medwireNews: Treatment with biologic DMARDs could reduce the risk for developing psoriatic arthritis among patients with moderate-to-severe chronic plaque psoriasis, suggest findings from a retrospective study.
“Chronic plaque psoriasis is associated with psoriatic arthritis (PsA) in up to nearly 20%–25% of adult [psoriasis] cases,” and “[t]he delay between the onset of skin manifestations of psoriasis and joint disease may provide a therapeutic window of clinical opportunity for preventing the progression from psoriasis to PsA,” explain the researchers.
As reported in the Annals of the Rheumatic Diseases, the team analyzed data from 464 psoriasis patients treated with either biologic DMARDs (n=234) or narrow-band ultraviolet light B phototherapy (n=230) at the University Hospital of Verona in Italy between 2012 and 2020. The most commonly used biologic was adalimumab (29%), followed by secukinumab (26%) and ustekinumab (21%), and 15% of patients switched biologics over the course of the study.
In all, 11% of the total study population developed PsA during an average follow-up of 6.76 years, with rates of 8% in the biologics group and 14% in the phototherapy group.
The annual incidence rate for PsA was 1.20 cases per 100 patients for those taking biologics versus 2.17 cases per 100 patients for those given phototherapy. This translated into a significant 73% reduced risk in the biologics group in a multivariate analysis adjusting for factors including age, sex, psoriasis duration, family history of PsA, and baseline PASI score.
Paolo Gisondi (Università degli Studi di Verona, Italy) and team also found that older age, psoriasis duration of more than 10 years, and the presence of nail psoriasis were significantly and independently associated with higher PsA risk in the multivariate analysis.
They note that the most common pattern of PsA experienced by patients in the study was peripheral arthritis (84%), while 20% experienced dactylitis, 16% enthesitis, and 6% axial involvement.
“More than one pattern could be observed in a single psoriatic patient,” they add.
Taken together, the study results suggest that “[e]arly therapeutic intervention with bDMARDs may delay or reduce the risk of PsA development in patients with moderate-to-severe chronic plaque psoriasis,” write Gisondi and team in the Annals of the Rheumatic Diseases.
They caution that their study had a number of limitations, including its retrospective nonrandomized design and limited patient numbers, meaning that “a subgroup analysis examining the effects of different [biologic] DMARD classes on the risk of incident PsA could not be performed.”
The researchers conclude: “Future large prospective and intervention studies are needed to further validate these findings in independent samples.”
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Ann Rheum Dis 2021; doi:10.1136/annrheumdis-2021-219961