Treating the skin with biologics in patients with psoriasis decreases the incidence of psoriatic arthritis

Abstract

ObjectivesTo compare the incidence of psoriatic arthritis (PsA) in patients with psoriasis (PsO) according to different treatments for their skin: topics/no treatment, conventional disease-modifying antirheumatic drugs (DMARDs) (cDMARDs) or biological DMARDs (bDMARDs).MethodsPatients with PsO without PsA followed at a university hospital were included in this retrospective cohort study. Patients were classified according to their treatment in topics (topics, phototherapy or no treatment), cDMARDs (methotrexate and cyclosporine) and bDMARDs (tumour necrosis factor inhibitors (TNFi), interleukin 17 inhibitors (IL-17i) and IL-12-23i ((interleukin (IL) 12/IL-23 inhibitor))) groups. Incident cases of PsA were attributed to one treatment if developed during the administration of that treatment. A Cox proportional hazards model was used to evaluate the adjusted risk of PsA development by treatment group.Results1719 patients with PsO contributed a total of 14 721 patient/years (py). 1387 (81%) patients were in the topics, 229 (13%) in cDMARDs and 103 (6%) in the bDMARDs group. During follow-up, 239 patients (14%) developed PsA (231 under topics, six under cDMARDs and two under bDMARDs). Global incidence was 1.6 per 100 py. The risk of developing PsA in patients with PsO treated with bDMARDs was significantly lower (incidence rate ratio (IRR)=0.26; 95% CI 0.03 to 0.94; p=0.0111), compared with topics, but not compared with cDMARDs (IRR=0.35; 95% CI 0.035 to 1.96; p=0.1007). Adjusted Cox proportional hazards regression analysis showed that male sex, nail involvement and higher body max index were associated with increased risk of developing PsA, while biologics use was protective (HR: 0.19; 95% CI 0.05 to 0.81).ConclusionTreatment with biologics in patients with PsO reduced the risk of PsA development.

Group for Research and Assessment of Psoriasis and Psoriatic Arthritis (GRAPPA): updated treatment recommendations for psoriatic arthritis 2021

“…However, we are still unable to identify those patients with psoriasis who ultimately go on to develop PsA. It has been shown in observational studies that treatment of psoriasis might prevent the development of PsA 43 , 44 . Longitudinal research is needed to establish whether highly effective treatment of psoriasis can prevent or mitigate development of PsA.…”

Predictors, Risk Factors, and Incidence Rates of Psoriatic Arthritis Development in Psoriasis Patients: A Systematic Literature Review and Meta-Analysis

“…In three other studies, nail involvement “per se” did not emerge as a predictor of PsA occurrence but this finding was probably affected by the small sample size of the studies and by the lack of a reasonable time frame for observation. More recently, two retrospective cohort studies [ 37 , 38 ], not included in this SLR since they were published in July 2021, confirmed the original observation of Wilson et al supporting PsO nail involvement as predictor of PsA development. Among PsO nail lesions, only nail pitting was selected as a possible predictor [ 39 ].…”

New-Onset Psoriatic Arthritis under Biologics in Psoriasis Patients: An Increasing Challenge?

“…Acosta Felquer et al [51] confirmed that the incidence of PsA in psoriatic patients treated with biologic drugs was significantly lower (incidence rate ratio (IRR) = 0.26; 95% CI 0.03 to 0.94; p = 0.0111) compared with patients treated with topical therapy, phototherapy, or no treatment. However, the authors also reported that PsA incidence under biolgics was not significantly lower compared with patients treated with conventional diseasemodifying antirheumatic drugs (methotrexate and cyclosporine) (IRR = 0.35; 95% CI 0.035 to 1.96; p = 0.1007).…”

“…Our study revealed that 8.5% (10 out of 118) psoriasis patients under biologics developed PsA during one-year follow-up, showing that new-onset PsA is possible for each existing class of biologics (anti-TNF, anti-IL12/23, anti-IL1, and anti-IL23), without any drug predilection and with the peripheral form representing most of the cases. Without any doubt, treating psoriasis with biologic drugs reduces the risk of PsA development [50,51].…”