Authors: Sneha Patel & Anand Kumthekar
Abstract
Psoriatic arthritis (PsA) is associated with a higher burden of co-morbidities such as obesity, cardiovascular disease, non-alcoholic fatty liver disease, inflammatory eye disease, inflammatory bowel disease, skin cancer and depression compared to the general population. In the last 20 years, the therapeutic options for PsA have increased exponentially with the availability of tumor necrosis factor-alpha (TNF) inhibitors, interleukin (IL)-17 inhibitors, IL-12/23 inhibitors and Janus kinases/signal transducer and activator of transcription proteins (JAK/STAT) inhibitors. The articular and extra-articular manifestations of PsA usually dictate the treatment choice but important consideration must be given to the corresponding co-morbidities while deciding the drug therapy due to associated safety profile, effect on disease activity, etc. This review provides a comprehensive review of common co-morbidities in PsA and how they can influence treatment choices.
Key Summary Points |
Psoriatic arthritis patients have a high burden of co-morbidities such as obesity, cardiovascular disease, etc., which should be considered while making therapeutic choices |
Overall cardiovascular risk is increased in patients with PsA, and there is evidence to suggest that treatment with TNFi can improve cardiovascular outcomes |
Although rare, IL-17 inhibition should be considered with caution if there is associated IBD with PsA due to low but reported risk of IBD flares |
There is no clear association between most malignancies and csDMARD/bDMARD but a shared decision should be made before starting therapy |
Obesity can increase risk of NAFLD and methotrexate toxicity and reduce TNFi efficacy, but a higher BMI has not been associated with a poor treatment response with IL-17A inhibitors, IL12/23 inhibitors or JAK/STAT inhibitors. |
The risk of liver disease and renal disease with bDMARD use appears low |