ATLANTA – In a new study presented at the 2019 ACR / ARP Annual Meeting, researchers found that the age of onset of psoriasis determines whether or not arthritis or psoriasis starts first in people with psoriatic arthritis. Additionally, they found that pustular psoriasis is associated with arthritis onset. and there is an increased delay for nail involvement, plaque psoriasis or family history of psoriasis. (Abstract # 2854).
Psoriatic arthritis (PsA) is a chronic arthritis that typically occurs in people with skin psoriasis, but it can occur in people without skin psoriasis, particularly in those who have relatives with psoriasis. It is a heterogeneous disorder with respect to the patterns and components of musculoskeletal involvement, as well as the types of skin involvement, and the timing of the joint and skin disease in patients. This study explored the relationships between the characteristics of skin psoriasis, arthritis and the timing of arthritis onset using PsART-International, which is a web-based registry of PsA patients under routine care in Turkey, Italy and Canada. PsART-International includes a detailed history of the disease.
"The PsART-International cohort focuses on PsA patients in whom musculoskeletal symptoms start before skin lesions, which is approximately five to 10 percent of all PsA patients. We need more patients to determine related factors," says Umut Kalyoncu, MD, professor, Internal Medicine and Rheumatology, at Hacettepe University in Turkey, and the study's lead author. "PsA is a heterogeneous disease for clinical presentation and treatment response. If there is a different subgroup, it means that the response and prognosis can be different from others. Indeed, in our cohort, achieving minimal disease activity is less "
The investigators extracted data on demographic characteristics, family history of psoriatic disease regardless of skin or arthritis, types of skin psoriasis, site of skin psoriasis onset and components of PsA ever observed. They have three groups: arthritis-first, psoriasis-first and synchronous, or onset of skin and joint disease within 12 months. The study's primary outcome was an absolute time elapsed.
They included 1,631 patients in the study, including 71 who had arthritis first, 309 with synchronous onset, and 1,251 who had psoriasis first. According to their findings, the age of psoriasis onset, not arthritis, determined if arthritis or psoriasis would appear first. Their analysis also shows a 65-month delay of arthritis onset after psoriasis.
"In the cluster analysis, we know that psoriasis has at least six different subtypes: starting age of disease, extensibility of skin involvement, psoriasis skin type (pustular or plaque), nail and musculoskeletal involvement. It depends on the genetic background. Kalyoncu. "Early-onset psoriasis is strongly associated with HLA-Cw6. However, late-onset psoriasis is not associated with it. In our study, arthritis is highly related to late-onset psoriasis. If the results are confirmed in other, well-defined PsA cohorts, we may have a subgroup of this highly heterogeneous disease. "
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Delay Between the Onset of Psoriasis and Arthritis in PsA Patients from the PsART International Cohort
Background / Purpose: Psoriatic arthritis is a heterogenous disorder. The interrelationships between characteristics of skin psoriasis, arthritis and the timing of arthritis are not well studied; we therefore sought to explore these in a large international cohort.
Methods: PsART-international is a web-based registry of PsA patients in Turkey, Italy and Canada. We have extracted data on demographic characteristics, family history of psoriatic disease (regardless of skin or arthritis), types of skin psoriasis, site of skin psoriasis onset, and components of psoriatic arthritis ever observed. For descriptive purposes we tabulated patient characteristics in three groups; arthritis-first, psoriasis-first and synchronous, the latter indicating the onset of skin and joint disease within 12 months. The primary analysis of the disease results in the elapsed time of the disease (arthritis onset before psoriasis). We have constructed a linear regression model for this primary outcome using demographic, skin disease and arthritis characteristics to explore the associations.
Results: We included 1631 patients; 71 had arthritis first, 309 had synchronous onset and 1251 had psoriasis first. Data shows that the age of psoriasis onset and not that of arthritis is determined, whether arthritis or psoriasis would be the first to appear (Table-1). Results of the regression analysis shows that model intercept, delay of arthritis after psoriasis , plaque psoriasis or family history of psoriasis are associated with an increased delay from psoriasis to arthritis, by approximately 2 years-each (Table-2). Adding all types of articular involvement into the model.
Conclusions: The age of psoriasis determines whether arthritis or psoriasis starts first in PsA patients. Pustular psoriasis is associated with a shorter time interval after psoriasis.
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