<p>The Skin May Clear But the Arthritis Won’t Disappear: Focusing on Concomitant and New-Onset Psoriatic Arthritis in a Daily Practice Cohort of Psoriasis Patients on Biologic Therapy</p>

Abstract

Background Previously identified risk factors for psoriatic arthritis (PsA); nail dystrophy and scalp lesions are highly prevalent in patients with moderate-to-severe psoriasis. Therefore, these variables may not be useful as predictors for PsA in this population. Objective We assessed the predictive value of demographic and clinical characteristics for development of PsA in a cohort of patients with moderate-to-severe psoriasis, currently treated with biologics. Furthermore, we reported the incidence of new-onset PsA in this population and described the characteristics of patients that developed PsA during biologic treatment. Methods Demographics and treatment characteristics of psoriasis patients currently using biologic therapy were extracted from the BioCAPTURE database (n=427). Poisson regression was used to calculate incidence rates. Multivariable logistic regression was performed to identify factors independently associated with PsA onset. Patient and treatment characteristics of patients that developed PsA during biologic treatment were described. Results The incidence of PsA was 1.0 (95% CI 0.8–1.2) per 100 psoriasis-years. Except for a lower risk for PsA in male gender (OR 0.58, 95% CI 0.34–0.98, p-value 0.04), no clinical factors were significantly associated with an altered risk of developing PsA. During biologic therapy, 32 patients (9.4%) newly developed PsA. In this group, 53.8% had PASI<5 at PsA diagnosis. The incidence rate of PsA was 1.6 (95% CI 1.1–2.2) per 100 years on biologic therapy. Conclusion Clinical risk factors might be inaccurate to predict PsA onset in patients with moderate-to-severe psoriasis on biologics. Even with low disease activity, psoriasis patients on biologics are still prone to develop PsA.

New-Onset Psoriatic Arthritis under Biologics in Psoriasis Patients: An Increasing Challenge?

“…Despite being slightly higher than the results reported by Napolitano et al [22], the percentage of new-onset PsA found in our study is slightly lower than those reported by Van Muijen et al [23], who showed that 32 (9.4%) patients developed PsA during biologic treatment (adalimumab, etanercept, infliximab, ustekinumab, secukinumab) collecting data from the BioCAPTURE database from 1 May 2005 until 1 May 2018. However, their inclusion criteria were different from our study and from those of Napolitano et al [22] concerning the phenotype of psoriasis.…”

“…Indeed, different studies [22][23][24]34] and real-life experiences [35][36][37][38][39][40][41][42] showed the possibility of PsA onset in patients treated with biologics for psoriasis in 4.5-9.4% of cases [22,24]. The present study aims to evaluate the incidence of new-onset PsA in patients with plaque psoriasis on anti-TNFα (adalimumab, certolizumab, etanercept, infliximab), anti-IL12/23 (ustekinumab), anti-IL23 (risankizumab, tildrakizumab, guselkumab) or anti-IL17 (brodalumab, ixekizumab, secukinumab) therapy attending our Dermatology Unit and undergoing at least 1-year follow-up.…”

“…To our knowledge, studies [22][23][24] investigating PsA onset during psoriasis treatment with biologics are very limited (three existing studies).…”

“…However, their inclusion criteria were different from our study and from those of Napolitano et al [22] concerning the phenotype of psoriasis. In fact, Van Muijen et al [23] also included patients with guttate, pustular, and erythrodermic psoriasis, recording the localization and types (scalp lesions, nail psoriasis, inverse psoriasis, and palmoplantar psoriasis), whereas our study and Napolitano et al [22] only considered plaque psoriasis, the only type of psoriasis for which biologics are approved. Moreover, Van Muijen et al [23] reported a trend toward significance for a lower risk of PsA onset in patients with inverse psoriasis (OR 0.61, 95% CI 0.36-1.05, p-value 0.07), non-confirming literature data that reported an increased risk of PsA development in patients with scalp, nail, and inverse psoriasis [39].…”

“…Indeed, they are all approved for PsA with brodalumab, risankizumab, and tildrakizumab awaiting FDA approval. However, several studies reported the possibility of new-onset of PsA during biologic therapies in psoriatic patients with two studies highlighting the concept of paradoxical PsA [22][23][24].…”