Background/Purpose: Psoriatic arthritis (PsA) is a type of inflammatory arthritis that is commonly comorbid with the skin condition, psoriasis. A major contributor to the severity and burden of psoriatic disease is the extent of skin lesions. The objective of this study was to characterize the demographic and clinical characteristics of PsA patients with >3% versus ≤3% of body surface area (BSA) affected by psoriasis and evaluate the association with outcomes such as minimal disease activity (MDA) and disability, measured by health assessment questionnaire (HAQ) in a large national observational cohort of patients with PsA and spondyloarthritis (Corrona).

Methods: All PsA patients ≥18 years enrolled in the Corrona registry and had data on BSA were included in this study. Descriptive analyses of patient characteristics, disease activity, and functionality measures at registry enrollment were assessed for patients with >3% versus ≤3% BSA. Regression models were used to evaluate the associations of BSA level with the outcome measures MDA and HAQ (0-3); adjusted for age, gender, race, BMI, disease duration, history of csDMARD use, history of biologic use and history of prednisone use at enrollment.

Results: Of the 1,240 PsA patients that were included in the analysis, 451 (36.4%) had >3% and 789 (63.6%) had ≤3% BSA. Patients with BSA>3% were younger with a mean (SD) age of 52.2 (13.4) years [vs 54.4 (13.2)], with 49.4% women [vs 52.1%], 89.1% Caucasian [vs 91.5%], with mean (SD) BMI 32 (7.5) [vs. 31.2 (7)] and mean (SD) disease duration of 9 (9.4) years [vs 8.7 (8.6)]. There were slightly higher rates of cardiovascular disease (61.25% vs. 59.4%), cancer (9.1% vs. 6.6%), and serious infections (5.1% vs. 4.4%) in the patients with BSA >3% vs. those with BSA ≤ 3% respectively. About 60% of patients in both groups used a biologic therapy and approximately 21% of patients with BSA>3% were in MDA vs. 30 % of patients with BSA ≤3%. Adjusted models showed that patients with BSA >3% were 1.79 times (OR=1.79, 95% CI=1.30, 2.47) more likely to not be in MDA relative to those with BSA ≤3%.  Sensitivity analysis evaluating the associations between BSA >3% and ≤ 3% and a modified MDA (5/6 criteria excluding BSA) showed consistent results (OR=1.71, 95% CI=1.21, 2.41).   Similarly, adjusted models showed a significant difference in mean HAQ in patients with >3% BSA (mean difference=0.21 units higher; 95% CI=0.13, 0.29) compared to patients with BSA≤3%. 

Conclusion: Data from the Corrona registry showed that PsA patients with >3% of BSA affected by psoriasis were significantly more likely to not be in MDA and more likely to be disabled than patients with ≤3% BSA at enrollment. Even at the low cutoff of >3% BSA affected used in this analysis, the extent of psoriasis lesions confers a significantly greater burden of disease in PsA. These findings underscore the importance of assessing and effectively managing psoriasis in patients with PsA.

« Back to 2015 ACR/ARHP Annual Meeting

ACR Meeting Abstracts - https://acrabstracts.org/abstract/clinical-characteristics-and-disease-outcomes-in-psoriatic-arthritis-patients-by-extent-of-body-surface-area-affected-by-psoriasis-results-from-corrona-registry/