The Skin May Clear But the Arthritis Won’t Disappear: Focusing on Concomitant and New-Onset Psoriatic Arthritis in a Daily Practice Cohort of Psoriasis Patients on Biologic Therapy

Abstract

Background

Previously identified risk factors for psoriatic arthritis (PsA); nail dystrophy and scalp lesions are highly prevalent in patients with moderate-to-severe psoriasis. Therefore, these variables may not be useful as predictors for PsA in this population.

Objective

We assessed the predictive value of demographic and clinical characteristics for development of PsA in a cohort of patients with moderate-to-severe psoriasis, currently treated with biologics. Furthermore, we reported the incidence of new-onset PsA in this population and described the characteristics of patients that developed PsA during biologic treatment.

Methods

Demographics and treatment characteristics of psoriasis patients currently using biologic therapy were extracted from the BioCAPTURE database (n=427). Poisson regression was used to calculate incidence rates. Multivariable logistic regression was performed to identify factors independently associated with PsA onset. Patient and treatment characteristics of patients that developed PsA during biologic treatment were described.

Results

The incidence of PsA was 1.0 (95% CI 0.8–1.2) per 100 psoriasis-years. Except for a lower risk for PsA in male gender (OR 0.58, 95% CI 0.34–0.98, p-value 0.04), no clinical factors were significantly associated with an altered risk of developing PsA. During biologic therapy, 32 patients (9.4%) newly developed PsA. In this group, 53.8% had PASI<5 at PsA diagnosis. The incidence rate of PsA was 1.6 (95% CI 1.1–2.2) per 100 years on biologic therapy.

Conclusion

Clinical risk factors might be inaccurate to predict PsA onset in patients with moderate-to-severe psoriasis on biologics. Even with low disease activity, psoriasis patients on biologics are still prone to develop PsA.

Keywords:

• psoriasis
• psoriatic arthritis
• risk factors
• biologic therapy
• phenotype
• localization

Ethics Approval and Informed Consent

Data were extracted from the Continuous Assessment of Psoriasis Treatment Use Registry with Biologics (BioCAPTURE). The registry was approved by our regional medical ethics committee (CMO regio Arnhem-Nijmegen). Every patient provided written informed consent to be included in the BioCAPTURE registry. Data from the BioCAPTURE are not freely available.

Disclosure

Marloes E van Muijen carries out clinical trials for Abbvie, Celgene, Janssen and Novartis, and has received a speaking fee from Janssen. All funding is not personal but goes to the independent Research Fund of the Department of Dermatology of the Radboud university medical center Nijmegen (Radboudumc), The Netherlands. Tamara W van Hal has acted as a paid speaker for Lily Eli and has received reimbursement for attending a symposium from UCB. Juul M P A van den Reek carries out clinical trials for AbbVie, Celgene and Janssen; has received speaking fees/attended advisory boards from AbbVie, BMS and Janssen and has received reimbursement for attending a symposium from Celgene and AbbVie. All funding is not personal but goes to the independent research fund of the department of dermatology of Radboud university medical center Nijmegen (Radboudumc), the Netherlands. Elke M G J de Jong has received research grants for the independent research fund of the department of dermatology of the Radboud university medical center Nijmegen, the Netherlands from AbbVie, Pfizer, Novartis, Janssen Pharmaceuticals and Leo Pharma and has acted as consultant and/or paid speaker for and/or participated in research sponsored by companies that manufacture drugs used for the treatment of psoriasis including AbbVie, Janssen, Novartis, Lily, Celgene, Leo Pharma, UCB and Almirall. All funding is not personal but goes to the independent research fund of the department of dermatology of Radboud university medical center Nijmegen (Radboudumc), the Netherlands. The authors report no other conflicts of interest in this work.