Predictors for PsA in patients with psoriasis identified
medwireNews: Musculoskeletal inflammation and damage is one of several factors that could help predict psoriatic arthritis (PsA) development among patients with psoriasis, suggest results of a meta-analysis and systematic review.
“Identifying [psoriasis] patients at increased risk for transition to PsA is challenging,” highlight Alen Zabotti (University of Udine, Italy) and colleagues.
This study “provides a synthesis of predictors and risk factors of PsA development in [psoriasis] patients,” say the researchers, who add that their “results are crucial for the characterization of the preclinical phases of PsA and for the design of prevention and interception trials.”
Twenty-six studies of patients with skin and/or nail psoriasis without a PsA diagnosis at baseline were included; predictors were identified from 16 cohort studies and risk factors were detected from 10 case-control studies.
The incidence of PsA per 100 patient–years ranged from 0.23–0.39 in population studies and from 2.70–3.70 in psoriasis registry studies. “As expected, the [incidence rate] broadly increased when estimated in an outpatient setting,” rising to 1.34–17.40 cases per 100 patient–years, note Zabotti et al.
Patients with musculoskeletal symptoms, namely arthralgia, were a significant two times more likely to develop PsA than those without, while those with imaging-detected musculoskeletal inflammation (inflammation synovitis, enthesitis, or tenosynovitis) or structural damage (erosion and entheseal new bone formation) were almost four times more likely.
“These results clearly underline the importance of [musculoskeletal] complaints referred by the patients and the subclinical disease detected by imaging to stratify [psoriasis] patients at imminent risk for PsA development,” write the investigators in Rheumatology and Therapy.
Disease severity measured as a continuous Psoriasis Area Severity Index (PASI) score was only “weakly predictive” of PsA development, whereas it was “clearly predictive” when classes of severity were compared, the researchers note. In one study, psoriasis patients with PASI scores above 20 were significantly more likely to develop PsA than those with a score below 10, with an adjusted hazard ratio (HR) of 5.39.
Nail psoriasis was not cumulatively associated with PsA development; three “pertinent” studies involved small sample sizes and had an average follow-up of only 2 years, the researchers point out. However, one large study supported nail involvement as a significant predictor in both univariate and multivariate analysis and the team highlights that another two studies published since the analysis, and therefore not included, have supported these findings.
In terms of types of nail lesions, only nail pitting was a possible predictive factor, with a significant pooled HR for PsA development of 2.14 from two cohort studies.
Patients with higher BMI categories had a greater risk for developing PsA than patients with a BMI of less than 25 kg/m2, ranging from a HR of 1.17 for those with a BMI of 25.0–29.9 kg/m2 to 1.96 for those with a BMI of 35 kg/m2 or above. Patients with a family history of PsA were also at greater risk of the condition than those without (odds ratio=4.43).
These factors along with environmental triggers, like trauma, “could assist clinicians and researchers for the characterization of [psoriasis] patients at high risk for PsA development but further longitudinal studies will be needed,” say Zabotti et al.
“Despite the strength of the overall results, the heterogeneity and the number of the cohort studies could be considered a limitation,” they note.
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