bDMARDs may delay or reduce the risk of PsA in people with moderate-to-severe chronic plaque psoriasis.
INTRODUCTION
Psoriasis is a chronic inflammatory skin condition that causes redness and scaling. Many people with psoriasis also have psoriatic arthritis (often shortened to PsA). In psoriatic arthritis, the disease causes pain and swelling in people’s joints, resulting in joint damage and disability. Psoriatic arthritis can affect joints in the arms, hands, legs, feet, as well as the spine. In general, people are diagnosed with psoriasis first. About a quarter of people with psoriasis of the skin go on to develop psoriatic arthritis in their joints within 5–10 years.
There are many different types of treatments available for people with psoriasis and psoriatic arthritis, including a group of medicines called biologic disease-modifying antirheumatic drugs (sometimes also called biologics, or shortened to bDMARDs). These drugs work by targeting specific molecules that cause inflammation. By doing so they reduce inflammation in the skin and joints.
WHAT DID THE AUTHORS HOPE TO FIND?
The authors wanted to work out whether the treatments that people receive early on for their skin psoriasis affect how many go on to develop psoriatic arthritis.
WHO WAS STUDIED?
The study looked at 464 adults diagnosed with moderate-to-severe chronic plaque psoriasis – but not initially with psoriatic arthritis. Everyone taking part was eligible to receive treatment with phototherapy or a bDMARD.
All the people in the study were treated at the University Hospital of Verona in Italy.
HOW WAS THE STUDY CONDUCTED?
This was a retrospective study, which means the authors looked back through medical records to find two sets of people. Group 1 included 234 people with psoriasis who had been prescribed at least 5 years of bDMARD treatment. Group 2 included 230 people who had received at least three courses of narrow-band ultraviolet light B phototherapy for their psoriasis. The authors then compared how many people went on to develop psoriatic arthritis over 5 years in each of the groups.
WHAT WERE THE MAIN FINDINGS OF THE STUDY?
The main finding was that people treated with bDMARDs had a lower risk of developing psoriatic arthritis compared to those treated with phototherapy. Overall, 8% of people in the bDMARD group developed psoriatic arthritis, compared to 14% of people in the phototherapy group. This provides early evidence that bDMARDs may delay or reduce the risk of psoriatic arthritis in people with moderate-to-severe chronic plaque psoriasis.
The authors also found some other individual factors that were associated with a higher risk of developing psoriatic arthritis. These included being older, having nail psoriasis, and having had psoriasis for over 10 years.
ARE THESE FINDINGS NEW?
Yes, these results are new.
WHAT ARE THE LIMITATIONS OF THE STUDY?
The study has some important limitations, including its retrospective, non-randomised intervention design, which may mean there could be bias in the way the data were selected and analysed. In addition, there is not an appropriate random group sample available for the study.
Confounding by indication is another major limitation. This means it is possible that the prescribing doctor may have thought some people could be prone to developing psoriatic arthritis – or even have the disease already, although the diagnosis had not been made – and this would have affected the medicines they chose. Because of this, future large prospective and interventional studies are needed to validate these findings in independent samples.
WHAT DO THE AUTHORS PLAN TO DO WITH THIS INFORMATION?
The authors are investigating the transition from psoriasis to psoriatic arthritis. They think the disease might evolve across various different phases, including a subclinical phase in which early medical and systemic intervention could stop progression to psoriatic arthritis.
WHAT DOES THIS MEAN FOR ME?
If you have moderate-to-severe psoriasis, you have a one in four chance of going on to develop psoriatic arthritis. This study suggests that early treatment of your skin condition with bDMARDs that target the underlying inflammation may reduce the risk of psoriatic arthritis.
If you have any concerns about your disease or its treatment, you should talk to your doctor.
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Date prepared: December 2021
Summary based on research article published on: 18 June 2021
From: Gisondi P, et al. Biological disease-modifying antirheumatic drugs may mitigate the risk of psoriatic arthritis in patients with chronic plaque psoriasis. Ann Rheum Dis 2022;81:68–73. doi:10.1136/annrheumdis-2021-219961
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