Psoriatic Arthritis: How it Stacks up to Rheumatoid Arthritis and Psoriasis

Inflammatory rheumatic diseases have long been associated with increased mortality and morbidity.

Psoriatic arthritis, for example, is associated with a long list of co-morbidities beginning with cardiovascular conditions, but also other inflammatory-related conditions, such as atherosclerosis and arterial stiffness.

A new study compares the prevalence of comorbidities among psoriatic arthritis, rheumatoid arthritis and psoriasis. The study, published in the July 15, 2015 issue of the International Journal of Rheumatic Diseases, compared the prevalence of the comorbidities of 173 patients with psoriatic arthritis (75 male, 98 female, mean age 41.8) to 138 patients with rheumatoid arthritis (17 male, 121 female, mean age 48.6) and 67 patients with psoriasis (43 male, 24 female, mean age 36.1).

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Rheumatic diseases are complex conditions associated with co-morbidities that can be fatal. The high mortality rates in rheumatoid arthritis, for example, are associated with the higher incidence of cardiovascular diseases, such as myocardial infarction and stroke.

The comparisons: Psoriatic arthritis and rheumatoid arthritis

Patients withpsoriatic arthritis had a higher risk for cataract/glaucoma surgery (OR =11.99; 95% CI 1.36–105.4, P = 0.025) as compared to patients with RA, but not for diabetes mellitus (OR = 1.67; 95% CI 0.78–3.57, P = 0.186) and arterial hypertension (OR = 1.59; 95% CI 0.74–3.43, P = 0.235).

The comparisons: Psoriatic arthritis and Psoriasis

Patients with psoriatic arthritis were younger (36.1 _ 13.97 vs. 41.9 _ 12.36 years, P = 0.004), had a longer duration since onset of symptoms (11.5 _ 8.66 vs. 8.9 _8.01 years, P = 0.042), lower BMI (25.2 _ 4.63 vs. 27.1 _ 5.53, P = 0.007) and a higher rate of glucocorticoid use (41.8% vs. 20.2%, P = 0.001) than patients with psoriatic arthritis who had a higher risk for arterial hypertension (OR = 4.26; 95% CI 1.27–14.23, P = 0.018).

Other studies have compared patients with psoriatic arthritis versus psoriasis in terms of comorbidity and cardiovascular risks. One study showed that the risk of cardiovascular mortality, myocardial infarction and stroke was 1.2-fold higher in 34,300 patients with psoriasis compared to the general population, and the risk was much higher in those with severe cutaneous involvement and arthritis.

The study highlighted the use of corticosteroid in rheumatoid arthritis and its possible link to hypertension.

“Patients with psoriatic arthritis have lower percentages of comorbidities like rheumatoid arthritis, hypertension and cataract/glaucoma surgery compared to those with rheumatoid arthritis. The increase in comorbidity in the rheumatoid arthritis group may be particularly attributed to the glucocorticoids and non-steroid inflammatory drugs widely used in rheumatoid arthritis. Well-designed controlled studies are needed in order to elicit more robust results,” the authors wrote.

References:

Nas K, Karkucak M, Durmus B, et al., Comorbidities in patients with psoriatic arthritis: a comparison with rheumatoid arthritis and psoriasis.International Journal of Rheumatic Diseases. July 14, 2015. doi: 10.1111/1756-185X.12580