Greater Joint Involvement and Biologic Use Seen in Patients With Comorbid Psoriasis, Axial Spondyloarthritis

Psoriasis is a common comorbidity among patients with axial spondyloarthritis (axSpA), with associations of greater joint involvement and biologic use compared with axSpA diagnosis alone, according to study findings published in RMD Open: Rheumatic and Musculoskeletal Diseases.

As a frequent extra-articular manifestation associated with axSpA, psoriasis has been estimated to develop in 9.3% of patients with the condition. Despite its common prevalence, the time of onset of psoriasis is not well established in patients with axSpA, nor are potential risk factors and the comorbid impact on patient outcomes.

“The consequences of psoriasis associated with axSpA are unclear,” noted researchers. “There is evidence suggesting that psoriasis worsens the rheumatic disease. It is known that psoriasis has a significant detrimental effect on quality of life, through its psychological and social impact.”

Leveraging data of the longitudinal, prospective, multicenter DESIR cohort study, which included adult patients with recent inflammatory back pain suggestive of axSpA, they sought to examine the prevalence and incidence of psoriasis, identify the profiles of patients who developed psoriasis, and assess the outcomes associated with psoriasis over 6 years of follow-up.

In the analysis, patients with and without psoriasis at any time point were compared on key outcomes of disease activity, measured objectively via Ankylosing Spondylitis Disease Activity Score-C-reactive protein (ASDAS-CRP), joint and enthesitis count, CRP serum level, treatment use over 6 years, and self-reported outcomes for function (Health Assessment Questionnaire for axSpA [HAQ-AS]) and quality of life.

Of the 708 patients included in the DESIR cohort at baseline, 589 provided follow-up data up to 6 years (mean [SD] age, 40.5 [8.7] years; mean symptom duration, 1.5 [0.9] years; 45.8% men; 36.4% current smokers).

From baseline to the 6-year follow-up, the cumulative prevalence of psoriasis increased from 16.8% to 26.8%, leading to an incidence of 2.1 per 100 patient-years. Compared with patients who just had axSpA, those with comorbid axSpA and psoriasis developed more joint lining inflammation , or synovitis (P = .008) and received more methotrexate (cumulative use, 25.5% vs 11.8%; P < .001) and biological disease-modifying drugs (55.7% vs 38.5%; P < .001) over the follow-up.

No significant consequences of psoriasis on other outcomes were reported, including for disease activity (ASDAS-CRP), functional capacity (HAQ-AS), and quality of life.

Speaking on the study findings, the researchers concluded that the common incidence of psoriasis in patients with axSpA necessitates regular monitoring and multidisciplinary care with dermatologists.

Reference

Lucasson F, Richette P, Aouad K, et al. Prevalence and consequences of psoriasis in recent axial spondyloarthritis: an analysis of the DESIR cohort over 6 years. RMD Open. 2022;8(1):e001986. doi:10.1136/rmdopen-2021-001986