Biologic Agents Reduce Psoriatic Arthritis Incidence

arthritis in the hand
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The effect of psoriasis treatment with biologic agents and incidence of psoriatic arthritis is examined.

Psoriatic arthritis, which develops in about 30% of patients with psoriasis, exhibited a lower incidence in patients who received treatment with biologic agents compared with patients who did not, according to findings from a retrospective cohort study published in Arthritis & Rheumatology.

Investigators analyzed data from the Maccabi Healthcare Services electronic health records, the second largest health maintenance organization in Israel. They included patients who received treatment with biologic agents for psoriasis and were not diagnosed with psoriatic arthritis before or at the time of treatment. Investigators matched patients with control patients, defined as those diagnosed with psoriasis by a dermatologist and who had received at least 2 systemic medications or 1 systemic medication plus phototherapy, addressing the potential confounding effect of disease severity. The maximum follow-up period was 10 years for both groups. As the 2 groups varied significantly on demographic and clinical factors, investigators used a propensity score 1:1 matching.

A total of 1,326 patients were included in the analysis, 663 of whom received treatment with biologic agents and 663 who did not. With propensity score matching, the groups did not differ significantly on any predictors or potential confounders aside from sex and age at psoriasis diagnosis.

The log-rank test revealed a significantly increased risk for psoriatic arthritis in the 10-year follow-up period for patients not treated with biologic agents vs patients who were (P =.001). The Kaplan Meier curve for the propensity score-matched groups showed a statistically significant increase in psoriatic arthritis risk for the control group compared with the treatment group (P =.025). Multivariable Cox regression showed a significantly higher risk for psoriatic arthritis in the control group as well (adjusted HR [aHR], 1.39; 95% CI, 1.03-1.87). In addition, women were found to be at higher risk for developing psoriatic arthritis (aHR, 1.8; 95% CI, 1.34-2.42).

The study was limited by the lack of information about patients’ clinical characteristics of psoriasis and reasons for therapy discontinuation.

“Since a considerable number of patients eventually develop psoriatic arthritis, alongside its heavy burden on the quality of life, its prevention should be considered as one of the factors to favor initiation of biologic treatment in psoriasis,” the study authors wrote.

Disclosure: One study author declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of authors’ disclosures.


Rosenthal YS, Schwartz N, Sagy I, Pavlovsky L. Psoriatic arthritis incidence among patients receiving biologic medications for psoriasis: A nested case control study. Arthritis Rheumatol. Published online August 23, 2021. doi:10.1002/art.41946