Objective. To determine whether the presence of psoriatic arthritis (PsA) is associated with greater comorbidity, in particular cardiovascular morbidity, compared to psoriasis without arthritis. Methods. Six hundred eleven patients with PsA were recruited from the University of Toronto Psoriatic Arthritis Clinic and 449 psoriasis without arthritis patients were recruited from the University of Toronto Psoriasis Cohort. The clinical database was used to identify the prevalence of cardiovascular and other comorbidities in both PsA and psoriasis without arthritis patients. Univariate and multivariate logistic regression analyses were conducted to estimate odds ratios (ORs), comparing the odds of ever having a given comorbid disease in PsA patients with those in psoriasis without arthritis patients. Covariates included age, sex, education, smoking status, severity and duration of psoriasis, medication status, and other comorbidities. Results. The prevalence of hypertension, obesity, hyperlipidemia, type 2 diabetes mellitus, and at least 1 cardiovascular event in PsA patients was 37.1%, 30.0%, 20.7%, 12.0%, and 8.2%, respectively. This was significantly higher than in psoriasis without arthritis patients, with unadjusted ORs ranging from 1.54 to 2.59. In the multivariate analyses, hypertension remained significantly elevated (adjusted OR 2.17). PsA was also significantly associated with infections not treated with antibiotics (presumably viral), neurologic conditions, gastrointestinal disorders, and liver disease (adjusted ORs 2.83, 4.76, 21.53, and 7.74, respectively). Infections treated with antibiotics and depression/anxiety were relatively common in PsA, with a prevalence of 30.5% and 20.7%, respectively. However, this was not significantly different from psoriasis without arthritis after multivariate adjustments. Conclusion. The results suggest that inflammatory joint disease may play a role in both cardiovascular and noncardiovascular morbidity in PsA.

Objective. To estimate the incidence of psoriatic arthritis (PsA) in patients with psoriasis, and to identify risk factors for its development.Methods. The study was designed as a prospective cohort study involving psoriasis patients who did not have a diagnosis of arthritis at the time of study enrollment. Information was collected about lifestyle habits, comorbidities, psoriasis activity, and medications. Patients who developed inflammatory arthritis or spondylitis were classified as having PsA if they fulfilled the criteria of the Classification of Psoriatic Arthritis Study group. The annual incidence of PsA was estimated using an event per person-years analysis. Cox proportional hazards models, involving fixed and timedependent explanatory variables, were fitted to obtain estimates of the relative risk (RR) of the onset of PsA, determined in multivariate models stratified by sex and controlled for age at onset of psoriasis.Results. The data obtained from the 464 patients who were followed up for 8 years were analyzed. A total of 51 patients developed PsA during the 8 years since enrollment. The annual incidence rate of PsA was 2.7 cases (95% confidence interval 2.1-3.6) per 100 psoriasis patients. The following baseline variables were associated with the development of PsA in multivariate analysis: severe psoriasis (RR 5.4, P 5 0.006), low level of education (university/college versus high school incomplete RR 0.22, P 5 0.005; high school graduate versus high school incomplete RR 0.30, P 5 0.049), and use of retinoid medications (RR 3.4, P 5 0.02). In multivariate models with time-dependent variables, psoriatic nail pitting (RR 2.5, P 5 0.002) and uveitis (RR 31.5, P 5 0.0002) were associated with the development of PsA.Conclusion. The incidence of PsA in patients with psoriasis is higher than previously reported. A severe psoriasis phenotype, presence of nail pitting, low level of education, and uveitis are predictive of the development of PsA in patients with psoriasis.

ObjectiveTo identify a core set of domains (outcomes) to be measured in psoriatic arthritis (PsA) clinical trials that represent both patients' and physicians' priorities.MethodsWe conducted (1) a systematic literature review (SLR) of domains assessed in PsA; (2) international focus groups to identify domains important to people with PsA; (3) two international surveys with patients and physicians to prioritise domains; (4) an international face-to-face meeting with patients and physicians using the nominal group technique method to agree on the most important domains; and (5) presentation and votes at the Outcome Measures in Rheumatology (OMERACT) conference in May 2016. All phases were performed in collaboration with patient research partners.ResultsWe identified 39 unique domains through the SLR (24 domains) and international focus groups (34 domains). 50 patients and 75 physicians rated domain importance. During the March 2016 consensus meeting, 12 patients and 12 physicians agreed on 10 candidate domains. Then, 49 patients and 71 physicians rated these domains' importance. Five were important to >70% of both groups: musculoskeletal disease activity, skin disease activity, structural damage, pain and physical function. Fatigue and participation were important to >70% of patients. Patient global and systemic inflammation were important to >70% of physicians. The updated PsA core domain set endorsed by 90% of OMERACT 2016 participants includes musculoskeletal disease activity, skin disease activity, pain, patient global, physical function, health-related quality of life, fatigue and systemic inflammation.ConclusionsThe updated PsA core domain set incorporates patients' and physicians' priorities and evolving PsA research. Next steps include identifying outcome measures that adequately assess these domains.

The rate of depression and anxiety is significantly higher in patients with PsA than in those with PsC. Depression and anxiety are associated with disease-related factors.