Skip to main content

Advertisement

SpringerLink
Log in

Managing Comorbid Disease in Patients with Psoriatic Arthritis

  • Published:
Current Rheumatology Reports Aims and scope Submit manuscript

Abstract

Psoriatic arthritis (PsA) is a unique type of inflammatory arthritis that is associated with skin psoriasis. The concept that PsA is simply a skin and joint disease has been challenged by large epidemiologic studies that link PsA with substantial comorbidity. Important comorbidities related to PsA include premature cardiovascular disease, infectious complications, malignancy risk, osteoporosis, and reduced quality of life. This review focuses on the prevalent comorbid diseases in patients with PsA and highlights how the presence of these associated comorbidities can affect the management of these patients.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

  1. • Eder L, Zisman D, Barzilai M, et al.: Subclinical atherosclerosis in psoriatic arthritis: a case-control study. J Rheumatol 2008, 35:877–882. This was a small case-control study that recently highlighted the increased prevalence of subclinical atherosclerosis, concentrating on PsA patients.

  2. •• Tam LS, Tomlinson B, Chu TT, et al.: Cardiovascular risk profile of patients with psoriatic arthritis compared to controls—the role of inflammation. Rheumatology (Oxford) 2008, 47:718–723. This excellent controlled study adjusted for both traditional and novel CV risk factors that may affect PsA patients and CV disease. It provides a logical framework of the multitude of CV risk factors that can be involved and need to be adjusted to provide a comprehensive picture of PsA and CV risk.

  3. • Ciocon DH, Horn EJ, Kimball AB: Quality of life and treatment satisfaction among patients with psoriasis and psoriatic arthritis and patients with psoriasis only: results of the 2005 spring US National Psoriasis Foundation survey. Am J Clin Dermatol 2008, 9:111–117. This was an important study that highlights quality-of-life and treatment satisfaction issues. It was conducted in association with the National Psoriasis Foundation.

  4. Gelfand JM, Neimann AL, Shin DB, et al.: Risk of myocardial infarction in patients with psoriasis. JAMA 2006, 296:1735–1741.

    Article  CAS  PubMed  Google Scholar 

  5. Gladman DD: Mortality in psoriatic arthritis. Clin Exp Rheumatol 2008, 26(5 Suppl 51):S62–S65.

    CAS  PubMed  Google Scholar 

  6. Kimball AB, Jacobson C, Weiss S, et al.: The psychosocial burden of psoriasis. Am J Clin Dermatol 2005, 6:383–392.

    Article  PubMed  Google Scholar 

  7. Gottlieb AB, Dann F: Comorbidities in patients with psoriasis. Am J Med 2009, 122:1150.e1–1150.e9.

    Article  Google Scholar 

  8. Laas K, Roine R, Rasanen P, et al.; HUS QoL Study Group: Health-related quality of life in patients with common rheumatic diseases referred to a university clinic. Rheumatol Int 2009, 29:267–273.

    Article  PubMed  Google Scholar 

  9. Mease PJ, Menter MA: Quality-of-life issues in psoriasis and psoriatic arthritis: outcome measures and therapies from a dermatological perspective. J Am Acad Dermatol 2006, 54:685–704.

    Article  PubMed  Google Scholar 

  10. Naldi L, Chatenoud L, Linder D, et al.: Cigarette smoking, body mass index, and stressful life events as risk factors for psoriasis: results from an Italian case-control study. J Invest Dermatol 2005, 125:61–67.

    Article  CAS  PubMed  Google Scholar 

  11. Kimball AB, Gladman D, Gelfand JM, et al.: National Psoriasis Foundation clinical consensus on psoriasis comorbidities and recommendations for screening. J Am Acad Dermatol 2008, 58:1031–1042.

    Article  PubMed  Google Scholar 

  12. Han C, Robinson DW Jr, Hackett MV, et al.: Cardiovascular disease and risk factors in patients with rheumatoid arthritis, psoriatic arthritis, and ankylosing spondylitis. J Rheumatol 2006, 33:2167–2172.

    PubMed  Google Scholar 

  13. Gelfand JM, Troxel AB, Lewis JD, et al.: The risk of mortality in patients with psoriasis: results from a population-based study. Arch Dermatol 2007, 143:1493–1499.

    Article  PubMed  Google Scholar 

  14. •• Gladman DD, Ang M, Su L, et al.: Cardiovascular morbidity in psoriatic arthritis. Ann Rheum Dis 2009, 68:1131–1135. This was an excellent prospective study that reviewed and discussed the CV outcomes of more than 600 patients in a Toronto cohort. The severity of psoriasis is an important risk factor for PsA patients.

  15. Ridker PM, Koenig W, Fuster V: C-reactive protein and coronary heart disease. N Engl J Med 2004, 351:295–298; author reply 295–298.

    Article  PubMed  Google Scholar 

  16. Kimhi O, Caspi D, Bornstein NM, et al.: Prevalence and risk factors of atherosclerosis in patients with psoriatic arthritis. Semin Arthritis Rheum 2007, 36:203–209.

    Article  PubMed  Google Scholar 

  17. • Gonzalez-Gay MA, Gonzalez-Juanatey C, Vazquez-Rodriguez TR, et al.: Asymptomatic hyperuricemia and serum uric acid concentration correlate with subclinical atherosclerosis in psoriatic arthritis patients without clinically evident cardiovascular disease. Semin Arthritis Rheum 2009, 39:157–162. This was a study of subclinical atherosclerosis for PsA patients that used uric acid concentration as a correlate.

  18. •• Peters MJ, Symmons DP, McCarey D, et al.: EULAR evidence-based recommendations for cardiovascular risk management in patients with rheumatoid arthritis and other forms of inflammatory arthritis. Ann Rheum Dis 2010, 69:325–331. This is an important evidence-based guideline addressing the wealth of research in the area of CV risk and inflammatory arthritis. It provides the prospective clinician with some clear strategies on the CV risk management for our inflammatory arthritis patients.

  19. Mallbris L, Ritchlin CT, Stahle M: Metabolic disorders in patients with psoriasis and psoriatic arthritis. Curr Rheumatol Rep 2006, 8:355–363.

    Article  CAS  PubMed  Google Scholar 

  20. Angel K, Provan SA, Gulseth HL, et al.: Tumor necrosis factor-alpha antagonists improve aortic stiffness in patients with inflammatory arthropathies: a controlled study. Hypertension 2010, 55:333–338.

    Article  CAS  PubMed  Google Scholar 

  21. •• Sattar N, Crompton P, Cherry L, et al.: Effects of tumor necrosis factor blockade on cardiovascular risk factors in psoriatic arthritis: a double-blind, placebo-controlled study. Arthritis Rheum 2007, 56:831–839. This well-designed study specifically in PsA patients defined the effects of TNF inhibition on CV risk factors.

  22. Strober B, Teller C, Yamauchi P, et al.: Effects of etanercept on C-reactive protein levels in psoriasis and psoriatic arthritis. Br J Dermatol 2008, 159:322–330.

    Article  CAS  PubMed  Google Scholar 

  23. Channual J, Wu JJ, Dann FJ: Effects of tumor necrosis factor-alpha blockade on metabolic syndrome components in psoriasis and psoriatic arthritis and additional lessons learned from rheumatoid arthritis. Dermatol Ther 2009, 22:61–73.

    Article  PubMed  Google Scholar 

  24. Saraceno R, Schipani C, Mazzotta A, et al.: Effect of anti-tumor necrosis factor-alpha therapies on body mass index in patients with psoriasis. Pharmacol Res 2008, 57:290–295.

    Article  CAS  PubMed  Google Scholar 

  25. Gelfand JM, Gladman DD, Mease PJ, et al.: Epidemiology of psoriatic arthritis in the population of the United States. J Am Acad Dermatol 2005, 53:573.

    Article  PubMed  Google Scholar 

  26. Husted JA, Gladman DD, Farewell VT, Cook RJ: Health-related quality of life of patients with psoriatic arthritis: a comparison with patients with rheumatoid arthritis. Arthritis Rheum 2001, 45:151–158.

    Article  CAS  PubMed  Google Scholar 

  27. • Burmester GR, Mease P, Dijkmans BA, et al.: Adalimumab safety and mortality rates from global clinical trials of six immune-mediated inflammatory diseases. Ann Rheum Dis 2009, 68:1863–1869. This is a nice overview allowing a comparative study of various inflammatory diseases treated with adalimumab and its effects on safety and mortality. Because PsA is less studied in comparison with RA, it is helpful to have a comparative study available.

    Google Scholar 

  28. Spadaro A, Scrivo R, Spinelli FR, Valesini G: Monitoring biological therapies in psoriatic arthritis. J Rheumatol Suppl 2009, 83:69–70.

    Article  PubMed  Google Scholar 

  29. Askling J, van Vollenhoven RF, Granath F, et al.: Cancer risk in patients with rheumatoid arthritis treated with anti-tumor necrosis factor alpha therapies: does the risk change with the time since start of treatment? Arthritis Rheum 2009, 60:3180–3189.

    Article  CAS  PubMed  Google Scholar 

  30. Rohekar S, Tom BD, Hassa A, et al.: Prevalence of malignancy in psoriatic arthritis. Arthritis Rheum 2008, 58:82–87.

    Article  PubMed  Google Scholar 

  31. • Nannini C, Cantini F, Niccoli L, et al.: Single-center series and systematic review of randomized controlled trials of malignancies in patients with rheumatoid arthritis, psoriatic arthritis, and ankylosing spondylitis receiving anti-tumor necrosis factor alpha therapy: is there a need for more comprehensive screening procedures? Arthritis Rheum 2009, 61:801–812. This was an interesting study examining malignancy and TNF inhibitor therapy that addressed the need for more comprehensive screening.

  32. Frediani B, Allegri A, Falsetti P, et al.: Bone mineral density in patients with psoriatic arthritis. J Rheumatol 2001, 28:138–143.

    CAS  PubMed  Google Scholar 

  33. Borman P, Babaoglu S, Gur G, et al.: Bone mineral density and bone turnover in patients with psoriatic arthritis. Clin Rheumatol 2008, 27:443–447.

    Article  PubMed  Google Scholar 

  34. Reddy SM, Anandarajah AP, Fisher MC, et al.: Comparative analysis of disease activity measures, radiographic features, and bone density in psoriatic arthritis and rheumatoid arthritis. J Rheumatol 2010 (in press).

  35. Wright V: Psoriatic arthritis. Acomparative radiographic study of rheumatoid arthritis and arthritis associated with psoriasis. Ann Rheum Dis 1961, 20:123–131.

    Article  CAS  PubMed  Google Scholar 

  36. Harrison BJ, Hutchinson CE, Adams J, et al.: Assessing periarticular bone mineral density in patients with early psoriatic arthritis or rheumatoid arthritis. Ann Rheum Dis 2002, 61:1007–1011.

    Article  CAS  PubMed  Google Scholar 

  37. •• Qureshi AA, Dominguez P, Duffin KC, et al.: Psoriatic arthritis screening tools. J Rheumatol 2008, 35:1423–1425. This noteworthy review examined the need for efficient screening tools for PsA and the importance of early detection, which would allow for early treatment.

Download references

Disclosure

Dr. Mease has received research grants from Abbott Laboratories, Amgen, Biogen Idec, Bristol-Myers Squibb, Centocor, Genentech, Roche, Wyeth, and Pfizer; has served as a consultant for Abbott Laboratories, Amgen, Biogen Idec, Bristol-Myers Squibb, Centocor, Genentech, Roche, UCB, Wyeth, and Pfizer; and has served as a speaker for Abbott Laboratories, Amgen, Biogen Idec, Bristol-Myers Squibb, Centocor, Genentech, UCB, Wyeth, and Pfizer. No other potential conflicts of interest relevant to this article were reported.

Author information

Authors and Affiliations

  1. Cleveland Clinic, Orthopedic and Rheumatologic Institute, 9500 Euclid Avenue, Cleveland, OH, 44195, USA

    M. Elaine Husni

  2. Division of Rheumatology Research, Swedish Medical Center, University of Washington School of Medicine, Seattle, WA, USA

    Philip J. Mease

Authors
  1. M. Elaine Husni
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Philip J. Mease
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to M. Elaine Husni.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Husni, M.E., Mease, P.J. Managing Comorbid Disease in Patients with Psoriatic Arthritis. Curr Rheumatol Rep 12, 281–287 (2010). https://doi.org/10.1007/s11926-010-0112-3

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11926-010-0112-3

Keywords

Search

Navigation