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Psoriatic arthritis (PsA) is classified as a spondyloarthropathy and is characterised by synovitis, enthesitis, dactylitis and spondylitis, usually following the development of cutaneous and nail psoriasis.1 PsA patients have a higher prevalence of some comorbidities (obesity, metabolic syndrome, depression and premature cardiovascular disease) than patients with psoriasis (Pso) without arthritis.2 Increased adiposity and weight gain have been associated with the risk of psoriasis in a prospective study,3 and because 10–30% of Pso patients develop PsA, it is increasingly important to determine whether obesity is solely a comorbid condition in PsA or a risk factor.
A case–control study in patients with Pso found that patient-reported body mass index (BMI) at age 18 years, but not current BMI, was associated with the development of PsA.4 However, the study had some important limitations, including the case definition of PsA, difficulties in establishing a temporal relationship between the factors evaluated, and a lack of validated data on the accuracy of patient recall of BMI at 18 years of age.5
This issue of the journal includes two large prospective studies that suggest obesity is a risk factor for PsA.6 ,7 The cohort study by Love et al, which was conducted using an electronic database of medical records representative of the general UK population and with a 15-year time horizon, found the incidence rates of PsA increased in tandem with BMI, both in the 75 395 people with psoriasis and in the general population (almost 2 million), independent of …
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