Prevalence of psoriatic arthritis in patients with psoriasis: A systematic review and meta-analysis of observational and clinical studies

doi:10.1016/j.jaad.2018.06.027

Journal of the American Academy of Dermatology

Volume 80, Issue 1, January 2019, Pages 251-265.e19

https://doi.org/10.1016/j.jaad.2018.06.027 Get rights and content

Background

Wide-ranging prevalence estimates of psoriatic arthritis (PsA) in patients with psoriasis have been reported.

Objectives

To assess the prevalence and incidence of PsA in patients with psoriasis.

Methods

Two authors independently searched 3 databases for studies reporting on the prevalence or incidence of PsA in patients with psoriasis. A proportion meta-analysis was performed to calculate the pooled proportion estimates of PsA in patients with psoriasis.

Results

A total of 266 studies examining 976,408 patients with psoriasis were included. Overall, the pooled proportion (95% confidence interval [CI]) of PsA among patients with psoriasis was 19.7% (95% CI, 18.5%-20.9%). In children and adolescents (<18 years of age), the pooled prevalence was 3.3% (95% CI, 2.1%-4.9%). The PsA prevalence was 22.7% (95% CI, 20.6%-25.0%) in European patients with psoriasis, 21.5% (95% CI, 15.4%-28.2%) in South American patients with psoriasis, 19.5% (95% CI, 17.1%-22.1%) in North American patients with psoriasis, 15.5% (95% CI, 0.009%-51.5%) in African patients with psoriasis, and 14.0% (95% CI, 95% CI, 11.7%-16.3%) in Asian patients with psoriasis. The prevalence of PsA was 23.8% (95% CI, 20.1%-27.6%) in studies in which the Classification Criteria for Psoriatic Arthritis were applied. The incidence of PsA among patients with psoriasis ranged from 0.27 to 2.7 per 100 person-years.

Limitations

Between-study heterogeneity may have affected the estimates.

Conclusions

We found that 1 in 4 patients with psoriasis have PsA. With the growing recognition of the Classification Criteria for Psoriatic Arthritis, more homogenous and comparable prevalence estimates are expected to be reported.

Section snippets

Literature search

This study was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses, and a study protocol was developed a priori.

All articles from inception of the databases through November 2017 were potentially eligible for inclusion. Two authors independently screened the 3 databases (PubMed, Web of Science, and EMBASE) using the following search terms: (psoriasis) AND (psoriatic OR arthritis OR arthropathy OR incidence OR prevalence).

Inclusion and exclusion criteria

To qualify for inclusion,

Results

We identified 6331 records through database searching (2139 in PubMed, 1217 in Web of Science, and 2975 in EMBASE); 4323 nonduplicate records were screened by title and abstract, yielding 1302 articles for full-text assessment. Counting the additional 41 studies identified by screening references, 287 studies were included for data extraction and 266 studies were selected for quantitative analysis (Fig 1); together, these studies included 976,408 patients with psoriasis (12,884 children and

Discussion

Quantitative analysis of 266 studies yielded a PsA prevalence of 19.7% among 976,408 patients with psoriasis. The prevalence of PsA was markedly lower in children and adolescents than in adults but equally frequent in both sexes. Notably, higher estimates were found in patients with moderate-to-severe psoriasis than in patients with mild psoriasis, suggesting that increased attention among this group of patients is warranted.

The prevalence of PsA among patients with psoriasis was lowest in

References (294)

L.C. Coates et al.
Psoriatic arthritis: state of the art review
Clin Med
(2017)
J.M. Moll et al.
Psoriatic arthritis
Semin Arthritis Rheum
(1973)
M. Soy
Susceptibility to atherosclerosis in patients with psoriasis and psoriatic arthritis as determined by carotid-femoral (aortic) pulse-wave velocity measurement
Rev Esp Cardiol
(2009)
J.J. Miller
Inverse of the Freeman-Tukey double arcsine transformation
The Am Statistician
(1978)
R. DerSimonian et al.
Meta-analysis in clinical trials
Control Clin Trials
(1986)
J. Economidou
Human lymphocyte antigens A, B, and C in Greek patients with psoriasis: relation to age and clinical expression of the disease
J Am Acad Dermatol
(1985)
A.B. Fleischer
Disease severity measures in a population of psoriasis patients: the symptoms of psoriasis correlate with self-administered psoriasis area severity index scores
J Invest Dermatol
(1996)
C. Ferrandiz
Psoriasis of early and late onset: a clinical and epidemiologic study from Spain
J Am Acad Dermatol
(2002)
A. Kawada
A survey of psoriasis patients in Japan from 1982 to 2001
J Dermatol Sci
(2003)
L. Mallbris
Psoriasis phenotype at disease onset: clinical characterization of 400 adult cases
J Invest Dermatol
(2005)

V. Chandran et al.

Geoepidemiology and environmental factors of psoriasis and psoriatic arthritis

J Autoimmun

(2010)

R.M. Bennett

Psoriatic arthritis

F.a.E.L.R. Vasey

Psoriatic arthropathy

D.D. Gladman

Psoriatic-arthritis (PSA)–an analysis of 220 patients

Q J Med

H. Zachariae

Quality of life and prevalence of arthritis reported by 5,795 members of the Nordic Poriasis Associations. Data from the Nordic Quality of Life Study

Acta Derm Venereol

(2002)

M.A. Radtke

Prevalence and clinical features of psoriatic arthritis and joint complaints in 2009 patients with psoriasis: results of a German national survey

J Eur Acad Dermatol Venereol

(2009)

Wells GA, Shea B, O'Connell D, et al. The Newcastle-Ottawa Scale (NOS) for assessing the quality of nonrandomised...

C. Biondi Oriente et al.

Prevalence and clinical features of juvenile psoriatic arthritis in 425 psoriatic patients

Acta Derm Venereol Suppl (Stockh)

(1994)

B. Kumar

Epidemiology of childhood psoriasis: a study of 419 patients from Northern India

Int J Dermatol

(2004)

M. Seyhan

Psoriasis in childhood and adolescence: evaluation of demographic and clinical features

Pediatr Int

(2006)

N. Al-Mutairi et al.

Nail changes in childhood psoriasis: a study from Kuwait

Pediatr Dermatol

(2007)

A.S. Paller

Etanercept treatment for children and adolescents with plaque psoriasis

N Engl J Med

(2008)

L.Y. Chiam

Juvenile psoriasis in European and Asian children: similarities and differences

Br J Dermatol

(2011)

M.G. Ozden

Environmental risk factors in pediatric psoriasis: a multicenter case-control study

Pediatr Dermatol

(2011)

A.B. Kimball

Risks of developing psychiatric disorders in pediatric patients with psoriasis

J Am Acad Dermatol

(2012)

K. Mercy

Clinical manifestations of pediatric psoriasis: results of a multicenter study in the United States

Pediatr Dermatol

(2013)

A.S. Paller

Association of pediatric psoriasis severity with excess and central adiposity: an international cross-sectional study

JAMA Dermatol

(2013)

A.E. Moustou

Childhood and adolescent psoriasis in Greece: a retrospective analysis of 842 patients

Int J Dermatol

(2014)

M.J. Van Geel

Methotrexate in pediatric plaque-type psoriasis: long-term daily clinical practice results from the Child-CAPTURE registry

J Dermatolog Treat

(2015)

J. Lysell

Clinical characterisation at onset of childhood psoriasis - a cross sectional study in Sweden

Acta Derm Venereol

(2015)

E. Mahe

Psoriasis and obesity in French children: a case-control, multicentre study

Br J Dermatol

(2015)

Cited by (353)

Global and regional epidemiology of psoriatic arthritis in patients with psoriasis: A comprehensive systematic analysis and modelling study
2024, Journal of Autoimmunity
To provide a comprehensive analysis and modelling of the global epidemiology of psoriatic arthritis (PsA) in patients with psoriasis.
We reviewed and analysed PsA epidemiology studies over the past 45 years. A Bayesian hierarchical linear mixed model was developed to provide comprehensive age- and sex-specific epidemiologic estimates in different countries and regions.
Three hundred and sixty-three studies were systematically reviewed. The incidence of PsA in patients with psoriasis varied from 2.31 per 1000 person-years in the United Kingdom to 74.00 per 1000 person-years in several Western European countries. The global prevalence of PsA in patients with psoriasis is estimated to be 17.58% (3.33%, 43.69%). Regionally, the overall prevalence of PsA in patients with psoriasis varies from 7.62% (4.18%, 12.28%) in Australasia to 26.59% (18.89%, 35.76%) in North America. The Caribbean and Central Latin America also have relatively high prevalence and are estimated at 23.14% (14.06%, 35.17%) and 22.81% (14.36%, 32.25%), respectively. The prevalence of PsA is higher in adults than children (23.93% vs 8.59%) and also slightly higher in females than males (19.14% vs 16.01%).
This study provides valuable insights into the global epidemiology of PsA. It also serves as a useful resource for researchers in areas lacking relevant studies. These findings have important implications for clinicians managing the course of PsA and for health policymakers in resource allocation.
Autoimmune diseases and female-specific cancer risk: A systematic review and meta-analysis
2024, Journal of Autoimmunity
Among the over 80 different autoimmune diseases, psoriasis (PsO), rheumatoid arthritis (RA), and ankylosing spondylitis (AS) are common representatives. Previous studies indicated a potential link with cancer risk, but suffered often from low statistical power. Thus, we aimed to synthesize the evidence and quantify the association to different female-specific cancer sites.
The systematic review was performed according to PRISMA guidelines. A search string was developed for the databases PubMed, Web of Science, Cochrane Library and Embase. Results were screened independently by two investigators and the risk of bias was assessed using the ROBINS-E tool. Meta-analyses were performed using inverse variance weighted random-effects models. Statistical between-study heterogeneity was quantified by calculating Cochran's Q, $τ^{2}$ , and Higgins' I² statistics. Sources of heterogeneity were analyzed and adjusted for within an intensive bias assessment in the form of meta-regression, outlier, influential, and subgroup analyses. A range of methods were used to test and adjust for publication bias.
Of 10,096 records that were originally identified by the search strategy, 45 were included in the meta-analyses. RA was inversely associated with both breast and uterine cancer occurrence, while PsO was associated with a higher breast cancer risk. Outlier-adjusted estimates confirmed these findings. Bias assessment revealed differences in geographic regions, particularly in RA patients, with higher estimates among Asian studies. An additional analysis revealed no association between psoriatic arthritis and breast cancer.
RA seems to reduce the risk of breast and uterine cancers, while PsO appears to increase breast cancer risk. Further large studies are required to investigate potential therapy-effects and detailed biological mechanisms.
A clinical review of structural damage in psoriatic arthritis for dermatologists: From pathogenesis to ongoing controversies
2024, Journal of the American Academy of Dermatology
Psoriatic arthritis (PsA) is a chronic inflammatory disease that often goes unrecognized in patients with psoriasis. As a result, patients may develop significant structural damage before diagnosis and initiation of adequate treatment. Dermatologists are in an unique position to identify early signs and symptoms of PsA. Here, we briefly review the pathogenesis of PsA, differences in PsA presentation within real-world dermatology practice versus rheumatology clinical trials, and imaging modalities that can be used to assess structural damage. We then discuss several ongoing controversies related to prediction, assessment, and treatment of PsA-related structural damage. Debated questions include the following: (1) Does subclinical enthesitis predict progression from psoriasis to PsA?, (2) Does methotrexate inhibit progression of structural damage?, (3) Does structural damage correlate with clinical disease activity?, and (4) Can progression from psoriasis to PsA be prevented? Evidence presented herein suggests that dermatologists, together with rheumatologists, can play important roles in the early diagnosis and treatment of PsA, thereby potentially preventing irreversible structural damage.
Prevention of Psoriatic Arthritis: The Need for Prospective Studies
2024, Dermatologic Clinics
Characteristics and drivers of fatigue in patients with psoriasis and psoriatic arthritis: A cross sectional study
2024, Journal of the American Academy of Dermatology
A multitude of factors may influence fatigue in psoriasis and psoriatic arthritis (PsA); however, their individual fatigue components have not been thoroughly examined.
To explore characteristics of fatigue and its potential drivers in a cohort of patients with psoriasis with or without PsA.
Adults with psoriasis and a nonpsoriasis control group completed the Multidimensional Fatigue Inventory-20 questionnaire. Patients with psoriasis also reported joint pain intensity, pruritus, skin pain, and sleep problems using a numerical rating scale. Linear regression models were applied to continuous outcomes, and beta coefficients (β) for the slopes were estimated with 95% confidence intervals (CIs).
Among 2741 adults with psoriasis (of which 593 also had PsA) and 3788 controls, the impact on total fatigue was greatest for PsA (β = 5.22; 95% CI, 3.55-6.90), followed by psoriasis (β = 2.10; 95% CI, 0.96-3.25), compared with the general population (P_trend < .0001). Among patients with psoriasis with or without PsA, increasing joint pain intensity was associated with overall fatigue (β = 2.23 [95% CI, 2.03-2.44] for each 1-point increase in joint pain numerical rating scale score).
We lacked information on the effect of pharmacotherapy.
These findings highlight the importance of a symptom-based approach when treating psoriasis, rather than focusing on objective severity measures alone.
Psoriasis Comorbidities and Their Treatment Impact
2024, Dermatologic Clinics

View all citing articles on Scopus

: Funding sources: None.

: Disclosure: Dr Kristensen has received fees for speaking and consultancy from Pfizer, MSD, AbbVie, UCB, Eli Lilly and Company, Novartis, Celgene, Janssen Pharmaceuticals, Roche, Forward Pharma, and BMS. Dr Gladman has received consultancy fees and/or grant support from AbbVie, Amgen, BMS, Celgene, Eli Lilly and Company, Janssen, Pfizer, Novartis, and UCB. Dr Jullien has received research funding from Pfizer and honoraria as a consultant and/or speaker from Abbvie, Amgen, Celgene, Eli Lilly and Company, Janssen Pharmaceuticals, MSD, Novartis, and Pfizer. Dr Gottlieb has received honoraria as a consultant and/or speaker from Janssen Inc, Celgene Corp, Bristol-Myers Squibb, Beiersdorf Inc, Abbvie, UCB, Novartis, Incyte, Eli Lilly and Company, Reddy Labs, Valeant, Dermira, Allergan, and Sun Pharmaceutical Industries, and he has received research funding from Janssen, Incyte, Eli Lilly and Company, Novartis, Allergan, and Leo Pharma. Dr Gisondi has received honoraria as a consultant and/or speaker from AbbVie, Celgene, Eli Lilly and Company, Janssen, Leo Pharma, MSD, Novartis, Pfizer, and UCB. Dr Wu is an investigator for AbbVie, Amgen, Eli Lilly and Company, Janssen, Novartis, and Regeneron. Dr Thyssen is supported by an unrestricted grant from the Lundbeck Foundation; he has received speaker honoraria from Galderma, Sanofi-Genzyme, and MEDA; has attended advisory board meetings for Roche and Sanofi-Genzyme; and is an investigator for LEO Pharma. Dr Egeberg has received research funding from Pfizer, Eli Lilly and Company, the Danish National Psoriasis Foundation, and the Kgl Hofbundtmager Aage Bang Foundation and has received honoraria as a consultant and/or speaker from Almirall, Leo Pharma, Samsung Bioepis Co Ltd, Pfizer, Eli Lilly and Company, Novartis, Galderma, and Janssen Pharmaceuticals. Drs Alinaghi, Calov, and Coates have no conflicts of interest to disclose.

: Drs Alinaghi and Calov had full access to all of the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis. Drs Egeberg and Thyssen take responsibility for study concept and design. All the authors take responsibility for acquisition, analysis, and interpretation of the data and for critical revision of the manuscript for important intellectual content. Drs Alinaghi and Egeberg take responsibility for drafting of the manuscript. Dr Egeberg takes responsibility for statistical analysis. Drs Egeberg and Thyssen take responsibility for administrative, technical, or material support and for study supervision.

: Reprints not available from the authors.

View full text

ReviewPrevalence of psoriatic arthritis in patients with psoriasis: A systematic review and meta-analysis of observational and clinical studies

Background

Objectives

Methods

Results

Limitations

Conclusions

Section snippets

Literature search

Inclusion and exclusion criteria

Results

Discussion

Clin Med

Semin Arthritis Rheum

Rev Esp Cardiol

The Am Statistician

Control Clin Trials

J Am Acad Dermatol

J Invest Dermatol

J Am Acad Dermatol

J Dermatol Sci

J Invest Dermatol

Lancet

J Invest Dermatol

J Am Acad Dermatol

Gen Hosp Psychiatry

Lancet

J Am Acad Dermatol

Lancet

J Am Acad Dermatol

J Am Acad Dermatol

J Hepatol

J Autoimmun

Psoriatic arthritis

Psoriatic arthropathy

Psoriatic-arthritis (PSA)–an analysis of 220 patients

Q J Med

Rev Rhum Mal Osteoartic

The European Spondylarthropathy Study Group preliminary criteria for the classification of spondylarthropathy

Arthritis Rheum

Psoriatic arthritis: a unified concept twenty years on

Arthritis Rheum

Proposed classification criteria of psoriatic arthritis. A preliminary study in 260 patients

Rev Rhum Engl Ed

Classification criteria for psoriatic arthritis: development of new criteria from a large international study

Arthritis Rheum

The early psoriatic arthritis screening questionnaire: a simple and fast method for the identification of arthritis in patients with psoriasis

Rheumatology

Prevalence and clinical characteristics of psoriatic arthritis in Japan

J Rheumatol

Developing the Thai Siriraj Psoriatic Arthritis Screening Tool and validating the Thai Psoriasis Epidemiology Screening Tool and the Early Arthritis for Psoriatic Patients questionnaire

Rheumatol Int

Clinic characteristics of psoriasis in China: a nationwide survey in over 12000 patients

Oncotarget

Quality of life and prevalence of arthritis reported by 5,795 members of the Nordic Poriasis Associations. Data from the Nordic Quality of Life Study

Acta Derm Venereol

Prevalence and clinical features of psoriatic arthritis and joint complaints in 2009 patients with psoriasis: results of a German national survey

J Eur Acad Dermatol Venereol

Prevalence and clinical features of juvenile psoriatic arthritis in 425 psoriatic patients

Acta Derm Venereol Suppl (Stockh)

Epidemiology of childhood psoriasis: a study of 419 patients from Northern India

Int J Dermatol

Psoriasis in childhood and adolescence: evaluation of demographic and clinical features

Pediatr Int

Nail changes in childhood psoriasis: a study from Kuwait

Pediatr Dermatol

Etanercept treatment for children and adolescents with plaque psoriasis

N Engl J Med

Juvenile psoriasis in European and Asian children: similarities and differences

Br J Dermatol

Environmental risk factors in pediatric psoriasis: a multicenter case-control study

Pediatr Dermatol

Risks of developing psychiatric disorders in pediatric patients with psoriasis

J Am Acad Dermatol

Clinical manifestations of pediatric psoriasis: results of a multicenter study in the United States

Pediatr Dermatol

Association of pediatric psoriasis severity with excess and central adiposity: an international cross-sectional study

JAMA Dermatol

Childhood and adolescent psoriasis in Greece: a retrospective analysis of 842 patients

Int J Dermatol

Review
Prevalence of psoriatic arthritis in patients with psoriasis: A systematic review and meta-analysis of observational and clinical studies