People With Psoriatic Arthritis at Risk For Chronic Kidney Disease

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Chronic kidney disease (CKD) is not infrequent in patients with psoriatic arthritis (PsA) and its development is associated with joint damage and NSAID use, with a possible protective association with methotrexate.¹

“PsA develops in up to 30% of patients with psoriasis and is characterized by diverse clinical features. It is recognized that PsA often leads to impaired function and a reduced quality of life. The disease is associated with multiple comorbidities, including obesity, type 2 diabetes mellitus (DM), hypertension, metabolic syndrome, fatty liver and an increased risk of cardiovascular events. Despite the paucity of data on PsA, kidney disease has also been described,” lead investigator Fadi Kharouf, MD, Krembil-Gladman Psoriatic Arthritis Research Program, Centre for Prognosis Studies in the Rheumatic Diseases, Schroeder Arthritis Institute, Krembil Research Institute, University Health Network, Toronto, Ontario, Canada, and colleagues wrote.¹

Kharouf and colleagues analyzed data from patients with PsA in a prospective observational cohort and assessed the incidence of CKD and long-term renal outcomes in participants with CKD. They also used time-dependent Cox regression models to identify factors associated with CKD development.

The cohort included 1336 patients, 123 (9.2%) of which overall had CKD. Of these participants, 25 (20.3%) had CKD at clinic entry and 98 (79.7%) developed CKD during follow-up. Follow-up lasted a median of 8.2 years (IQR, 2.8-14.0) from baseline. During that time, 18 of 98 (18.3%) new patients with CKD had their baseline creatinine double, 49 (50%) developed a sustained ≥40% reduction in baseline eGFR, and 2 developed eGFR a sustained <15 mL/min/1.73 m2 eGFR.¹

After adjusting for age at study entry, sex and baseline eGFR in the multivariate Cox regression model, Kharouf and colleagues found that included diabetes mellitus (HR 2.58, P <.001), kidney stones (HR 2.14, P = .01), radiographic damaged joint count (HR 1.02, P = .02), uric acid (HR 1.21, P <.001; 50-unit increase), and daily use of non-steroidal anti-inflammatory drugs (NSAIDs) (HR 1.77, P = .02) were associated with an increased risk of developing CKD, while methotrexate use (HR 0.51, P = .01) had a protective association with CKD development.

“In conclusion, CKD is not infrequent in patients with PsA. Its development is associated with related comorbidities, joint damage and the use of NSAIDs. MTX appears to provide a renoprotective effect. Better control of risk factors and proper use of medications, besides having other health-related benefits, will also help preserve renal function,” Kharoud and colleagues concluded.¹

Other recent research investigating multimorbidities in people with rheumatic diseases found that systematic multimorbidity screening in this population boosted preventive medication use and reduced hospital admissions in a recent study, which investigators say justify time and resource allocation for screening.²

Patients exposed to multimorbidity screening met the composite endpoint of dispensation of multimorbidity-preventing drugs at a higher rate than the unexposed patients (adjusted OR, 1.6 [95% CI, 1.2–2.2]; P <.01). This trend held in the propensity score-matched analysis, in which 54.8% of exposed patients met the endpoint compared with 44.5% of matched controls (OR, 1.5; P = .015).²

REFERENCES
1. Kharouf F, Gao S, Al-Matar S, Cook RJ, Chandran V, Gladman DD. Chronic kidney disease in patients with psoriatic arthritis: a cohort study. RMD Open 2024;10:e004636. doi: 10.1136/rmdopen-2024-004636

2. Immediato Daien C, Georgescu V, Decarriere G, Mercier G, Morel J. Systematic screening for multimorbidities in patients with inflammatory rheumatic diseases enhanced preventive medication use and reduced hospitalisations: an exposed-non-exposed study. RMD Open. 2024;10(4):e004490. Published 2024 Oct 2. doi:10.1136/rmdopen-2024-004490