Background/Purpose:

Psoriatic arthritis (PsA) is a chronic inflammatory disease that is associated with various comorbidities. This study aimed to assess the comorbidity burden and medication use among PsA patients as compared to matched controls who did not have PsA or psoriasis (PsO).

Methods:

Adults (18-64 years) with ≥2 claims for PsA diagnosis (ICD-9-CM: 696.0) that are ≥30 days apart were selected from the Truven Health MarketScan claims database (07/2009-06/2014) and constituted the case group. The index date was a randomly selected calendar date after the first claim for PsA. Cases were required to have ≥ 12 months continuous eligibility after the index date (the study period). Controls free of PsA and PsO (ICD-9-CM code: 696.0 and 696.1) in the entire claims history were assigned the same index date and study period as the matched cases. All selected patients were further required to have ≥12 months before the index date (washout period), which was used to confirm that controls were free of PsA and PsO. Cases and controls were matched 1:1 on age as of the index date, gender, and geographic region. Patient demographics as of the index date, comorbidities (including both PsA-associated and non-PsA-associated comorbidities), and medication use during the study period were compared between cases and controls. Wilcoxon signed rank tests were used to compare continuous variables and McNemar’s tests were used to compare binary variables. Bonferroni correction was used to adjust for multiple comparisons.

Results:

A total of 35,061 matched pairs were included in this study with a mean age of 49.11±10.20 years and 47.27% were male. In general, PsA patients had significant higher rates of non-PsA-associated comorbidities compared to the controls, most notably, chronic pulmonary disease (22.70% vs. 14.50%, p<0.0001), liver disease [excluding fatty liver] (12.78% vs. 5.48%, p<0.0001) and co-prevalent rheumatic disease (6.25% vs. 0.98%, p<0.0001). PsA patients also had higher rates of PsA-associated comorbidities, notably, psychiatric diseases including anxiety (17.34% vs. 12.04%) and depression (21.71% vs. 13.14%), inflammatory eye disease including uveitis (2.41% vs. 0.64%) and scleritis (0.89% vs. 0.27%), inflammatory bowel disease [Crohn’s disease or ulcerative colitis] (2.70% vs. 1.08%), celiac disease (0.75% vs. 0.30%) and gout (6.93% vs. 2.88%) (all p<0.0001). PsA patients had significantly higher rates of all-cause medication use (96.64%) and larger number of unique medications filled (12.04) than controls (78.95% and 5.59 respectively). Significant differences were also seen in the mean number of unique medications filled between PsA patients and controls for non-PsA-related medications (9.74 vs. 5.20), antidepressants (0.58 vs. 0.31), antidiabetics (0.28 vs. 0.18) and cardiovascular agents (1.53 vs. 1.05) (all p<0.0001).   

Conclusion:

PsA patients had a significantly higher comorbidity burden compared to matched subjects without  PsA or PsO. PsA patients also incurred significantly more medication use overall and related to these comorbid conditions. This study represents a unique look at the comorbidity burden and prevalence among a large US PsA population.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/comorbidity-burden-and-medication-use-among-patients-with-psoriatic-arthritis-in-the-us/