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TOPLINE:

Biologic treatments are linked to a lower incidence of psoriatic arthritis (PsA) than methotrexate in patients with psoriasis, with topical therapy showing the lowest PsA incidence rate.

METHODOLOGY:

• Researchers conducted a retrospective cohort study using an Israeli administrative claims database in which they analyzed the incidence of PsA in 58,671 patients who were first diagnosed with psoriasis between January 1, 2000, and December 31, 2020.
• Patients were categorized by treatment regimens: Biologics, methotrexate, phototherapy, or topical treatments.
• Patients in the phototherapy and topical therapy groups did not receive any systemic treatments prior to enrollment in the study, which followed patients until PsA diagnosis, treatment was switched, death, or the end of the study on February 10, 2022.

TAKEAWAY:

• The methotrexate group showed the highest PsA incidence, followed by the anti-interleukin (IL)-12/23, anti-IL-17, phototherapy, and tumor necrosis factor inhibitor groups.
• All biologic treatment groups collectively showed a reduced risk for PsA compared with the methotrexate group (hazard ratio [HR], 0.46; 95% CI, 0.35-0.62).
• Biologic treatments were associated with a notably higher risk for PsA than topical therapy (HR, 2.16; 95% CI, 1.44-3.24).
• Exposure to at least two biologic agents (odds ratio [OR], 6.09; P < .001) or prior methotrexate therapy (OR, 1.88; P = .026) was linked to a significantly higher risk for PsA.
• The investigators did not have access to Psoriasis Area and Severity Index scores, and so disease severity and other potential confounding factors and sources of bias may have influenced the association such that the use of biologic agents could be seen not as a cause but rather as a marker for more severe disease characteristics.

IN PRACTICE:

"These findings collectively support the notion that severe psoriasis is a significant risk factor for PsA," the authors wrote.

SOURCE:

The study was led by Abdulla Watad, MD, Sheba Medical Center, Ramat Gan, Israel. It was published online on June 7 in Rheumatology and Therapy.

LIMITATIONS:

The study's limitations include a potential underestimation of axial involvement due to its retrospective design and reliance on administrative data. The imbalance between patients on systemic vs nonsystemic therapy could decrease statistical power. 

DISCLOSURES:

This study was supported by an educational grant provided by Janssen Pharmaceuticals. The authors had no relevant disclosures, except one author, who is an editorial board member of Rheumatology and Therapy.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.