Background/Purpose: Psoriasis (PsO) is a systemic inflammatory disease accompanied by comorbidities such as depression, cardiovascular diseases or metabolic syndrome. Approximately 10 – 27% of PsO patients develop psoriatic arthritis (PsA), a rheumatologic comorbidity of PsO. Due to increased impairment of working ability and risk of a potential destructive disease course of PsA, early diagnosis and therapeutic intervention are crucial for optimal patient care. This analysis on German health claims data was conducted to determine the rate of development of PsA in PsO patients over 4 years. Furthermore, comorbidity profiles of PsO patients with and without concomitant PsA were compared as well as potential risk factors for the development of PsA were assessed.

Methods: This was a non-interventional retrospective analysis of anonymized insurance health claims data using a subset of the Institute of Applied Health Research Berlin (InGef) database, which was observable between 2012 and 2017. The database contained 2.9 million subjects stratified by age and gender based on the population structure of Germany as reported by the German Federal Statistical Office DeStatis. Continuously insured individuals were identified by ICD-10 GM version 2019 codes (L40.0: psoriasis vulgaris, L40.5: psoriatic arthritis). Risk factors for the development of PsA in Pso patients were determined by conditional logistic regression analysis in sex- and age-matched populations.

Results: The cumulative percentage of patients with incident PsO developing PsA (PsO-PsA) over 4 years was 3% with a mean time to diagnosis of PsA of 1.5 years. Patients developing PsA were on average approx. 5 years younger than patients not developing PsA within 4 years. Although both patient groups displayed a similar spectrum of comorbidities with a high frequency of diseases associated to metabolic syndrome, unspecific arthritic symptoms were distinctly more frequent in PsO-PsA patients. However, only 4% of patients with PsO and 43% of patients with concomitant PsA consulted ambulatory rheumatologists. PsO patients diagnosed with “acute rheumatism” (odds ratio: 2.93, 95% CI=1.01-2.99; p= < 0.001) or “pain in unspecific joints” (odds ratio: 1.74, 95% CI=1.76-4.86; p= 0.047) showed an increased risk to develop PsA later on. Specific arthritic symptoms such as “Bouchard’s nodes” and “Heberden’s nodes”, on the other hand, did not confer a higher risk for development of PsA

Conclusion: The lower mean age of PsO–PsA patients and the mean time to PsA diagnosis of only 1.5 years show that PsA development can already start early after PsO diagnosis reinforcing the need for early involvement of rheumatologists in the medical care of PsO patients. The small percentage of patients with or without concomitant PsA presented to rheumatologists suggests that the majority of PsO patients with concomitant PsA were not under specialized rheumatologic care and patients with existing PsO might profit from intensified rheumatologic screening. The identified risk factors for the development of PsA, “acute rheumatism” and “pain in unspecific joints”, confirm previous findings that PsA diagnosis is preceded by unspecific arthritic symptoms.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/psoriatic-arthritis-epidemiology-incidence-rate-in-psoriasis-patients-comorbidity-profiles-and-risk-factor-analysis/