Concurrent Skin and Joint Onset May Indicate More Severe PsA

Concurrent skin lesion and joint symptom onset increases the risk for moderate or high disease activity (MDA/HDA) status in psoriatic arthritis (PsA), according to a letter to the editor published in the Journal of the American Academy of Dermatology.

The timing of skin and joint symptom onset in PsA varies from patient to patient, but most experience skin lesion onset before joint symptoms (64.5%). A small proportion of patients (16.1%), however, develop concurrent skin and joint symptom onset.

Researchers from Central South University in China recruited patients (N=286) with PsA between 2019 and 2022 and evaluated whether the timing of skin and joint symptom onset associated with disease outcomes. Disease activity was assessed using the Psoriatic Arthritis Disease Activity Score (PASDAS) and Psoriasis Area and Severity Index (PASI) instruments. Moderate or high disease activity was defined as having a PASDAS of greater than 3.2.

The patient group comprised mostly men (64.0%) and few (n=88) had a PASDAS of 3.2 or less.

Stratified by PASDAS score, those with moderate or high disease and very low or low disease activity differed significantly by Dermatology Life Quality Index score (mean, 6.67 vs 4.95 points; P =.011), concurrent skin and joint symptom onset (28.2% vs 4.9%; P =.011), and PASI score of at least 3 (72.5% vs 53.7%; P =.002), respectively.

Risk for MDA/HDA was associated with concurrent skin and joint symptom onset (adjusted odds ratio [aOR], 4.70; 95% CI, 1.54-14.31; P =.006), PASI score of at least 3 (aOR, 2.38; 95% CI, 1.35-4.20; P =.003), and DLQI score (aOR, 1.06; 95% CI, 1.00-1.12; P =.044).

Limitations of the study include selection bias, lack of adjustment, and unknown confounders.

Study authors conclude, “[T]he above results uncover new information that the concurrent onset of skin lesions and joint symptoms was correlated with an increased likelihood of MDA/HDA status based on PASDAS, indicating that dermatologists and rheumatologists should pay extra attention to the sequence of onset between the skin and joint symptoms in the disease management of PsA.”

This article originally appeared on Dermatology Advisor