More than a random association between chronic obstructive pulmonary disease and psoriatic arthritis: shared pathogenic features and implications for treatment

ABSTRACT

Introduction

Psoriatic arthritis (PsA) is a chronic inflammatory condition characterized by skin and joints involvement, and with a great burden of comorbidity that could affect the choice of treatment. Chronic obstructive pulmonary disease (COPD) is one of the primary causes of morbidity and mortality. Medical therapy can improve symptoms and the frequency and severity of exacerbations. A variety of evidence showed an increasing association between COPD and PsA.

Areas covered

Psoriatic disease and COPD appear to have a possible pathophysiologic link. The inhibition of intracellular molecules responsible for pro-inflammatory responses could be a therapeutic approach for both psoriatic diseases and COPD. Inhibitors of phosphodiesterase 4 (PDE-4) were developed to treat chronic inflammatory conditions such as psoriasis, PsA and COPD. Roflumilast has been used to treat COPD and asthma, while Apremilast to treat psoriasis and PsA. Given the efficacy and safety of these treatments, we can speculate that blocking PDE-4 might also provide clinical benefits in patients with co-existing COPD and PsA.

Expert opinion

This hypothesis could offer the opportunity to screen patients for both diseases. Furthermore, this approach would increase the involvement of other specialists in the management of PsA, and it would improve the use of a tailored treatment for each patient.

KEYWORDS:

• Chronic obstructive pulmonary disease
• psoriatic arthritis
• inhibitors of phosphodiesterase 4
• Apremilast
• Roflumilast
• comorbidity

Article highlights

• Chronic obstructive pulmonary disease (COPD) and psoriatic arthritis (PsA) may be associated.

• A possible pathophysiologic link between COPD and PsA has been hypothesised.

• The intracellular molecules involved in pro-inflammatory responses could represent a therapeutic approach for both diseases.

• Inhibitors of phosphodiesterase 4 (PDE-4) such as Roflumilast and Apremilast showed beneficial effects in the treatment of COPD and PsA, respectively.

• PDE-4 inhibitors might also provide benefits in patients with co-existing COPD and PsA.

Acknowledgments

Thanks to Dr Francesco Gozza for your help.

Declaration of interest

F Atzeni, L Quartuccio, M Sebastiani, F Spinelli, F Di Marco, R Peluso, S D’Angelo, A Cauli and M Rossini received a consultation fee from Amgen. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.

Reviewer disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Author contributions

All authors participated in the literature search and the summary of all articles. All the authors drafted the manuscript, which was critically reviewed by L Quartuccio and F Atzeni. All the authors read and approved the final manuscript to be published.

Additional information

Funding

This paper was not funded.