Comorbidities, pain and fatigue in psoriatic arthritis, psoriasis and healthy controls: a clinical cohort study

Abstract

Objectives To explore the prognostic value of pre-specified comorbidities on treatment outcomes in PsA, and to compare baseline data with cutaneous psoriasis without arthritis and healthy controls (HC). Methods Patients initiating conventional synthetic/biological disease-modifying antirheumatic drugs were enrolled in this clinical observational cohort study, and data on comorbidities, and clinical and patient-reported outcomes were retrieved at baseline and after 4 months. Pearson’s chi-squared tests were performed to investigate the prognostic value of pre-specified comorbidities and achievement of ACR20, DAPSA50 and MDA. Mann–Whitney U tests were used to compare OMERACT PsA Core Outcome Set (COS) measures at baseline and follow-up for the pre-specified comorbidities. Results A total of 100 PsA patients were included at baseline. Statistically significantly fewer patients with obesity achieved DAPSA50 compared with patients without obesity (P =0.035), and fewer patients with hypertension (P =0.034) and Charlson Comorbidity Index (CCI) ≥1 (P =0.027), respectively, achieved MDA compared with patients without these comorbidities. Patients with obesity, hypertension, widespread pain, and CCI ≥1 had significantly worse COS measures at follow-up compared with patients without these comorbidities. At baseline, patients with PsA had higher disease burden compared with patients with cutaneous psoriasis and HC, including higher pain (P <0.001) and fatigue (P <0.001) scores, and more widespread pain (P =0.002). Conclusion Obesity, hypertension and CCI ≥1 were prognostic factors for poorer treatment outcome rates in PsA. Pain and fatigue were more frequently reported among patients with PsA compared with patients with cutaneous psoriasis and HC. Trial registration The Danish National Committee on Health Research Ethics: H-15009080; Data Protection Agency: 2012-58-0004; ClinicalTrials.gov: NCT02572700.

Do genetics contribute to TNF inhibitor response prediction in Psoriatic Arthritis?

“…Age at therapy initiation showed no effect on drug persistence [ 11 , 37 , 38 ]. The presence of comorbidities, assessed using the Charlson comorbidity index, found that Danish PsA patients ( n = 1750) with Charlson comorbidity index >2 had higher baseline disease activity, increased occurrence of depression and anxiety and shorter TNF-i persistence compared to Charlson comorbidity index = 0 [ 39 ]. Anxiety or depression may impact drug response due to the pro-inflammatory cytokines and altered immune response observed with psychiatric conditions [ 40 ].…”

“…Lifestyle factors have also been reported to correlate with TNF-i response, with current smoking and higher alcohol intake having a negative correlation with drug persistence and 6 month EULAR response respectively [ 11 , 36 , 42 ]. Obesity is associated with cytokine production and higher levels of inflammation; it has also been consistently negatively correlated with response to TNF-i in patients with PsA patients [ 36 , 39 , 43 – 45 ]. In a systematic meta-analysis review of patients with autoimmune diseases ( n = 19,372), almost a quarter of all Ps and PsA patients (23% of n = 11,873) were obese, and TNF-i were less likely to be effective in obese patients [ 46 ].…”

Update on Cardiovascular Risk and Obesity in Psoriatic Arthritis

“…Recognizing and addressing comorbidities are critical to safely and effectively treating PsA patients as they often have implications not only for physical function and the quality of life but also the choice of therapy. For instance, obesity, hypertension, and a Charlson comorbidity index >1 are prognostic factors for worse treatment outcomes (4).…”

Psoriatic arthritis: one year in review 2022

“…On the other hand, Ballegaard at al. reported that obesity, hypertension, widespread pain and a Charlson Comorbidity Index ≥1 seemed to compromise the control of disease activity (32). Finally, a Danish matched-cohort study highlighted the risk of a serious infective adverse event (AE) in patients with chronic arthritis beginning bDMARDs was four times that of the general population.…”

“…• Comorbidities associated with a higher CV risk are confirmed as prevalent in PsA patients (28, 29); • Nail psoriatic involvement seems to be an independent risk factor for atherosclerosis in PsA (30); • A worse control of PsA activity is associated with a higher CV risk (31,32); • PsA patients who should start b-DMARDs have a higher risk of serious infections (33). (36).…”