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01-10-2021 | Psoriatic arthritis | Adis Journal Club | Article

Rheumatology and Therapy

Predictors, Risk Factors, and Incidence Rates of Psoriatic Arthritis Development in Psoriasis Patients: A Systematic Literature Review and Meta-Analysis

Authors: Alen Zabotti, Orazio De Lucia, Garifallia Sakellariou, Alberto Batticciotto, Gilberto Cincinelli, Ivan Giovannini, Luca Idolazzi, Gabriella Maioli, Ilaria Tinazzi, Daniel Aletaha, Salvatore De Vita, Antonio Marchesoni, Josef Smolen, Annamaria Iagnocco, Dennis McGonagle & Roberto Cap



Agreement on how to identify psoriasis (PsO) patients at risk of developing psoriatic arthritis (PsA) is lacking.


To identify predictors, risk factors and incidence rate (IR) of PsA development in PsO patients through a systematic literature review (SLR) and meta-analyses (MA).


MEDLINE, Embase, and Cochrane databases were searched. Cohort studies were used to assess the predictors, while case–control studies for PsA risk factor determination.


We screened 4698 articles for eligibility, and 110 underwent a full reading and 26 were finally included. Among skin and nail phenotypes, PsO severity and nail pitting were selected as predictors of PsA development. Furthermore, PsO patients with arthralgia (pooled RR 2.15 [1.16; 3.99]) and/or with imaging-MSK inflammation (pooled RR 3.72 [2.12; 6.51]) were at high risk of PsA. Higher categories of BMI and a family history of PsA were other predictors. In outpatient-based cohort studies, the IR of PsA per 100 patient-years varied from 1.34 to 17.4.


Despite the strength of the overall results, the heterogeneity and the number of the cohort studies could be considered a limitation.


This study provides a tentative profile of the PsO patient at risk of PsA and will help the design of PsA prevention trials.

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Key Summary Points

Identifying PsO patients at increased risk for transition to PsA is challenging.

This SRL provides a synthesis of predictors and risk factors of PsA development in PsO patients.

These results are crucial for the characterization of the preclinical phases of PsA and for the design of prevention and interception trials.

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