Background: Psoriatic arthritis (PsA) is a chronic inflammatory arthritis associated with psoriasis (PsO) and multiple comorbidities.1 Approximately one-third of PsO patients develop PsA during the course of their disease.2 As patient cohorts included in randomised clinical trials are not necessarily representative of the real world, registry data can complement any information gained on patient characteristics and disease outcomes.3 The British Association of Dermatologists Biologic and Immunomodulators Register (BADBIR) is one such registry for patients with plaque PsO, with PsA being one of the recorded comorbidities at time of patient enrolment into the database.
Objectives: The primary objective of this study was to evaluate baseline characteristics and comorbidities in PsO patients with and without a PsA diagnosis using the BADBIR database. The hypothesis was that patients with both diseases show a higher likelihood of being diagnosed with additional comorbid conditions vs. PsO alone.
Methods: This was a retrospective observational study using two cohorts of BADBIR data (i.e. adult PsO patients either receiving ustekinumab [UST] as their biologic treatment or receiving conventional systemic anti-psoriatic medication [conventional systemic]). Comparisons were made between PsA and PsO alone in each cohort at baseline, additionally stratifying by biologic experience in the UST treatment group. Baseline characteristics of interest were evaluated, including body mass index, smoking and employment status, as well as comorbidities (i.e. diabetes, hypertension, myocardial infarction and depression). Effect sizes and 95% confidence intervals were generated via matching with a two-sided Fisher’s exact test.
Results: Cohort patient counts were as follows: 2697 UST treated without PsA; 590 UST treated with PsA; 5105 conventional systemic without PsA; 529 conventional systemic with PsA. PsO patients with a PsA diagnosis had a higher prevalence of diabetes, obesity and hypertension across both conventional systemic and UST cohorts vs. PsO alone (Table 1). Similarly, inability to work was notably higher in PsO patients with PsA vs. PsO alone (Figure 1). Patients with PsO and comorbid PsA who were receiving UST were more likely to have a diagnosis of depression than those receiving conventional systemic treatment (Table 1).
Conclusion: These results indicate that PsO patients with PsA had a higher prevalence of obesity, diabetes, hypertension and inability to work vs. PsO alone. Depression also seems to be more prevalent in PsO patients with comorbid PsA receiving biologic treatment vs. those receiving conventional systemics. These results potentially indicate a higher inflammatory and quality-of-life burden in PsO patients with a PsA diagnosis, highlighting the need for adequate patient assessment and follow-up to ensure a best possible holistic patient management approach.
References: Shah et al. RMD Open 2017;3:e000588
Coates et al. Lancet 2015;386:2489–98
Mason et al. JAMA Dermatol 2018;154:581–8
Disclosure of Interests: William Tillett Speakers bureau: AbbVie, Amgen, Celgene, Eli Lilly, Janssen, Novartis, Pfizer and UCB, Consultant of: AbbVie, Amgen, Celgene, Eli Lilly, Janssen, Novartis, MSD, Pfizer and UCB, Grant/research support from: AbbVie, Celgene, Eli Lilly, Janssen and UCB, Alexis Ogdie Consultant of: AbbVie, Amgen, Bristol-Myers Squibb, Celgene, Corrona, Janssen, Eli Lilly, Novartis and Pfizer, Grant/research support from: Pfizer to Penn, Novartis to Penn, Amgen to Forward/NDB, Patricia Gorecki Employee of: Janssen-Cilag Ltd, Alun Passey Employee of: Janssen-Cilag Ltd
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