Summary Background Psoriatic arthritis (PsA) is a progressive and often destructive joint disease affecting approximately 20% of people with psoriasis. Objectives To investigate associations between obesity, changes in body mass index (BMI), alcohol intake and smoking status and the development of PsA in people with psoriasis. Methods We undertook a cohort study involving incident cases of psoriasis identified from the U.K. Clinical Practice Research Datalink between 1998 and 2014. The associations between smoking, alcohol and BMI and development of PsA were assessed using generalized additive models. Additionally, the risks associated with a change in BMI during follow‐up were investigated using distributed lag nonlinear models. Results We identified 90 189 incident cases of psoriasis (42% male, mean age 51 years), of whom 1409 had a subsequent record of PsA diagnosis. BMIs of 25·0–29·9, 30·0–34·9 and ≥ 35·0 kg m−2 were significantly associated with an increased risk of developing PsA compared with BMIs < 25·0 kg m−2: adjusted odds ratios (95% confidence intervals) 1·79 (1·46–2·19), 2·10 (1·67–2·63) and 2·68 (2·09–3·43), respectively. Reducing BMI over a 10‐year period (linearly) was associated with a reduction in the risk of developing PsA compared with BMI remaining constant over the same period. Increased risks of developing PsA were associated with moderate drinking but not with former or heavy drinking or with current or past smoking status. Conclusions In this incident psoriasis cohort, increased BMI and moderate drinking, but not heavy drinking or smoking status, were associated with an increased risk of PsA in people with psoriasis. Importantly, we have shown that reducing weight may result in a reduction in the risk of developing PsA. What's already known about this topic? There is some evidence that increased body mass index is associated with an increased risk of developing psoriatic arthritis. There are conflicting results surrounding the relationship between smoking and the development of psoriatic arthritis among patients with psoriasis. What does this study add? Using a nonlinear and lagged effect of body mass index measured over time we have shown that reducing body mass index may be associated with a reduction in the risk of developing psoriatic arthritis. We have found no evidence that smoking alters the risk of developing psoriatic arthritis in patients with psoriasis.
BackgroundPsoriatic arthritis (PsA) is underdiagnosed in primary care, and can be difficult to distinguish from osteoarthritis. Accumulating evidence suggests that diagnostic delay is associated with poorer functional outcome despite treatment.ObjectivesTo develop a better understanding of the diagnostic delay and burden of disease in patients with PsA, and to investigate management within the first three months of diagnosis.MethodsData were analysed on all participants with a final diagnosis of PsA from The National Clinical Audit for Rheumatoid and Early Inflammatory Arthritis, undertaken by the British Society for Rheumatology and commissioned by the Healthcare Quality Improvement Programme, recruited between 1/2/2014 and 30/10/2015. Data were collected from patients and clinicians at baseline and three months. 1016 participants with PsA (mean age 49.4±14.5 years; 54% female) were matched 1:1 by age and sex with participants with Rheumatoid Arthritis (RA).ResultsPatients with PsA had a significantly longer delay to presentation and diagnosis than those with RA (p<0.02, Table 1), and this remained significant when adjusted for age, sex, ethnicity and social status.PsA patients had lower median tender (4.0 vs 7.0) and swollen (3.0 vs 5.0) joint counts and lower mean baseline ESR (21.9 vs 27.8 mm/hr) and CRP (16.2 vs 24.2 mg/L) values than patients with RA (p<0.01 for all comparisons), and this remained significant when adjusted for potential confounders. Mean baseline scores for the Inflammatory Arthritis Impact of Disease (IAID) questionnaire were lower in patients with PsA (5.34±2.25 vs 5.94±2.35 in RA, lower scores indicating less impact), although this was not statistically significant when adjusted for demographics and disease activity (p=0.36). There was no significant difference between physical function at baseline between the groups (median HAQ 0.88 PsA vs 1.13 RA, p=0.70).At follow-up, patients with PsA had significantly higher mean IAID scores (4.32±2.60 vs 3.78±2.56, P<0.05). In those with paired results, the mean improvement in IAID score was 1.32 (95% CI 0.99–1.65) in PsA vs 2.37 (95% CI 2.07–2.67) in RA. In patients with high disease activity at baseline (DAS28 >5.1) a good EULAR response was seen in only 21.4% in PsA vs 30.3% in RA. There was a marked difference in the DMARDs initially prescribed, and the differences remained significant when only those with a DAS28 score indicating moderate or high disease activity at presentation were analysed, as shown in Figure 1.Table 1.Median delay in weeksPsARA UnadjustedAdjusted*UnadjustedAdjusted* Symptoms to GP Presentation8.98.97.16.6GP Presentation to Referral5.35.44.34GP Presentation to Diagnosis12.412.19.99.7Symptoms to Diagnosis29.028.621.421.6*Adjusted for age, sex, ethnicity and deprivation Index; p<0.02 for all between group comparisons.ConclusionsThis study demonstrates that patients with PsA have a longer delay to diagnosis between both symptom onset and presentation to primary care, and referral to secondary care and diagnosis than those wit...
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