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Evidence that systemic therapies for psoriasis may reduce psoriatic arthritis occurrence
D. Solmaz1, A. Ehlebracht2, J. Karsh3, S. Bakirci4, D. Mcgonagle5, S.Z. Aydin6
- Rheumatology, University of Ottawa Faculty of Medicine, Ottawa, Canada.
- McGill University, Montreal, Quebec, Canada.
- Rheumatology, University of Ottawa Faculty of Medicine, Ottawa, Canada.
- Rheumatology, University of Ottawa Faculty of Medicine, Ottawa, Canada.
- University of Leeds Faculty of Medicine, Rheumatology, Leeds, UK.
- Rheumatology, University of Ottawa Faculty of Medicine, and Ottawa Hospital Research Institute (OHRI), Ottawa, Canada. saydin@toh.ca
CER12213
2020 Vol.38, N°2
PI 0257, PF 0261
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PMID: 31287403 [PubMed]
Received: 05/03/2019
Accepted : 20/05/2019
In Press: 28/06/2019
Published: 26/03/2020
Abstract
OBJECTIVES:
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.
METHODS:
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.
RESULTS:
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).
CONCLUSIONS:
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.
