Study Highlights Risk of PsA Development Among Varied Manifestations of Psoriasis

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Lowest risk of developing psoriatic arthritis (PsA) among psoriasis patients exists among Black or African American individuals with pustulosis palmoplantaris, according to new findings, and the highest risk is present among female patients with psoriasis.¹

These recent findings also suggest that there is wide variance among psoriasis patients’ risk in developing PsA, depending upon sex, disease variants, and ethnicity. Such conclusions were the result of new research into risk of PsA across psoriasis variations.

This research was led by Bernard Gershater, from the Lübeck Institute of Experimental Dermatology at the University of Lübeck in Germany. Gershater at al. highlighted prior research that suggested a connection between generalized pustular psoriasis and PsA, adding that the elevated risk of developing PsA among psoriasis patients indicates that treatments to address this problem may be especially helpful.²

“Thus, we aimed here to determine PsA risk in patients diagnosed with different forms of psoriasis,” Gershater and colleagues wrote. “For this, a retrospective cohort study using a large-scale federated database of electronic health records (EHRs) was used.”¹

Study Design

The investigators conducted a study with a global population-based retrospective cohort design, utilizing propensity-score matching and accessing patients’ electronic health records for subjects diagnosed with pustulosis palmoplantaris, psoriasis vulgaris, or generalized pustular psoriasis in addition to control subjects without such conditions.

The research team based their grouping criteria on ICD-10 codes, investigating the risk of developing PsA and comparing risk among those with the aforementioned 3 conditions versus controls. They also used similar forms of analyses using the TriNetX network.

The team additionally used the US Collaborative Network to draw comparisons related to PsA development risk among those with the 3 aforementioned variants of psoriasis and their sex- and ethnicity-specific risks for development within the same network.

The investigators gathered their data from February - May 2023, with information evaluated on 91 million individuals drawn from 57 American healthcare organizations. They looked at 15 million patients from 24 healthcare organizations across Sweden, Poland, the UK, Spain, Finland, Belgium, Italy, Germany, Bulgaria, Hungary, and Israel.

The research team also looked at the data of 26 million individuals from 24 healthcare organizations within Brazil.

The team from University Clinic of Schleswig-Holstein was accessed through the TriNetX network as part of a collaboration. For the purposes of enhancing comparability in their evaluation of the risk of subsequent diagnosis of PsA, the investigators carried out propensity-score matching by establishing covariate matrices.

There were 2 models which were used for propensity matching. One was a model which would include female sex, age at index, and ethnicity as variables. The second model the investigators used involved the incorporation of known PsA risk factors in addition to those variables.

Findings

Overall, the data of 486 Black or African American-stratified generalized pustular psoriasis patients and 35,281 psoriasis patients’ electronic health records from the US Collaborative Network. Substantial variations of PsA development risk were established by the investigators.

The research team found that the highest risk was linked with psoriasis (hazard ratio [HR] 87.7, confidence interval [CI] 63.4–121.1, P < .001), followed then by generalized pustular psoriasis (HR 26.8, CI 6.5–110.1, P < .0001), and pustulosis palmoplantaris (HR 15.3, CI 7.9–29.5, P < .0001). There were also a set of significant disparities which were sex- and ethnicity-specific in the formation of PsA.

The team concluded that White patients with psoriasis were found to be more likely to develop PsA than Black or African American patients (HR 1.3, CI 1.04–1.7, P = .0244). The team also reported that female individuals with psoriasis were shown to have a higher risk of developing PsA versus males with psoriasis (HR 1.1, CI 1.1–1.2, P = .002).

These key findings were validated by the investigators through the use of alternative propensity. They matched strategies and independent databases.

“This study has several limitations to be appreciated,” they wrote. “Primarily, cohorts were identified using ICD-10 codes, which to a certain degree include coding inaccuracies. This issue likely applies to our study because the observed prevalence of PsA was lower than has been reported elsewhere. Thus, PsA is most likely under-diagnosed within the HCOs contributing data to TriNetX.”

References

1. ^{Gershater B, Bieber K, Vorobyev A, Ludwig MA, Zirpel H, De Luca DA, Thaci D, Kridin K, Ludwig RJ. Differential risks of psoriatic arthritis development in patients with varied psoriasis manifestations: a sex- and ethnicity-specific analysis. Front Med (Lausanne). 2024 Jun 21;11:1385491. doi: 10.3389/fmed.2024.1385491. PMID: 38975056; PMCID: PMC11224429.}
2. ^{Wang, HM, Xu, JM, and Jin, HZ. Characteristics and burdens of disease in patients from Beijing with generalized pustular psoriasis and palmoplantar pustulosis: multicenter retrospective cohort study using a regional database. Am J Clin Dermatol. (2023) 17:425–43. doi: 10.1007/s40257-023-00807-2.}