Older Age Linked to Shorter Interval Between Psoriasis, Psoriatic Arthritis

Individuals with a diagnosis of psoriasis (PsO) aged 43 years or older are more likely to have a shorter interval between PsO and psoriatic arthritis (PsA), as well as have concurrent diagnoses, compared with younger individuals, a study finds.¹

In this study, the researchers identified patients with PsO and PsA diagnoses from a tertiary care psoriatic disease biorepository, which included clinical information and patient-reported outcomes.

This longitudinal, real-world study is published in ACR Open Rheumatology.

“Given the high rates of undiagnosed PsA or delayed diagnoses in PsA and the frequency of erosions in patients with PsA on first presenting to rheumatologic care, there is an urgent need to identify patients with PsO who are more likely to develop PsA in a short period of time,” wrote the researchers of the study. “This study aimed to identify clinical and demographic features that were associated with a shorter interval between PsO and PsA diagnoses (including concurrent diagnoses), using patient- and clinician-derived data from our institution's psoriatic disease biorepository.”

PsO is a clear risk factor for PsA, however, there is often significant delay in diagnosing PsA, with one-third to one-half of patients experiencing a 2-year delay, and many patients experiencing up to 4 years of delay. Moreover, female patients with severe skin PsO who have nail involvement and require oral systemic therapy have been found to be at increased risk of PsA.²

In this study, the researchers identified patients with PsO and PsA diagnoses from a tertiary care psoriatic disease biorepository, which included clinical information and patient-reported outcomes. All patients enrolled between November 18, 2010, and May 18, 2021, were included in the study.

The researchers selected variables that are known to be associated with increased risk of PsA in patients with PsO, including cardiovascular disease, body madd index (BMI), metabolic syndrome components (diabetes mellitus, hypertension, and hyperlipidemia, history of smoking or alcohol use, nail PsO, and family history of PsO.

Additionally, the researchers included demographic features for age at PsO diagnosis, sex, and type of psoriatic disease treatment.

A total of 577 patients were enrolled in the PsA registry, in which 384 had a diagnosis of PsA that was made after or concurrent with their diagnosis of PsO. Of these patients, 52.2% were female, and the mean (SD) age of PsO onset was 31.5 (15.3) years.

Advanced age at PsO onset was associated with a shorter interval between PsO and PsA, and patients with PsO onset at age 42.6 years had a 62% shorter interval compared with patients with PsO onset at age 18.9 years (P < .001). These patients were also more likely to have concurrent diagnoses (OR, 4.56; 95% CI, 2.9-7.2).

Additionally, patients with a BMI of 34 had a 10% shorter interval between PsO and PsA compared with patients with a BMI of 26, which tended toward statistical significance (P = .053).

However, the researchers acknowledged some limitations to the study, including having no information about PsO subtypes, which may be relevant in predicting the interval between diagnoses. Additionally, the retrospective design of the study may have led to recall bias, which may have been especially apparent among patients who were enrolled into the registry at a late time in their psoriatic disease course.

Despite these limitations, the researchers believe the study found that older age at PsO onset is linked to concurrent PsA diagnosis and shorter interval to PsA development.

“This result has implications for more proscriptive screening practices for PsA and referral patterns to rheumatologists with the goal of improving psoriatic disease health outcomes,” wrote the researchers.

References

1. Cheemalavagu S, Jin Y, Husni ME. What clinical factors affect length of transition to psoriatic arthritis in patients with psoriasis? ACR Open Rheumatol. Published online June 28, 2024. doi:10.1002/acr2.11703

2. Grossi G. From psoriasis to PsA: Study identifies predictive factors for development. February 20. 2024. https://www.ajmc.com/view/from-psoriasis-to-psa-study-identifies-predictive-factors-for-development