New Studies Seek Markers of Pain and Early Drug Response in Psoriatic Disease

Roughly 40 to 50 percent of patients with seemingly well-controlled psoriatic disease continue to experience joint pain, for unknown reasons. Immunomodulators can address pain associated with the immune system, but often cannot control pain that arises elsewhere. “We have to think outside of the box to help these patients,” says rheumatologist Rebecca Haberman, MD.

A new study led by Dr. Haberman is aiming to determine the underlying cause of such pain, whether depression, anxiety, inflammation, centralized pain syndrome, or another etiology. To do so, she and colleagues are administering surveys that ask patients about their pain level as well as how it interferes with sleep, work, and other activities, and whether they are experiencing mental health conditions such as depression and anxiety. “It’s about understanding not only what intensity patients assign to their pain, but what that actually means to them,” she says.

As part of the study, the researchers identified a link between catastrophizing—when patients ruminate on the pain, feel helpless, and think about worst-case scenarios—with persistent pain. Dr. Haberman presented research at the American College of Rheumatology (ACR) annual meeting in October 2025 that suggested this form of psychosocial distress could worsen outcomes. “We found that a high level of pain catastrophizing, irrespective of a patient’s pain level, was a negative predictor of remission and well-controlled disease,” Dr. Haberman says.

The work highlights the potential benefit of combining inflammation mitigation with interventions for behavioral and mood disorders in psoriatic arthritis.

Markers of Persistent Pain

Research has already suggested that patients with active psoriatic arthritis also have high levels of depression. “Because there’s a mind-body connection, depression can make a patient’s pain worse, their sleep worse, and their disease worse; it’s a vicious cycle,” Dr. Haberman says. “You often have to break the cycle from multiple parts, including the psychosocial aspects of the disease, to truly improve outcomes.”

In addition to surveys, the researchers are collecting blood samples to identify biomarkers that might help explain the pain. Functional MRIs (fMRIs) are also being performed in a subset of patients to seek out pain signals in the brain’s neuro-connectivity patterns. By conducting fMRIs before and after treatment initiation, the team might be able to detect signals indicating whether the pain is likely to respond to medication, and how immunomodulating drugs are affecting neuro-connectivity.

In a small pilot study, the scans implicated pathways within the brain’s default mode network—connections that are most active during periods of wakeful rest—as promising targets in the search for more objective pain measures.

“Looking at these other factors might give us insight into treatments that we can use in addition to immunomodulators,” Dr. Haberman says. If brain signals are altered, for example, treatments that regulate brain connectivity may be warranted.

Activity Trackers for Treatment Response

Another clinical challenge Dr. Haberman is focused on is knowing which medication is right for which patient with psoriatic arthritis. “We don’t know beforehand whether the medication is going to work, and it takes about three months for a lot of these medications to kick in,” she says.

Reducing that period of uncertainty is particularly important in light of research showing that patients can develop permanent joint damage even within the first six months of disease.

Capturing early signs of a successful treatment could come via actigraphs, including wristwatch-like activity trackers. “The research-grade trackers we’re using give us insight into physical activity, like step count and intensity, as well as heart rate, body temperature, oxygen saturation, sleep, gait, and balance,” Dr. Haberman says.

As patients with swollen knees or ankles start to improve, for example, the actigraph may show their gait becoming more symmetrical. Other patients may move more, sleep better, or have a lower body temperature associated with less inflammation. “These might be the first signs that patients are responding to their medication and improving, even before they realize that they’re feeling better,” she says.

To test the idea, the team has launched a study of 30 patients who have been diagnosed with psoriatic arthritis and are starting a medication or who are switching to a second biologic medication; each will wear the activity trackers for three months. “We will look backwards and ask, what were the signals of the people that responded versus those that didn’t?” Dr. Haberman says.

Monitoring and Prescribing Movement

So far, a preliminary analysis of FitBit accelerometry data in the NIH’s All of Us database, also presented at the 2025 ACR annual meeting, has revealed intriguing connections. As expected, lower steps counts are observed in individuals with inflammatory arthritis, Dr. Haberman says. But unexpectedly, higher step counts among those without the condition are associated with a reduced risk of developing inflammatory arthritis.

“There’s a dose dependent response, meaning the more that you’re walking, the lower your risk of eventually developing inflammatory arthritis.” The actigraphs, in effect, might prove useful for both prediction and intervention.