**8. Future perspectives and summary**

It is intriguing to explore and validate metabolomic biomarkers that can accurately and reliably predict which psoriatic patients will develop psoriatic arthritis. Identifying metabolites that could differentiate psoriatic arthritis patients from patients with other inflammatory arthritides would be a great added advantage. The synovial fluid, being in direct contact with articular cartilage, bone and synoviocytes, is a very promising candidate for deciphering metabolomic information which can serve as a promising source of biomarkers for psoriatic arthritis.

Metabolic health and gut microbiome dysbiosis are emerging areas of intense investigation as the gut microbiome influences host immunity and metabolism by producing numerous compounds [100]. The connection between the microbiome and the metabolome of patients with heterogenous psoriatic disease holds the potential to highlight aberrant signaling pathways likely driving "psoriatic march". This could pave the path for the development of clinically useful biomarkers for early recognition and management of comorbidities for this patient population [101].

Thus, immuno-metabolic reprogramming may be worth further exploration for the comprehension of its therapeutic potential in psoriasis. In future studies, it will be quite intriguing to define the interplay between IL-17–driven metabolic reprogramming and epigenetics/chromatin remodeling that are responsible for chronic, sustained transcriptional responses seen in psoriasis, which in turn modulate the activity of IL-17- related proinflammatory cytokine programs.

Integrating metabolomics with other high-throughput-omic technologies such as genomics, epigenomics, transcriptomics, and proteomics can unravel molecular, cellular, and functional signatures associated with psoriasis pathogenesis [102, 103]. The "omics" datasets, thus generated, can help construct predictive or diagnostic classifiers, grouping psoriatic patients based on their probability of developing systemic comorbidities or their likelihood to respond to a specific therapy [104]. This cutting-edge, systemic, and holistic approach will allow the clinicians to institute tailored, targeted, precision medicine, based on individual patient characteristics thereby maximizing efficacy and minimizing toxicity and at the same time overcoming the biggest challenge we face in achieving long-term, stable remission in psoriatic patients.
