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< BACK Advancing Digital Health Solutions: Updates on User Research and Co-Creation Nov 20, 2023 Navigating the Development of PDPID-App, Insights from Co-Creation Sessions Updates on user research and co-creation The current status of user research and co-creation involves a dedicated focus on advancing the development of the PDPID-app , scheduled for delivery before January 2023. In early October 2023, Erasmus MC ( EMC) conducted a co-creation session with patient partners to assess the general looks and feel of the User Interface (UI) and identify points to improve the app's usability. In apps used for medical data collection, it is of utmost importance that users know what is expected of them. Furthermore, users should be engaged with the app to a level that minimises missing data. Following this, bi-weekly meetings with patient partners were established to maintain alignment with their ideas. Furthermore, project partner FACULDADE DE MOTRICIDADE HUMANA (FMH-ULISBOA) is developing storyboards for the personalised gaming suite . Three co-creation sessions have been executed: one with healthcare professionals and two with patient partners. Additionally, project partners The Centre for Research and Technology Hellas (CERTH) and FACULDADE DE MOTRICIDADE HUMANA (FMH-ULISBOA) have been working with the clinical partners to identify movements for the video analysis tasks that will be included in the iPROLEPSIS-PDPID study. Multiple hand gestures and full-body movements have been identified for further assessment. Key take-away messages The development of the Digital health tools is still at an early stage. However, several take-away messages from the discussions about the PDPID app are : The general looks and UI of the miPROLEPSIS app have been approved by the patient partners. Even though the PDPID-app is a data-collection app for research purposes, patients find it of utmost importance that they can review their own data entries. Participants indicated that the app needs to improve its’ visual cues of when they need to perform certain activities. Take-away messages from the discussions about personalised gaming suite development: Smart games meant for disease management should be highly tailored to the capabilities of the patients. Gaming is for patients a way of relaxation, any game designed should not incorporate any stressful factors. Patient partners expressed interest in the proposed gaming categories. Future steps Future steps involve initiating a round of user testing for the PDPID version of the miPROLEPSIS app to validate designs with patients not involved in the development process. Subsequently, attention will shift to developing recommendation systems for physical activity and diet, incorporating insights from experts in the field (occupational therapists, physical therapists & nutritionists) and patients themselves. For the personalised gaming suite, the completion of the storyboard is planned for the end of December 2023, when the development of the first prototypes will follow. 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

< BACK Hot topic debate: preventing psoriatic arthritis in patients with psoriasis Nov 13, 2024 Preventing PsA: Insights from the IFPA-WPPA 2024 Conference Conference IFPA-WPPA 2024 Conference At the 7th World Psoriasis & Psoriatic Arthritis (IFPA-WPPA) Conference , experts discussed whether effective treatment for psoriasis (PsO) could help prevent the onset of psoriatic arthritis (PsA). In this session, Prof. Laura Coates highlighted early intervention as a key strategy for PsA prevention. Supporting these efforts, the iPROLEPSIS consortium, active across Europe, is exploring digital, non-pharmacological tools aimed at improving patient outcomes. These include stress management games designed to offer additional support for people with PsO, focusing on prevention beyond medications alone. Alongside iPROLEPSIS, other studies, including the PAMPA study and HIPPOCRATES Prospective Observational Study (HPOS), are investigating early detection and intervention strategies. Digital tools such as the Psorcast app, along with new apps from iPROLEPSIS, are being developed to monitor psoriasis patients for early signs of PsA. These efforts aim to pave the way for more personalised and preventive care approaches. Abstract Can effective treatment of psoriasis (PsO) prevent the development of psoriatic arthritis (PsA)? In a Hot Topic Debate at the 7th World Psoriasis & Psoriatic Arthritis Conference, Dr. Soriano and Dr. Ogdie, both experts in the field, presented contrasting views based on existing research and clinical studies.1 Dr. Soriano argued that biologic treatments for PsO may reduce PsA risk, citing several retrospective studies. On the other hand, Dr. Ogdie argued that current observational data are plagued by biases, making it difficult to conclude whether biologics play a protective role. The session outlined the complexity of this issue, with both speakers agreeing on the need for prospective randomised controlled trials, such as the ongoing PAMPA study, to provide definitive answers. Prof. Laura Coates added that identifying at-risk patients and intervening early to potentially prevent PsA may point to a strategic research approach to address these unanswered questions. Read the full article: https://conferences.medicom-publishers.com/proceedings/proceedings-in-dermatology/7th-ifpa-wppa-conference/preventing-psoriatic-arthritis-in-patients-with-psoriasis/ 1/1 PREVIOUS NEXT

< BACK Developing Sensorimotor Art Games for Psoriatic Arthritis using Agile Storyboarding and Game Co-Design Processes Jul 31, 2024 Innovative Sensorimotor Art Games for Psoriatic Arthritis: Agile Storyboarding and Co-Design Approaches Serious Games (SGs) have the potential to provide clinical care and enhance patients’ quality of life, while incorporating an element of entertainment. As part of the iPROLEPSIS Horizon Europe project, we introduce two Sensorimotor Art games designed as SGs to assist Psoriatic Arthritis (PsA) patients in managing their symptoms. These SGs provide a platform for self-expression and pain relief through engaging in rhythmic puzzle activities. The co-design process for the proposed Sensorimotor Art games followed an agile methodology, involving 14 experts (including clinicians, researchers, and game developers), to gather feedback on game requirements, storyboards, and mechanics. From the thematic analysis of the transcribed discussion, four main themes emerged, namely: Clinical value (Theme 1), Motor skills and adaptation (Theme 2), Creative engagement (Theme 3), and Feedback and future directions (Theme 4). Clinical value underlines the therapeutic benefits of Sensorimotor Art games for pain distraction and emotional well-being. Motor skills and adaptation focus on hand/finger use and adapting games for older patients. Creative engagement emphasizes fostering creativity, a positive environment, and goal achievement. Finally, Feedback and future directions highlight the importance of continuous feedback and occupational therapists’ involvement in coming sessions. The development of Sensorimotor Art games lays the groundwork for digital interventions to alleviate psychological distress and improve fine motor symptoms in PsA patients. At the same time, these SGs can also provide insights to healthcare providers and policymakers for developing future digital solutions tailored to PsA patients. Read the full publication: https://zenodo.org/records/13142606 Ramalho et al_DSAI_2024 .pdf Download PDF • 1.29MB 1/1 PREVIOUS NEXT

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

< BACK iPROLEPSIS Clinical Studies' Planning Feb 12, 2023 iPROLEPSIS team starts the planning of the four clinical studies that will be conducted in the project. iPROLEPSIS team starts the planning of the four clinical studies that will be conducted in the project. iPROLEPSIS plans to carry out: 1) a study to design novel digital biomarkers for PsA; 2) a study to investigate new opto-acoustics biomarkers and the role of mast cells in PsA; 3) a study to validate the potential of the novel digital biomarkers to screen for PsA in persons with psoriasis; and 4) a study to evaluate the effectiveness of the envisioned iPROLEPSIS digital care ecosystem in reducing flares of persons with PsA. Office Scene .jpg Office Scene .jpg 1/1 PREVIOUS NEXT

Meet our people Meet the people behind the iPROLEPSIS project. Coordination About team Software development About team Clinical experts About team Ethics, legal and exploitation About team Data sience About team Dissemination and communication About team

Software development team 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

Read publications about iProlepsis project for psoriatic arthritis. Discover insights and project progress. iPROLEPSIS project publications Modeling Interphalangeal Joints for Swelling Assessment in Psoriatic Arthritis via Smartphone Photographs February 4, 2026 Digital assessment of swollen joints from smartphone photographs can support remote monitoring of patients with inflammatory arthritis, enabling more efficient care delivery. In this study, we propose a method to classify each interphalangeal joint in hand photographs as swollen or not. Read More European advances in digital rheumatology: explainable insights and personalized digital health tools for psoriatic arthritis May 19, 2025 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, the 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 More Developing Sensorimotor Art Games for Psoriatic Arthritis using Agile Storyboarding and Game Co-Design Processes June 28, 2024 Serious Games (SGs) have the potential to provide clinical care and enhance patients’ quality of life, while incorporating an element of entertainment. As part of the iPROLEPSIS Horizon Europe project, we introduce two Sensorimotor Art games designed as SGs to assist Psoriatic Arthritis (PsA) patients in managing their symptoms. Read More Can ChatGPT provide appropriate meal plans for NCD patients? May 30, 2024 Dietary habits significantly affect health conditions and are closely related to the onset and progression of non-communicable diseases (NCDs). Consequently, a well-balanced diet plays an important role in lessening the effects of various disorders, including NCDs. Read More Designing Exergames for Psoriatic Arthritis: The Spy and Zen Forest Paradigms February 4, 2026 In addition to biological interventions, traditional treatments often include physiotherapy and exercise to improve range of motion and physical function. However, a prevalence of low consistency, high costs, and lack of engagement leads to high drop-out rates, making these interventions ineffective. Exergames, short for exercise games, provide an accessible alternative to complement traditional interventions, which embed therapeutic movements into game mechanics, motivating patients to remain active and consistent in their rehabilitation routines. Here we present the design of two exergames for PsA, namely The Spy and Zen Forest. Read More Hot topic debate: preventing psoriatic arthritis in patients with psoriasis November 11, 2024 Can effective treatment of psoriasis (PsO) prevent the development of psoriatic arthritis (PsA)? In a Hot Topic Debate at the 7th World Psoriasis & Psoriatic Arthritis Conference, Dr. Soriano and Dr. Ogdie, both experts in the field, presented contrasting views based on existing research and clinical studies.1 Dr. Soriano argued that biologic treatments for PsO may reduce PsA risk, citing several retrospective studies. On the other hand, Dr. Ogdie argued that current observational data are plagued by biases, making it difficult to conclude whether biologics play a protective role. The session outlined the complexity of this issue, with both speakers agreeing on the need for prospective randomised controlled trials, such as the ongoing PAMPA study, to provide definitive answers. Prof. Laura Coates added that identifying at-risk patients and intervening early to potentially prevent PsA may point to a strategic research approach to address these unanswered questions. Read More “The Kite” Breathing Serious Game: Agile Co-Design for Psoriatic Arthritis June 27, 2024 Serious Games (SGs) have been explored in healthcare for their potential as gamified means for disease assessment and/or intervention. Designing effective SGs requires attention to user requirements and iterative development. We introduce a SG design process for Psoriatic Arthritis (PsA) patients, aiming to enhance their quality of life. Read More AI nutrition recommendation using a deep generative model and ChatGPT May 31, 2024 In recent years, major advances in artificial intelligence (AI) have led to the development of powerful AI systems for use in the field of nutrition in order to enhance personalized dietary recommendations and improve overall health and well-being. Read More Co-Designing Mobile Serious Games to Support Patients With Psoriatic Arthritis and Chronic Pain: Mixed Methods Study February 3, 2026 This study aimed to co-design mobile serious games—NoPain Games—to support patients with PsA in managing chronic pain. Conducted within the iPROLEPSIS Horizon Europe project, the study involved a multidisciplinary cocreation session with rheumatologists, researchers, and technical experts, followed by a usability feedback session with patients with PsA. The goal was to identify therapeutic priorities, refine game mechanics, and assess usability to inform the development of personalized, accessible digital interventions. Read More Digital biomarkers for psoriatic arthritis: a qualitative focus group study on patient-perceived opportunities and barriers October 30, 2024 The widespread adoption of wearables, for example, smartphones and smartwatches in the daily lives of the general population, allows passive monitoring of physiological and behavioural data in the real world. This qualitative study explores the perspective of psoriatic arthritis (PsA) patients towards these so-called digital biomarkers (dBMs). Read More ChatGPT in Nutrition: Trends Challenges and Future Directions June 26, 2024 A healthy and balanced diet is of paramount importance to the physical and psychological well-being of an individual, since unhealthy dietary choices have been linked with the occurrence of non-communicable diseases. Read More Developing Exergames for Psoriatic Arthritis using Agile Storyboarding and Game Design Processes June 26, 2024 Serious Games (SGs) offer significant potential in healthcare for disease assessment and intervention, enhancing patients’ quality of life. Exercise SGs, or Exergames, promote physical activity and mobility in a gamified environment, encouraging tailored exercises based on individual abilities and needs. Read More

< 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 Ongoing preparation for the iPROLEPSIS-PDPID study Mar 4, 2024 iPROLEPSIS-PDPID Study: Advancing Psoriatic Arthritis through Innovative Digital Biomarkers Patients with Psoriatic arthritis (PsA) experience difficulties in dealing with unpredictable disease activity, which can affect their quality of life. Developing a digital biomarker using a smartphone and smartwatch would allow for unobtrusive monitoring of the disease activity in these patients. Besides, understanding what factors trigger flare would allow for better disease control. The iPROLEPSIS-PDPID study is a multicentre observational cohort study that aims to develop an unobtrusive and affordable digital biomarker capable of detecting changes in disease activity, including flare, and to identify triggers of flare in patients with PsA. The study will be conducted in four countries: the Netherlands, the UK, Portugal and Greece. Ethical approval for initiating the iPROLEPSIS-PDPID study in the Netherlands and the UK has been granted. The OpenClinica platform will be used in the collection and storage of data for the iPROLEPSIS-PDPID study. Future steps include obtaining ethical approvals for Portugal and Greece as well as local approvals from centres participating in each country, and inclusion of patients from each participating country. The miPROLEPSIS phone app , currently under development, will be used in this study. The app will be installed on the patient smartphone and utilised as a data collector, which will be then used for algorithms development and training. The app will measure physical activity, the length of sleep, self-registered flare, and register daily pain, fatigue, sleep and morning stiffness. The Garmin smartwatch Vivoactive 5 device will be used to collect data on physical activity, heart rate, heart rate variability and sleep quality. The collected data from Garmin will be downloaded from the miPROLEPSIS app by Wellics software (developer in the project), which allows extracting, visualising and exporting collected both company-processed data, as well as raw data. 10.png 13.png 14.png 10.png 1/5 PREVIOUS NEXT

Data science team 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