Multi-omics insights into spondyloarthritis and psoriatic arthritis: integrating genomics, transcriptomics, proteomics, and the microbiome for immunological and clinical translation.

Spondyloarthritis (SpA) and psoriatic arthritis (PsA) are interrelated, immune-mediated inflammatory diseases characterized by significant clinical heterogeneity. Early differential diagnosis, accurate disease activity assessment, and the development of personalized treatment strategies remain significant clinical challenges. Single-omics approaches have provided only a limited view of this complexity, highlighting the need for integrative strategies. This review systematically synthesizes findings from multi-omics studies-including genomics, transcriptomics, proteomics, and microbiomics-in SpA and PsA. We focus on their application in three key areas: (i) elucidating shared and distinct immunopathological mechanisms, (ii) facilitating differential diagnosis, and (iii) discovering novel biomarkers. By comparing their molecular landscapes, we explore the shared and distinct immunological foundations of SpA and PsA. Furthermore, we critically evaluate the translational potential of integrated multi-omics strategies for advancing early diagnosis, precision monitoring, predicting treatment responses, and identifying novel therapeutic targets. This integrated, multi-omics framework promises to refine disease taxonomy and guide personalized therapeutic decisions, paving the way for precision medicine in SpA and PsA.