Which patients with psoriasis are at risk to develop PsA? Save

The potential transition from psoriasis (PsO) to psoriatic arthritis (PsA) has not been a strong focus for several years but is gaining momentum.

Many patients do have psoriasis before onset of symptoms. This question can either be explored retrospectively using existing data or prospectively merging the perspective of both dermatologists and rheumatologists. During EULAR 2021, two presentations have put forward this topic from different angles. 

Felbo et al (POS0149) outlined data of health-related quality of life, disability and musculoskeletal symptoms gathered via a Danish nationwide survey among patients with PsO and PsA. 561 PsO patients and 108 PsA patients were included. 43% of PsO patients reported to never have had pain, the remaining previous or current pain. In those with pain history nail psoriasis, dactylitis and enthesitis was found in 21%,15% and 13% respectively compared to 15%, 1% and 2% in those without pain history. Furthermore, quality of life by DLQI and EQ5D was reduced in the pain group compared to no pain history. Still 72% of those with musculoskeletal pain have never been seen by a rheumatologist.

This abstract of Felbo et al provided a good background to Zabotti et al’s presentation (POS0145) on his systematic literature review and meta-analysis on predictors of PsA development in PsO patients. 26 articles were included, that reported on patients with skin and/or nail PsO. The following risk factors could be found: Patients with imaging detected inflammatory or structural changes (RR: 3.72), arthralgia (RR: 2.15), nail pitting (RR:2.14), family history of PsA (RR: 4.43) and those with higher BMI. 

The findings, on the one hand, outline the underadressed burden of musculoskeletal symptoms in Pso patients, which might be for some the first signs for development of PsA if further stratified by risk factors. On the other hand, they depict a good basis to design studies and registries to better understand the transition of PsO to PsA and furthermore develop early interventions.