Redefining Synovial Pathotypes in Psoriatic Arthritis through Multi-Modal Histology and Machine Learning (The PSYNOVIUM Study)

Background Synovial inflammation in psoriatic arthritis (PsA) lacks a validated histological classification framework. Current approaches apply rheumatoid arthritis (RA) synovial pathotypes to PsA, which overlooks immunobiological differences between the diseases and limits the predictive power of tissue stratification. We aimed to define data-driven, PsA-specific synovial pathotypes to facilitate tissue-driven precision medicine. Methods In this cross-sectional study, ultrasound-guided synovial biopsies were obtained from 61 patients with PsA (n=22), seropositive RA (n=23), seronegative RA (n

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