Personal History of Psoriasis Linked to Axial Joint Disease in Psoriatic Arthritis

In patients with psoriatic arthritis (PsA), existing cutaneous lesions or a personal history of psoriasis are associated with disease activity and severity of axial joint damage, but family history does not appear to impact the disease activity, according to study results published in Rheumatology and Therapy.1

“Careful personal and familial history taking may not only help decide the most appropriate treatments for different PsA patients but also predict the involvement of axial joint and improve prognosis,” Tian-Fang Li, MD, PhD, of the First Affiliated Hospital of Zhengzhou University in China, stated.

Few studies have compared the clinical manifestations and disease activity in patients with PsA with or without a personal or family history of psoriasis. This prospective observational study investigated the association between a history of psoriasis and the clinical characteristics of PsA in 296 patients recruited from 2019 to 2020 at the First Affiliated Hospital of Zhengzhou University.

Patients were divided into 3 groups based on the history of psoriasis as follows: 145 patients with psoriasis themselves, 96 patients with a family history of psoriasis, and 55 patients with both a family history and coexisting psoriasis themselves. These patients underwent clinical, radiographic and biochemical examinations, and their disease activity was evaluated.

Compared with patients with both a family history and coexisting psoriasis, C-reactive protein (CRP), erythrocyte sedimentation rate (ESR), uric acid, Disease Activity index for Psoriatic Arthritis (DAPSA), Bath Ankylosing Spondylitis Disease Activity Index (BASDAI), Ankylosing Spondylitis Disease Activity Score (ASDAS), and Bath Ankylosing Spondylitis Functional Index (BASFI), were lower in patients with a family history alone but similar to those with psoriasis themselves. Further, sacroiliitis was more severe in patients with both a family history and coexisting psoriasis compared with patients with a family history alone (Odds ratio [OR]2 vs 3 0.508; 95% CI 0.272 to 0.949, p < 0.05).

Among the 3 groups, there were no significant differences in HLA-B-27 and common inflammatory articular and extra-articular manifestations. No differences were evident in the Leeds Enthesitis index (LEI), tender joint count (TJC), swollen joint count (SJC)

and DAS28/CRP. Interestingly, the earliest arthritis onset (average age: 34.8), occurred in patients with both a family history and coexisting psoriasis (p < 0.001).

Investigators noted that they found a female predominance (57.3%) in patients with a family history alone, which differs from previous epidemiological data from Western countries showing that the male-to-female ratio is about 1:1.

“Our study did reveal similar disease patterns of patients in the 3 groups with regards to inflammatory arthritis, and extra-articular manifestation such as the prevalence of different parts of arthritis and dactylitis,” investigators explained. However, compared with a family history alone, those with both a family history and personal history of psoriasis “seem to have higher disease activity as evidenced by higher levels of CRP and ESR, and more severe sacroiliitis.”

Reference:

Li SS, Du N, He SH, et al. Exploring the Association Between History of Psoriasis (PSO) and Disease Activity in Patients with Psoriatic Arthritis (PsA) [published online ahead of print, 2022 May 17]. Rheumatol Ther. 2022;10.1007/s40744-022-00455-8. doi:10.1007/s40744-022-00455-8