Evidence that systemic therapies for psoriasis may reduce psoriatic arthritis occurrence

• Published in: Clinical and experimental rheumatology Vol. 38; no. 2; p. 257
• Main Authors: Solmaz, Dilek, Ehlebracht, Alexa, Karsh, Jacob, Bakirci, Sibel, McGonagle, Dennis, Aydin, Sibel Z
• Format: Journal Article
• Language: English
• Published: Italy 01.03.2020
• Subjects: Antibodies, Monoclonal - therapeutic use; Arthritis, Psoriatic - epidemiology; Arthritis, Psoriatic - prevention & control; Biological Products; Biological Therapy; Humans; Immunosuppressive Agents - therapeutic use; Psoriasis - epidemiology; Psoriasis - therapy; Retrospective Studies
• ISSN: 0392-856X
• DOI: 10.55563/CLINEXPRHEUMATOL/8THJ0L

Contemporary biologic therapies for psoriasis are independently licensed for psoriatic arthritis (PsA). Since skin disease generally predates PsA and PsA has a subclinical phase, we investigated the pattern of PsA evolution in psoriasis treated with biologic agents compared to other medications including oral therapy, topical agents or no treatments. A retrospective chart review was performed in psoriasis patients with musculoskeletal symptoms referred for rheumatological assessment. Patients who had a final diagnosis of PsA were identified. The frequency and clinical features of PsA were compared for biologics versus the other strategies. Between 2015-18, 203 psoriasis patients were referred for musculoskeletal symptoms with 25 on biologics, 31 on non-biologic systemic therapies and 147 on topical/no therapies. A final diagnosis of PsA was similar in all groups (biologics: 36%; non-biologic systemic treatments: 35.4%; none/local treatments: 37.4%). Most patients had musculoskeletal symptoms before systemic therapy initiation but new onset PsA was evident in 12% (3/25) biologics treated patients, 9.6% (3/31) in non-biologic systemic therapy patients and was significantly higher in patients on topical/no therapy (55/147; 37.4%, p<0.001). Among patients with PsA, none of the patients on biologics exhibited dactylitis compared to 28.6% of other systemic treatments and 48.6% of none/local treatments (p=0.046). New symptoms and signs leading to PsA diagnosis appear to decrease with systemic treatments. The characteristic PsA dactylitis lesion was not evident in the biologic therapy group.