Which Patients With Psoriasis Will Develop Psoriatic Arthritis?

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A new study published in the Journal of International Medical Research revealed 4 factors that may help predict whether a patient with psoriasis will develop psoriatic arthritis.

The retrospective cohort study included 330 patients with psoriasis and was conducted at the University of Malaya in Kuala Lumpur among patients who were Malay, Chinese, and Indian. The study data were collected in a retrospective chart review of patient records.The mean duration of follow-up was 10.2 years.

Female patients, patients whose nails are affected, those who had severe disease, and those who had received oral systemic therapy were found to be more at risk for developing psoriatic arthritis.

The researchers found 25% (83) developed psoriatic arthritis over the course of the study. The mean age of patients who developed psoriatic arthritis was 54.2 years, and the duration from diagnosis of psoriasis to diagnosis of psoriatic arthritis was 36 months.

Although various risk factors (eg, affected skin areas, psoriasis severity, nail involvement, sex, smoking, and body mass index, according to the study authors) for development of psoriatic arthritis have been identified, evidence for the effects of these factors among different ethnic groups has been limited, they wrote.

While approximately 10% to 30% of all patients with psoriasis will develop psoriatic arthritis, the prevalence is lower in Asian patients with psoriasis, of whom about 14%have psoriatic arthritis, compared to 19.7% overall, according to the researchers.

“Nearly one-third of patients develop psoriatic arthritis after being diagnosed with psoriasis for 30 years, and the risk appears to remain constant after the initial diagnosis,” they wrote. Because the amount of time a patient has had psoriasis does not apparently increase risk of psoriatic arthritis, they examined other factors that may contribute to development of the condition.Thirty-eight (45.8%) of the patients who developed psoriatic arthritis were Malay, 24 (28.9%) were Chinese, and 21 (25.3%) were Indian. (Of the 330 total patients, 325 of them were one of these ethnicities, and 5 were of “other” ethnicity.)

The researchers wrote they “did not find any association between race and ethnicity and the risk of developing [psoriatic arthritis], nor did we observe any differences in race and ethnicity between the psoriasis-only and [psoriatic arthritis] groups.”

Environmental factors such as tobacco and alcohol use may also play a role in the development of psoriatic arthritis, and the researchers noted that these factors, as well as genetic differences, should be considered when reviewing previous studies that have shown patients of some ethnic groups to be more prone to psoriatic arthritis.

Rather than race or ethnic group, they found, the predictive factors for developing psoriatic arthritis in this population were female sex (odds ratio [OR]3.33), presence of nail involvement (OR 5.36), severe psoriasis (OR 27.41), and oral systemic therapy prior to psoriatic arthritis diagnosis (OR 4.09).

Patients whose histories fit these criteria may benefit from increased screening, the study authors wrote, since this may lead to earlier diagnosis and treatment. The authors also recommended more extensive studies be performed to better understand the predictive factors of psoriatic arthritis.

Reference

Loo WY, Tee YC, Han WH, et al. Predictive factors of psoriatic arthritis in a diverse population with psoriasis. J Int Med Res. 2024;52(1):3000605231221014. doi:10.1177/03000605231221014