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Psoriatic arthritis (PsA) is a chronic, inflammatory arthritis that affects an estimated 30% of patients with psoriasis. PsA is underdiagnosed in primary care and dermatology clinics due to a variety of reasons, including failure of healthcare providers to ask about symptoms, overlap of symptoms and signs with other rheumatologic conditions, and lack of a specific diagnostic test. A delay in PsA diagnosis and treatment, even as short as 6 months, can lead to decreased quality of life, increased joint damage, and worse long-term physical function. In this study, we sought to identify the clinical and genetic factors that help discriminate patients with PsA from those with cutaneous psoriasis only.
We analyzed a cohort of 974 psoriasis patients at an academic medical center, of whom 175 had confirmed PsA, and performed univariate, multivariate, and predictive modeling to determine factors associated with PsA.
The univariate analysis revealed significant positive associations of PsA with age, nail involvement, scalp involvement, skin fold involvement, elbow/knee involvement, psoriasis severity, plaque subtype, erythrodermic subtype, hypertension, type 2 diabetes, and coronary artery disease, and a significant negative association of PsA with the human leukocyte antigen (HLA)-C*06:02 allele. In the multivariate analysis, nail involvement, type 2 diabetes, and pustular psoriasis remained significantly associated with PsA, while HLA-C*06:02 positivity remained protective. There was a trend towards an association of PsA with older age, younger age of psoriasis onset, and skin fold involvement, while there was protective trend for smoking. A predictive model including both clinical and genetic factors showed reasonable discriminative ability between psoriasis and PsA, with an area under the curve of 0.87 for a receiver operating characteristic curve.
This study identified a number of clinical and genetic features that could help stratify patients who are at higher risk for having PsA and for whom rheumatology referral may be beneficial.
Ritchlin CT, Colbert RA, Gladman DD. Psoriatic arthritis. N Engl J Med. 2017;376(10):957–70. CrossRef
Girolomoni G, Gisondi P. Psoriasis and systemic inflammation: underdiagnosed enthesopathy. J Eur Acad Dermatol Venereol. 2009;23[Suppl 1]:3–8. CrossRef
Betteridge N, Boehncke WH, Bundy C, Gossec L, Gratacos J, Augustin M. Promoting patient-centred care in psoriatic arthritis: a multidisciplinary European perspective on improving the patient experience. J Eur Acad Dermatol Venereol. 2016;30(4):576–85. CrossRef
Kavanaugh A, Helliwell P, Ritchlin CT. Psoriatic arthritis and burden of disease: patient perspectives from the population-based multinational assessment of psoriasis and psoriatic arthritis (MAPP) survey. Rheumatol Ther. 2016;3(1):91–102. CrossRef
Haroon M, Gallagher P, FitzGerald O. Diagnostic delay of more than 6 months contributes to poor radiographic and functional outcome in psoriatic arthritis. Ann Rheum Dis. 2015;74(6):1045–50. CrossRef
Duffin KC, Freeny IC, Schrodi SJ, et al. Association between IL13 polymorphisms and psoriatic arthritis is modified by smoking. J Invest Dermatol. 2009;129(12):2777–83. CrossRef
Li W, Han J, Qureshi AA. Smoking and risk of incident psoriatic arthritis in US women. Ann Rheum Dis. 2012;71(6):804–8. CrossRef
Eder L, Shanmugarajah S, Thavaneswaran A, et al. The association between smoking and the development of psoriatic arthritis among psoriasis patients. Ann Rheum Dis. 2012;71(2):219–24. CrossRef
Soltani-Arabshahi R, Wong B, Feng BJ, Goldgar DE, Duffin KC, Krueger GG. Obesity in early adulthood as a risk factor for psoriatic arthritis. Arch Dermatol. 2010;146(7):721–6. CrossRef
Ho PY, Barton A, Worthington J, Thomson W, Silman AJ, Bruce IN. HLA-Cw6 and HLA-DRB1*07 together are associated with less severe joint disease in psoriatic arthritis. Ann Rheum Dis. 2007;66(6):807–11. CrossRef
Ogdie A, Gelfand JM. Identification of risk factors for psoriatic arthritis: scientific opportunity meets clinical need. Arch Dermatol. 2010;146(7):785–8. CrossRef
Wilson FC, Icen M, Crowson CS, McEvoy MT, Gabriel SE, Kremers HM. Incidence and clinical predictors of psoriatic arthritis in patients with psoriasis: a population-based study. Arthritis Rheum. 2009;61(2):233–9. CrossRef
Dilthey A, Leslie S, Moutsianas L, et al. Multi-population classical HLA type imputation. PLoS Comput Biol. 2013;9(2):e1002877. CrossRef
FitzGerald O, Haroon M, Giles JT, Winchester R. Concepts of pathogenesis in psoriatic arthritis: genotype determines clinical phenotype. Arthritis Res Ther. 2015;17:115. CrossRef
Winchester R, Minevich G, Steshenko V, et al. HLA associations reveal genetic heterogeneity in psoriatic arthritis and in the psoriasis phenotype. Arthritis Rheum. 2012;64(4):1134–44. CrossRef
Eder L, Chandran V, Pellet F, et al. Human leucocyte antigen risk alleles for psoriatic arthritis among patients with psoriasis. Ann Rheum Dis. 2012;71(1):50–5. CrossRef
Generalized additive models. London: Chapman and Hall; 1990.
Prevention CfDCa. National Health and Nutrition Examination Survey: healthy weight, overweight, and obesity among U.S. adults; 2003. https://www.cdc.gov/nchs/data/nhanes/databriefs/adultweight.pdf
Gudjonsson JE, Karason A, Antonsdottir AA, et al. HLA-Cw6-positive and HLA-Cw6-negative patients with Psoriasis vulgaris have distinct clinical features. J Invest Dermatol. 2002;118(2):362–5. CrossRef
Coto-Segura P, Eiris-Salvado N, Gonzalez-Lara L, et al. Psoriasis, psoriatic arthritis and type 2 diabetes mellitus: a systematic review and meta-analysis. Br J Dermatol. 2013;169(4):783–93. CrossRef
Wan MT, Shin DB, Hubbard RA, Noe MH, Mehta NN, Gelfand JM. Psoriasis and the risk of diabetes: a prospective population-based cohort study. J Am Acad Dermatol. 2018;78(2):315 e1–322 e1. CrossRef
Choi JW, Kim BR, Seo E, Youn SW. Could psoriatic arthritis be easily diagnosed from current suspicious physical findings in the dermatology clinic? Ann Dermatol. 2017;29(1):48–54. CrossRef
Feingold KR, Grunfeld C. The effect of inflammation and infection on lipids and lipoproteins. In: De Groot LJ, Chrousos G, Dungan K, et al. (eds) Endotext. South Dartmouth: MDText.com, Inc.; 2000.
Navarro-Millan I, Charles-Schoeman C, Yang S, et al. Changes in lipoproteins associated with methotrexate or combination therapy in early rheumatoid arthritis: results from the treatment of early rheumatoid arthritis trial. Arthritis Rheum. 2013;65(6):1430–8. CrossRef
Hassan S, Milman U, Feld J, et al. Effects of anti-TNF-alpha treatment on lipid profile in rheumatic diseases: an analytical cohort study. Arthritis Res Ther. 2016;18(1):261. CrossRef
Saiki O, Takao R, Naruse Y, Kuhara M, Imai S, Uda H. Infliximab but not methotrexate induces extra-high levels of VLDL-triglyceride in patients with rheumatoid arthritis. J Rheumatol. 2007;34(10):1997–2004. PubMed
David M, Abraham D, Weinberger A, Feuerman EJ. Generalised pustular psoriasis, psoriatic arthritis and nephrotic syndrome associated with systemic amyloidosis. Dermatologica. 1982;165(3):168–71. CrossRef
- Clinical and Genetic Risk Factors Associated with Psoriatic Arthritis among Patients with Psoriasis
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