Psoriasis onset determines sequence of symptoms

Data from the PsART-International cohort showed that the age of psoriasis onset determines whether arthritis or psoriasis starts first in people with psoriatic arthritis (PsA) [1].

PsART-International is a web-based registry of PsA patients under routine care in Turkey, Italy, and Canada. It includes detailed disease history about the type and onset of skin and joint disease. “PsA is a heterogeneous disease regarding clinical presentation and treatment response. If patients presenting with arthritis first are really a different subgroup, then treatment response and prognosis could also be different. Indeed, in our cohort, achieving minimal disease activity (MDA) was statistically less frequent in patients with arthritis first.” said Prof. Umut Kalyoncu (Hacettepe University, Turkey).

In the study, data on demographic characteristics, family history of psoriatic disease, types of skin psoriasis, site of skin psoriasis onset, and components of PsA ever observed were extracted. Patient characteristics were divided in 3 groups: arthritis-first, psoriasis-first, and synchronous, the latter indicating the onset of skin and joint disease within 12 months. The study’s primary outcome was the absolute time elapsed in months after skin disease to arthritis, with negative values indicating arthritis onset before psoriasis. A total of 1,631 patients were included in the study: 71 who had arthritis first, 309 with synchronous onset, and 1,251 who had psoriasis first.

Data showed that the age of psoriasis onset, not that of arthritis, determined if arthritis or psoriasis would appear first. Pustular psoriasis was associated with a 2-year shorter time interval after psoriasis to arthritis, whereas nail involvement, plaque psoriasis, or family history of psoriasis were associated with an increased delay from psoriasis to arthritis, by approximately 2 years for each factor. “Starting age of psoriasis is particularly important, because it depends on the genetic background,” said Prof. Kalyoncu. “Early-onset psoriasis is strongly associated with HLA-Cw06. However, late-onset psoriasis is not associated with it. In our study, arthritis first was highly related with late-onset psoriasis. This means arthritis-first patients may be a different subgroup of PsA, and treatment response could be worse in these patients as well. If these results are confirmed in other well-defined PsA cohorts, we may have determined a subgroup of this highly heterogeneous disease.”

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   1. Kalyoncu U et al. Abstract 2854. ACR 2019, 9-13 November, Atlanta (GA/USA).

Posted on 4 February 202012 March 2021