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Progression from Psoriasis to Psoriatic Arthritis

Jun 22, 2021 6:00 pm

The question of whether psoriasis is a state or pre-clinical psoriatic arthritis has been addressed by several studies; with one suggesting that biologic use in psoriasis may aver the future development of psoratic arthritis (PsA).

A retrospecitve analysis of non-randomized moderate-to-severe plaque psoriasis patients who were prescribed at least 5 years of bDMARDs or at least three narrow-band ultraviolet light B (nb-UVB) phototherapy courses, looked at the future incidence of psoriatic arthritis (PsA). 

From a total of 464 psoriasis (no PsA) patients (bDMARDs, n=234 and nb-UVB, n=230) followed for nearly 1500 person-years, the found and annual incidence of PsA to be 1.20 cases versus 2.17 cases of PsA per 100 patients/year in the bDMARDs versus UVB groups, respectively (HR 0.29, 0.12–0.70; p=0.006).

A higher risk of PsA was seen with older age (adjusted HR 1.04), nail psoriasis (adjusted HR 3.15) and psoriasis duration >10 years (adjusted HR 2.02).

Interestingly bDMARDs treatment was associated with a 73% lower risk of incident PsA (adjusted HR 0.27, 0.11–0.66).

These retrospective data suggest that bDMARDs treatment may reduce the risk of incident PsA in patients with moderate-to-severe chronic plaque psoriasis.

The author has no conflicts of interest to disclose related to this subject
The author has received compensation as an advisor or consultant on this subject

Rheumatologists’ Comments

Gary Botstein

| Jun 22, 2021 8:32 pm

How can they distinguish
"preventing" PSA from "PSA- in -remission" from the biologic?

GB - good point... their contention is that the bioilogic prevented the onset of new incident PsA. This has been suggested by a few other cohort studies but also there is data against this effect. nonetheless, treat early and aggressively and maybe there are downstream benefits? JC

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