A clinical and radiographic comparison of patients with psoriatic arthritis from different ethnic backgrounds

Abstract

Objectives There are few papers concerning ethnic differences in disease expression in PsA, which may be influenced by a number of genetic, lifestyle and cultural factors. This article aims to compare clinical and radiographic phenotypes in people of South Asian (SA) and North European (NE) origin with a diagnosis of PsA. Methods This was a cross-sectional observational study recruiting patients of SA and NE origin from two hospitals in a well-defined area in the North of England. Results A total of 58 SA and 48 NE patients were recruited. SA patients had a more severe clinical phenotype with more tender (median 5 vs 2) and swollen (median 1 vs 0) joints, more severe enthesitis (median 3 vs 1.5), more patients with dactylitis (24% vs 8%), more severe skin disease (median PASI 2.2 vs 1) and worse disease activity as measured by the composite Psoriatic Arthritis Disease Activity Score (mean 4.5 vs 3.6). With regards to patient-completed measures, SA patients had worse impact with poorer quality of life and function (mean HAQ 0.9 vs 0.6; mean PsAQoL 10.8 vs 6.2; mean 36-item short form physical component score 33.5 vs 38.9). No significant differences in current MTX and biologics use were found. Conclusions SA patients had a worse clinical phenotype and worse impact of disease than NE patients. Further studies are needed to confirm and explore the reasons behind these differences.

Crying out for equity: outcomes of rheumatic diseases confounded by ethnicity

“…In contrast, Giant cell arteritis (GCA) is much less common (risk reduced to about a quarter) in patients of South Asian descent [20,21]. In psoriatic arthritis, South Asian ethnicity appears to be associated with worse clinical phenotype and worse patient outcomes [22]. Ankylosing spondylitis and axial spondyloarthritis are more common in White patients and associated with higher rates of HLA B27 positivity compared to Blacks, but Blacks have increased severity and worse functional outcomes [23].…”

The evolving demographics of participants in psoriatic arthritis phase III randomised controlled trials of b/tsDMARDs: A systematic review

“…The extent to which epidemiological differences can be explained by under-diagnosis among patients with darker skin tones and in populations where there is inequity in access to healthcare is poorly understood. Limited studies into disease phenotype have suggested that non-white patients may have a more severe phenotype, which may well be multifactorial 9,11 .…”

Disabling foot pain and its impact on daily living among people with Psoriatic Arthritis in Singapore: A cross-sectional observational investigation

“…For example; lower prevalence has been reported in Asian countries like Japan and China (0.1 in 100,000, and 2 in 100,000 respectively) [18]; PsA in Korea had predominant spinal involvement; Chinese may have a milder course in relation to impact on physical function; and Indians with psoriasis had twice the risk of developing PsA compared with Chinese [16,19]. Compared with Chinese, Malay and European populations, ethnic South Asians may have greater disease activity and experience poorer physical function [15][16][17]20]. This nding was also observed in South Asians living in both Western and Asian countries, suggesting a stronger in uence from genetic rather than geographic factors [21].…”