help people protect their joints by performing tasks in different ways than they are used to (e.g., using both hands). SURGERY Most people diagnosed with psoriatic arthritis will never need joint surgery. However, if joints are severely damaged by the arthritis, or if other treatments do not reduce pain, damaged joints can be replaced by plastic, metal, or ceramic prosthesis to reduce pain, and improve function and quality of life. COMPLEMENTARY TREATMENTS Some people with psoriatic arthritis feel that complementary therapies can be helpful. However, you should always talk to your doctor before trying complementary therapies. There is no scientific evidence to support that taking any kind of dietary supplement, such as fish body oil capsules, works in treating psoriatic arthritis. In addition, there is not enough scientific evidence to support the use of complementary therapies, such as balneotherapy or acupuncture, as treatments for psoriatic arthritis. Complementary therapies can react with other treatments, so you should talk to your doctor if you are using or thinking of using any. See related Key Facts section SELF-CARE AND LIFESTYLE Sedentary behaviour Sedentary behaviour, characterised by prolonged periods of sitting, when accumulated daily for more than 8 hours or maintained for periods longer than 30 minutes without interruption, constitutes a risk to health and well-being. h2.4 h2.5 Since mechanical stress in the case of an inflammatory crisis can promote the appearance of enthesitis, it is necessary to control inflammation before increasing the level of usual physical activity or starting an exercise programme. In any case, the beneficial effects of physical activity and exercise on disease, well-being and associated comorbidities outweigh the risk of enthesitis induced by mechanical stress, which is low (25). Diet While there is no a specific diet that can treat psoriatic arthritis, adopting a nutritious and balanced eating plan can play a vital role in managing symptoms and improving overall wellbeing. Research suggests that adopting a Mediterranean-style diet (Figure 3, left-hand side), which includes fruits, vegetables, fibre, high-quality fats, and vitamins, might lessen the impact of your psoriatic arthritis (26). This type of diet has anti-inflammatory benefits that help manage disease activity. So, trying this eating approach might help you ease your psoriatic arthritis symptoms. Incorporating omega-3 fatty acids , commonly found in oily fish (such as salmon, mackerel, or flaxseeds), can also have anti-inflammatory effects, potentially reducing joint stiffness and tenderness (27). Antioxidants found in colourful fruits and vegetables (such as berries, spinach, and kale) also offer potent anti-inflammatory properties that could alleviate joint inflammation and discomfort in people living with psoriatic arthritis. Overall, it is recommended to aim for a balanced intake of 2-5 portions of fruits and 3-5 portions of vegetables daily, as these nutrient-rich foods provide essential antioxidants that may contribute to managing joint inflammation and overall health. Figure 3: Beneficial (on the left side) and harmful (on the right side) dietary patterns. Adapted from Guilliams et al., 2023 (28). Reducing the intake of sugar, saturated fats , and sodium can help you maintain a healthy weight. Obesity is linked to a higher chance of developing psoriatic arthritis, underlining the significance of weight management, especially for psoriasis patients who often suffer from metabolic syndrome and obesity (29). In people living with psoriatic arthritis, studies suggest that sedentary behaviour may contribute to increased joint stiffness, reduced muscle strength, and compromised joint function. Additionally, a sedentary lifestyle may exacerbate symptoms such as fatigue and depression, which are common in psoriatic arthritis. While the exact mechanisms are not fully understood, maintaining an active lifestyle is generally considered beneficial for managing psoriatic arthritis symptoms. The risks of sedentary behaviour increase even more when people are inactive; that is, they do not comply with the World Health Organization’s (WHO) recommendations for physical activity, described below. Physical activity Engaging in regular physical activity has been shown to have numerous benefits for people living with psoriatic arthritis. Physical activity concerns all body movements resulting from muscle contraction regardless of the context in which they are carried out: leisure, transportation to and from places, or as part of a person’s work. Physical activity can help improve joint flexibility, reduce inflammation, and enhance overall joint function. Moreover, physical activity may contribute to better mental health, as it can help alleviate symptoms of depression and anxiety that are often associated with chronic conditions like psoriatic arthritis. Physical activity also plays a role in weight management, which is essential as excess weight can increase joint stress (22). According to the WHO, it is recommended to accumulate at least ~20 minutes per day of physical activity, such as brisk walking (23). This recommendation is also adopted by the European Alliance of Associations for Rheumatology (24). A 20-minute physical activity of moderate intensity corresponds to an accumulation of around 2000 steps. Considering a functional activity of 4500 steps per day associated with carrying out activities of daily living such as grooming, cooking, cleaning, travelling to and from work/school, the WHO recommendations, when expressed in total number of steps per day, represent the sum of the two types of activity and correspond to an accumulation of 6500 daily steps under normal living conditions. Physical exercise The most beneficial types of exercise for psoriatic arthritis focus on improving flexibility, strength, and cardiovascular fitness without causing excessive joint stress. Low-impact activities such as swimming, walking, and cycling are often recommended. Strength training exercises, including resistance training and gentle yoga, can help enhance muscle support around the joints. Water-based exercises are particularly advantageous as they provide buoyancy, reducing impact on the joints. The benefits of these exercises include increased joint mobility, reduced pain and stiffness, improved muscle tone, and better overall well-being. People living with psoriatic arthritis should adopt a tailored physical activity routine, considering their specific symptoms and limitations. The iPROLEPSIS app intends to help you limit sedentary behaviours, increase physical activity, and improve daily functional capacity with specific and safe training program recommendations (for more information see section “iPROLEPSIS”). Excess weight can increase joint discomfort and inflammation, particularly in load-bearing joints (such as the hips, knees, and spine). Thus, be mindful of your dietary choices, as these can help you manage your symptoms. Vitamin D aids in calcium absorption, which is necessary for maintaining healthy bones. Additionally, vitamin D helps boost our immune system, fight off viruses, and combat fatigue. It has even been linked to good mood, with a deficiency potentially leading to anxiety and depression. Vitamin D is a fat-soluble vitamin that our bodies produce when the skin is exposed to sunlight. It can also be obtained from certain foods or supplements. This vitamin has several forms, but the most important ones are vitamin D2 (ergocalciferol) and vitamin D3 (cholecalciferol). Vitamin D3 is the form that our skin produces naturally in response to sunlight. Research indicates that people with psoriatic arthritis often have lower vitamin D levels than others (30). Having enough vitamin D might help ease some psoriatic arthritis symptoms. The best way to ensure this is through adequate sun exposure. Spending around 10 to 30 minutes in the sun between 10 AM and 3 PM, at least twice a week, is generally sufficient for most individuals to produce enough vitamin D. The exact time needed depends on factors such as skin type, latitude, altitude, and season. The Medical Board of the National Psoriasis Foundation recommends vitamin D supplementation for psoriatic arthritis patients and encourages overweight or obese patients to explore weight reduction through a controlled diet (31). However, you must seek advice from your doctor. Hydration is another key aspect often overlooked, but crucial in managing psoriatic arthritis. Though there are no specific hydration guidelines for people with psoriatic arthritis, drinking around two litres of water daily not only supports maintaining overall health (32), but also helps in joint lubrication and efficient functioning, easing discomfort associated with movement. Some individuals find that certain foods may trigger or exacerbate their psoriatic arthritis symptoms. While these triggers can vary among individuals, common contributors include red and processed meat, low-quality fats, salt and additives, and refined carbohydrates (Figure 3 ; right-hand side). Monitoring your diet and identifying potential trigger foods through a systematic dietary approach or under the guidance of a healthcare professional can help manage pain, fatigue, and flare-ups (33). It is essential to find guidance from a healthcare provider or a dietitian with expertise in psoriatic arthritis to develop a personalised dietary plan (28) aligned with individual preferences and needs. A personalised plan aims to guarantee sufficient nutrient intake, manage weight, and promote overall well-being, addressing the unique challenges associated with psoriatic arthritis. Moreover, embracing a healthy lifestyle, including consistent physical activity, stress management, and a well-balanced diet, holds significant potential to improve the quality of life for people with psoriatic arthritis. Smoking and alcohol consumption Smoking is bad for your overall health, as it increases the likelihood of potential complications, such as heart problems and cancer. Smoking can also make you less sensitive to treatment and worsen your psoriasis symptoms (34, 35). Alcohol can interfere with the effectiveness of some drugs or increase side effects (36, 37). Some studies also suggest that alcohol may act as a trigger for flare-ups (38). See related Key Facts section See related Key Facts Previous page Next page