Project Name: Leeds Axial PsA and PsO Service Improvement Project 

Project Summary:

The CWP aims to develop a new service model at the CW Partner for identifying and diagnosing axial Psoriatic Arthritis (axial PsA) in early Psoriatic Arthritis (PsA) patients by funding a research fellow to implement an MRI risk stratification and optimisation of medication review as a result of the MRI results.

The objective is to assess axial involvement in patients presenting with very early PsA by introducing routine imaging with magnetic resonance imaging (MRI) of spine/Sacroiliac Joints (SIJs) alongside peripheral joints as part of the diagnostic pathway. This will allow for implementation of an MRI risk stratification assessment from diagnosis which will lead to prompt decision making with the right treatment being selected for each patient from presentation. This initiative would see patients presenting with PsA benefitting for a full “mapping” of extent of disease by assessing skin, joints and axial involvement in one setting, allowing a change in the service offering for patients as a new model of care.

In addition this CWP will also include a subset of patients with psoriasis enriched with nail disease, as this is one of the biomarkers for subsequent development of PsA. These patients, with and without joint pain are coming through the combined Psoriasis (Pso)/PsA service at Leeds in the triage clinics. The aim is to identify Pso patients earlier who may be transitioning to PsA. Exploring the possibility of a link between nail disease in psoriasis and subclinical evidence of axial involvement will help confirm the validity of clinical nail psoriasis as a biomarker for PsA.

Amendment May 2025

The CW Partner  wishes to amend the original  Collaborative Working Agreement (“CWA”)  to include an additional cohort of 80 psoriasis patients enriched with nail disease for MRI, plus mentorship of other rheumatology departments on the benefits of cross-specialty working, as per the Leeds Combined Psoriatic Service. Mentorship will include virtual meetings and face to face meetings at Meet the expert at the British Society of Rheumatology meeting (BSR) to demonstrate the interim findings of the cohorts and how this changes the service and implications of commissioning a new pathway. The CW Partneralso wishes to extend the CWP  by 20 months due to delays incurred through the recruitment of the Research Fellow, bringing the total duration of the project to 45 months from the signing of the original CWA

Planned Milestones:

Milestone

Description

Planned Completion

1

Kick off meeting

Completed

2

Recruitment/training of Fellow

Completed

3

MRI scans early PsA cohort 20% recruitment  

Completed

4

MRI scans early PsA cohort 40% recruitment 

Completed

5

MRI scans early PsA cohort 80% recruitment 

7 months from signing of CWA 

6

MRI scans early PsA cohort 80% recruitment 

9 months from milestone 5

7

MRI scans early PsA cohort 100% recruitment 

3 months from milestone 6

8

Write up Business Case for Trust implementation of MRI/US to be included in PsA pt pathway and present to the Trust Board

3 months from milestone 7

9

Creation of abstract for Dermatology and Rheumatology organisations 

3 months from milestone 8

10

Creation and submission of the project outcomes summary in line with the ABPI Code of Practice

3 months from milestone 9

 

Expected Benefits:

ANTICIPATED BENEFITS FOR PATIENTS

  • Identification of prompt diagnosis and specific targeted treatment
  • Potential to change the treatment paradigm for PsO patients with undiagnosed Axial involvement
  • Prompt treatment could improve quality of life 
  • Potential expansion to additional Trusts through mentorship program could mean reaching many additional patients outside of the Leeds Teaching Trust
  • Participants may benefit from closer follow-up and monitoring through the project, which may include reassessment and adjustments in care that are more responsive than routine clinical practice.
  • Identification of phenotypic markers such as nail psoriasis could allow patients to be more accurately stratified, ensuring they receive the right investigations and interventions at the right time.
  • Patients will be assessed through a combined dermatology and rheumatology service, ensuring coordinated input from both specialties and avoiding fragmented care.
  • Participants will receive advanced MRI imaging and evaluation from a leading specialist centre, which may not be routinely available in standard care.

ANTICIPATED BENEFITS FOR THE ORGANISATION(S)

  • Precise treatment stratification with prompter escalation to biologics if required
  • Allows clinicians to treat PsA early with effective treatment and interventions, potentially limiting future societal and healthcare costs down the Patient pathway
  • Improved understanding and awareness of the scope and size of the problem for axial PsA for Dermatology and Rheumatology, GP and CCG colleagues
  • Demonstrates through publication of the results, the Trust’s ongoing commitment to providing the best care possible for their patients
  • Identifying phenotypic characteristics associated with axial PsA (such as Nail PsO) could enable effective patient stratification for proposed imaging assessment thus streamlining services. 
  • Demonstrates pro-active governance in identifying potentially under and over diagnosed PsA patients. 
  • The new model may act as a vanguard for the diagnosis and treatment of PsA patients previously diagnosed with PsO across Healthcare Systems iin the future 
  • Limits the risk to the Trust of a ‘missed’ PsA diagnosis.
  • Provide potential case study for NHS Rightcare Pathways, to improve variation and improve population heal

ANTICIPATED BENEFITS FOR NOVARTIS

  • Be seen as a partner of choice by the Rheumatology clinical community by working jointly with the NHS to improve PsA patient care, whilst supporting service improvements within the NHS
  • Improved use of medicines (including Novartis medicines) in patients in line with NICE, GRAPPA and BSR guidance. 
  • Demonstrable evidence of working with a Trust that improves care to patients through future publication of the results.
  • Better understanding of overall customers’ and patients’ needs;
  • Optimal use of medicines (including Novartis medicines) in appropriate patients.
  • Improved patient management and treatment initiation (including Novartis treatments). 
  • Opportunity to implement a scalable MRI project across other NHS sites. To collaborate with the CW Partner to improve their service and patient management, to become a preferred partner of the NHS.

Start Date & Duration: January 2024 for 45 months

FA-11450443 | June 2025