In patients with peripheral spondyloarthritis, clinical characteristics and treatment patterns varied between those with and without psoriasis despite similar disease burden, according to study results published in Rheumatology.
Researchers evaluated the clinical characteristics, disease burden, and treatment patterns in patients with peripheral spondyloarthritis in the presence and absence of psoriasis. They used data from the international ASAS-PerSpA study, which recruited adult patients with spondyloarthritis in 24 countries. All of the study participants had a diagnosis of peripheral spondyloarthritis. Psoriasis was confirmed by a dermatologist, or determined based on symptoms or a previous diagnosis. Statistical analyses compared clinical features, disease activity, patient-reported outcomes, and treatment modalities between subgroups of patients with and without psoriatic arthritis.
Among a total of 433 patients with peripheral spondyloarthritis, 83 (19.2%) had a history of psoriasis. Patients with psoriasis were older (48.4 vs 43.2 years) and had a longer diagnostic delay (7.4 vs 3.5 years) compared with patients without psoriasis. Dactylitis and enthesitis were more common in the presence of psoriasis (36.1% vs 20.0% and 65.1% vs 55.4%, respectively). In patients with psoriasis, dactylitis was more likely to occur in fingers, while toes were mainly affected in patients without psoriasis.
In multivariable regression analyses, the presence of psoriasis was significantly associated with a longer diagnostic delay (odds ratio [OR]=1.06; 95% CI, 1.01-1.11), negative human leukocyte antigen B27 status (OR=0.31; 95% CI, 0.15-0.65), and presence of enthesitis (OR=2.39; 95% CI, 1.16-4.93).
Disease activity and patient-reported outcomes were similar between groups. Use of biologic disease-modifying anti-rheumatic drugs (bDMARDs) was more common in patients with vs without psoriasis. This difference in bDMARD use was consistent across all musculoskeletal manifestations of peripheral spondyloarthritis.
Limitations of the study included the cross-sectional study design, potential selection bias due to subgroup assignment by the local rheumatologist, and recall bias of patient-reported disease history.
The study authors concluded, “[W]e could demonstrate that the presence of psoriasis has an impact on clinical characteristics of [peripheral spondyloarthritis]. [Patients with peripheral spondyloarthritis but] without psoriasis were less frequently treated with bDMARDs despite similar disease burden as compared with patients with psoriasis.”
Izci Duran T, Torgutalp M, Rios Rodriguez V, et al. The impact of psoriasis on the clinical characteristics, disease burden and treatment patterns of peripheral spondyloarthritis. Rheumatology (Oxford). Published online April 22, 2022. doi:10.1093/rheumatology/keac235