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< BACK iPROLEPSIS at IEEE HealthCom 2025: AI-Enabled Digital Health for Psoriatic Arthritis Nov 3, 2025 Project researchers presented new studies, co-chaired a workshop, and joined a panel on digital innovation in healthcare in Abu Dhabi The iPROLEPSIS team participated in the IEEE HealthCom 2025 Conference , held 21–23 October 2025 and hosted by Khalifa University in Abu Dhabi, United Arab Emirates . The event gathered international experts in digital health , artificial intelligence , and biomedical technologies to discuss how AI can improve the understanding and management of non-communicable diseases . Modeling joint swelling through smartphone photographs Giorgos Apostolidis from the Signal Processing & Biomedical Technology Unit – AUTH presented the paper “Modeling Interphalangeal Joints for Swelling Assessment in Psoriatic Arthritis via Smartphone Photographs”. By analyzing smartphone photos of hands, the study showcased that a digital estimation of joint thickness, namely effective width , with the aid of a logistic regression model , can serve as an effective tool for detecting interphalangeal joint swelling in people with PsA .This approach was validated on a real-world dataset collected within the PDPID study . Giorgos Apostolidis (Signal Processing & Biomedical Technology Unit – AUTH) Designing exergames for Psoriatic Arthritis care Prof. Leontios Hadjileontiadis (AUTH) presented the paper “Designing Exergames for Psoriatic Arthritis: The Spy and Zen Forest Paradigms”. The Spy and Zen Forest exergames were co-designed to complement PsA care by making therapeutic exercises more engaging and accessible at home. Using real-time body tracking on mobile devices , these games promote dynamic movement to enhance mobility and strength, and calm stretching for flexibility and relaxation. Prof. Leontios Hadjileontiadis (Signal Processing & Biomedical Technology Unit-AUTH) Panel discussion: Digital Bridges for Better Health Project Coordinator Prof. Leontios Hadjileontiadis , Scientific & Technical Manager Vasileios Charisis , and Stelios Hadjidimitriou from the Signal Processing & Biomedical Technology Unit – AUTH , together with Dr. Kosmas Dimitropoulos from the Centre for Research & Technology Hellas (CERTH) and Prof. Mohamed Seghier from Khalifa University , participated in the panel discussion “Digital Bridges for Better Health: AI Innovation from Europe to the Middle East and North Africa (MENA),” moderated by Giorgos Apostolidis. The panel provided insights into: The technical challenges in integrating AI with existing healthcare IT systems, How key stakeholders can collaborate to ensure AI digital health tools are user-friendly and clinically relevant, The role of patient engagement and digital literacy in the effectiveness of AI tools in chronic disease management How socio-cultural differences between Europe and MENA can influence the design and adoption of AI digital health solutions What are the key regulatory challenges in Europe and MENA regarding the use of AI in healthcare and what joint efforts can be undertaken to harmonize standards in these regions During the session, the iPROLEPSIS project and its AI-enabled digital health tools for assisting Psoriatic Arthritis management and care were highlighted as a case study of AI solutions with potential to improve outcomes for people with non-communicable diseases . Panel discussion "Digital Bridges for better health: AI Innovation from Europe to the Middle East and North Africa (MENA)" Workshop chairing Scientific & Technical Manager Vasileios Charisis from the Signal Processing & Biomedical Technology Unit-AUTH co-chaired the workshop "AI-enabled Digital Health Tools for Non-Communicable Diseases: From Concepts to Impact" . The workshop was co-organised with the AI-PROGNOSIS Horizon Europe project and included research works in the fields of psoriatic arthritis, Parkinson's disease, multiple sclerosis and post-stroke rehabilitation. Two of the presented papers stem from research carried out within iPROLEPSIS: Apostolidis et al., Modeling Interphalangeal Joints for Swelling Assessment in Psoriatic Arthritis via Smartphone Photographs Ramalho et al., Designing exergames for psoriatic arthritis: The Spy and Zen Forest paradigms Workshop “AI-enabled Digital Health Tools for Non-Communicable Diseases: From Concepts to Impact” The iPROLEPSIS and AI-PROGNOSIS teams from AUTH participated jointly at IEEE HealthCom 2025 , highlighting their shared commitment to advancing AI-enabled digital health solutions that enhance the understanding, early detection, and management of chronic diseases . iPROLEPSIS and AI-PROGNOSIS team members PXL_20251021_131742947.MP.jpg 2.jpg IMG_2954.jpg PXL_20251021_131742947.MP.jpg 1/11 PREVIOUS NEXT

< BACK iPROLEPSIS Research on Digital Rheumatology Published in The Lancet eClinicalMedicine May 19, 2025 New Publication Highlights Explainable AI Tools, Digital Biomarkers, and Multimodal Disease Monitoring for PsA A recent paper published in The Lancet eClinicalMedicine presents the iPROLEPSIS initiative as a comprehensive European research effort aimed at transforming the diagnosis and management of psoriatic arthritis (PsA) through digital innovation and patient-centred care . The paper, titled "European advances in digital rheumatology: explainable insights and personalized digital health tools for psoriatic arthritis", outlines how iPROLEPSIS addresses critical gaps in current PsA care by combining real-world data , wearable sensors , and explainable artificial intelligence (xAI) models. Abstract The shift from traditional to technology-based diagnosis and management of psoriatic arthritis (PsA) represents a significant evolution in patient care. Traditionally, PsA was diagnosed and managed through clinical evaluations, physical examinations, and basic imaging techniques. With the evolution of digital technologies, PsA care is transforming, giving rise to the field of digital rheumatology. In this vein, Europe has invested in research initiatives, like iPROLEPSIS, that could accelerate this transformation and redefine PsA care within a digital world. In this Viewpoint we present the current clinical PsA landscape, highlight the PsA patients’ interaction with the digital world, and showcase the novel iPROLEPSIS digital offerings. The latter scaffold digital rheumatology by identifying PsA key drivers. Moreover, they support personalized PsA risk prediction and improve early PsA detection. Furthermore, they enable precise PsA treatment strategies and digital therapeutics within a novel digital health ecosystem. Read the full paper here: https://www.thelancet.com/journals/eclinm/article/PIIS2589-5370(25)00175-0/fulltext PIIS2589537025001750 .pdf Download PDF • 1.20MB Lancet publication.png Lancet publication.png 1/1 PREVIOUS NEXT

< BACK iPROLEPSIS presented at the MULTIPULM project kick-off meeting Oct 8, 2025 iPROLEPSIS tools to be adapted for clinical studies in Brazil, Serbia, and Türkiye The iPROLEPSIS project was presented during the kick-off meeting of the MULTIPULM project, held on 29–30 September in Athens. iPROLEPSIS partners Aristotle University of Thessaloniki (AUTH) , Faculdade de Motricidade Humana (FMH) , and Wellics participated in the meeting, which brought together researchers, clinicians, user research experts, and technology providers. Several tools developed within iPROLEPSIS – including the breathing games created by FMH and the biAURA app developed by AUTH – will be further used in MULTIPULM. These tools will be adapted to the local needs of the project’s pilot sites in Brazil, Serbia, and Türkiye, and evaluated in relevant clinical studies. This collaboration demonstrates the adaptability and broader potential of iPROLEPSIS digital tools beyond psoriatic arthritis, supporting research in other chronic conditions. SPBTU_KoM_MULTIPULM_Athens.jpg ae74e3_e25adf83abf6411cace29ed99801554f~mv2.jpg SPBTU_KoM_MULTIPULM_Athens.jpg 1/2 PREVIOUS NEXT

< BACK iPROLEPSIS at the 2nd Healthy Longevity Symposium Nov 21, 2024 Showcasing the Serious Game Suite for PsA at the Healthy Longevity Symposium The iPROLEPSIS project coordinator, Prof. Leontios Hadjileontiadis , presented the Serious Game Suite for Psoriatic arthritis patients at the 2nd Healthy Longevity Symposium , held by Khalifa University in Abu Dhabi on 21-22 November 2024. The symposium gathered leading experts to explore key topics related to longevity and aging, which is recognised as the root cause of many chronic diseases. The event focused on the latest advancements in aging mechanisms, genomic precision medicine, rejuvenation, and social health policies. Discussions highlighted the potential of AI, advanced technologies, and precision medicine to address the challenges of aging, slow age-related diseases, and improve overall well-being. By integrating cutting-edge research and technology, iPROLEPSIS is advancing innovative solutions aimed at improving the lives of people living with PsA. 1/2 PREVIOUS NEXT

< BACK Insights from iPROLEPSIS 4th Plenary meeting Jul 3, 2024 iPROLEPSIS Plenary Meeting 2024 Recap The 4th iPROLEPSIS plenary meeting took place on 1-2 July 2024 in Munich, Germany, drawing partners from across Europe. The focus was on discussing progress updates and planning future actions towards developing a novel personalised digital care ecosystem for people with Psoriatic Arthritis (PsA). Agenda included: WP overviews, updates and planning next steps General Assembly & External Advisory Board sessions Workshop on : - IDBV (Inflammation digital biomarkers validation study) study: Overview of outcomes, data collection decisions, next steps; - PPIDC (Prevention of PsA inflammation through digital care: an intervention study) study: Objectives, cohort characteristics, study design. WP3 research activities and upcoming deliverables; - iPROLEPSIS ecosystem co-creation, usage scenarios identification, requirements definition; - Serious games co-creation: Introduction to iPROLEPSIS Games app, demonstrations, interactive feedback session. Special Acknowledgment: Gratitude to our patient partners who joined the Serious Games co-creation workshop online and provided valuable insights, ensuring our solutions are truly patient-centric. 1/10 PREVIOUS NEXT

< BACK iPROLEPSIS at Health Data Summit 2025 Feb 12, 2025 Trustworthy AI in Digital Health iPROLEPSIS is excited to join AI-PROGNOSIS and other Horizon Europe research and innovation projects - T RUSTroke, SmartCHANGE, and STRATIFYHF - at the Health Data Summit 2025 in Brussels. Together, these projects will focus on practical approaches for building trustworthy AI-enabled digital health tools aimed at assessing disease risk and progression. During the workshop titled " Trustworthy AI in Digital Health: From Guidelines to Practice" on 19-20 March 2025, iPROLEPSIS will join experts in discussing the importance of ensuring data quality, addressing bias, and applying ethical AI principles in healthcare solutions. The workshop will cover frameworks, methods, and techniques across the AI system development lifecycle, emphasising how to build AI tools that are robust, fair, transparent, and protect privacy. Key discussion topics include: Ensuring data quality and mitigating bias in AI-driven healthcare Applying ethical AI principles throughout AI system development Balancing fairness, privacy, transparency, and robustness The session will be an opportunity for iPROLEPSIS and its partners to contribute to advancing the responsible use of AI in healthcare and discuss solutions for improving digital health tools. Event details: Health Data Summit 2025 Programme details: Summit Programme 1/1 PREVIOUS NEXT

< BACK Innovating Psoriatic Arthritis Care with iPROLEPSIS Oct 29, 2024 Insights Shared in Psoriasis Magazine: An Interview with Psoriasis Patienten Nederland We are pleased to share that we were interviewed by Psoriasis Patients Netherlands ( https://psoriasispatientennederland.nl/ ) and featured in their Psoriasis Magazine . This dedicated volunteer organisation advocates for over 300,000 people in the Netherlands affected by psoriasis and psoriatic arthritis. Supporting Patients Psoriasis Patients Netherlands provides clear, unbiased information on managing chronic conditions and serves as a vital link between patients, healthcare providers, and the latest research. Their focus is on patient support, offering resources like their magazine, social media, and direct support channels, creating an invaluable network for those navigating these challenging conditions. Digital Health Innovation The Erasmus MC in Rotterdam, through the iPROLEPSIS Consortium , is developing an app to help patients with psoriatic arthritis monitor their condition using digital health tools. Over 600 patients across four countries will use the app and smartwatches to track their heart rate, activity, and symptoms daily, along with periodic video analyses and healthcare visits. Key Research Areas The key research areas include exploring the roles of genetics, gut microbiome, and lifestyle factors. Collaborations with organizations like HPOS will soon allow individuals with psoriasis to contribute their data, supporting predictive models for earlier diagnosis. Empowering Patients Through Partnership The Erasmus MC’s iPROLEPSIS study is not just about technological development; it is driven by the stories of patient partners like Elaine and Wendy. Their lived experience with psoriatic arthritis informs our work, ensuring that the tools we develop support their needs and enhance their well-being. With patient partners at the core of the iPROLEPSIS initiative, we are creating a future where digital tools empower psoriatic arthritis patients. 1/1 PREVIOUS NEXT

Learning Hub Explore resources to help you understand and manage psoriatic arthritis. Learning hub Key Facts Handbook News Feed Quizzes Search What causes psoriatic arthritis? See related Handbook section PREVIOUS NEXT

< BACK iPROLEPSIS Games Selected for HiTech 2025 Feb 13, 2025 Transforming Research into Real-World Solutions The iPROLEPSIS consortium partners from FMH/IST-ULisboa are pleased to announce that iPROLEPSIS Games has been selected as one of the 16 teams for the HiTech 2025 Program . HiTech 2025, organised by HiSeedTech , supports research teams in transforming deep tech innovations into market-ready solutions . This selection marks an exciting step forward for iPROLEPSIS Games , reinforcing our commitment to bridging the gap between scientific research and practical applications . 🔗 Read more about the program: HiSeedTech: Programs 1/1 PREVIOUS NEXT

< BACK Highlights from IEEE EMBC 2024 Sep 5, 2024 Showcasing AI-Based Solutions for Psoriatic Arthritis Care Our project partner, PLUX Biosignals, participated in the 46th Annual International Conference of the IEEE Engineering in Medicine and Biology Society (EMBC), held in Orlando, Florida, USA, from July 15-19, 2024. During this prestigious event, PLUX presented the innovative work of the iPROLEPSIS project, which focuses on developing a novel, personalised digital care ecosystem for individuals with psoriatic arthritis. The world's largest international biomedical engineering conference, IEEE EMBC 2024 featured an extensive range of scientific tracks covering cutting-edge research and innovations in biomedical engineering and healthcare technology. Topics included women and children's health, translational clinical research, technology transfer, entrepreneurship, and biomedical engineering education. This event provided a valuable platform for showcasing the potential of AI-based solutions in improving care for psoriatic arthritis patients and highlighted the role of digital tools in revolutionizing personalised healthcare. 1/2 PREVIOUS NEXT

< BACK The protocol for iPROLEPSIS-PDPID study approved in the Netherlands Nov 12, 2023 Ongoing preparation for iPROLEPSIS-PDPID study initiation In November 2023, the protocol for the PsA Digital Phenotyping and Inflammation Drivers Study (iPROLEPSIS-PDPID) received ethical approval In the Netherlands. Approvals in the UK, PT and GR are in progress. The research will be conducted in the Netherlands, the UK, Portugal and Greece. The primary objective of the iPROLEPSIS-PDPID is to establish a development cohort to create smartphone and smartwatch-based, AI-driven digital biomarkers for the remote assessment and monitoring of individuals with psoriatic arthritis. Two action types will occur in the development cohort: measure and predict. Measure: To develop novel smartphone and smart device digital biomarkers for the assessment of inflammatory symptoms with a particular focus on the recognition of changes in movement patterns, pain, fatigue, and morning stiffness in comparison to the gold standard – medical evaluation by clinical evaluation of the joints, tendons and skin. Predict: To predict the change from uninflamed to inflamed using three triggers that may cause longstanding inflammation in psoriatic arthritis patients at risk for flare. Those three triggers are stress, mechanical stress and changes in the gut microbiome. To achieve these objectives, iPROLEPSIS-PDPID will leverage cutting-edge technology and a comprehensive set of products, such as a mobile phone app and a smartwatch. The miPROLEPSIS phone app, which will be used in this study, is currently under development. The app will be installed on the patients’ smartphones and utilised as a data collector before being used to develop and train algorithms. mIPROLEPSIS app.png mIPROLEPSIS app.png 1/1 PREVIOUS NEXT

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