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. 2021 May;38(5):2458-2471.
doi: 10.1007/s12325-021-01698-7. Epub 2021 Apr 5.

Clinical Burden of Concomitant Joint Disease in Psoriasis: A US-Linked Claims and Electronic Health Records Database Analysis

Michelle Skornicki  1 , Patricia Prince  2 , Robert Suruki  3 , Edward Lee  4 , Anthony Louder  2
Affiliations

Clinical Burden of Concomitant Joint Disease in Psoriasis: A US-Linked Claims and Electronic Health Records Database Analysis

Michelle Skornicki et al. Adv Ther. 2021 May.

Abstract

Background: Few studies have evaluated the clinical burden of concomitant joint disease in patients with psoriasis (PSO). The objective of this study was to assess comorbidity rates in patients with psoriatic arthritis (PsA) compared with PSO alone.

Methods: This was a retrospective study of US patients with prevalent PSO. Linked medical claims and electronic health records (EHR) in Optum's de-identified Integrated Claims-Clinical dataset were analyzed from 2007 to 2018. Patients were followed for up to 5 years after the first claim/diagnostic code for PSO (index date). Baseline comorbidity prevalence and follow-up rates (cases per 1000 person-years) were assessed using descriptive statistics. Comorbidity rate analysis included patients with the respective comorbidity at baseline.

Results: Baseline demographics and comorbidity prevalence were numerically similar between patients with concomitant joint disease (PSO-PsA) and those with PSO alone (PSO-only). During follow-up, comorbidity rates were higher in patients in the PSO-PsA group than patients in the PSO-only group. Ratios of PSO-PsA comorbidity rates relative to PSO-only ranged from 1.1 for allergies and infections to 1.7 for fatigue, diabetes, and obesity. Comorbidity rate ratios increased from year 1 to year 5 for hypertension (1.05-1.34), hyperlipidemia (0.94-1.13), diabetes (1.00-1.49), cardiovascular disease (1.03-1.66), depression (0.97-1.19), and anxiety (0.87-0.98).

Conclusions: Patients with PsA have a larger clinical burden, characterized by higher comorbidity rates, than those with PSO. Future research should explore PsA risk factors and how physicians can monitor and treat patients with PSO to reduce the risk of PsA and the associated clinical burden.

Keywords: Claims; Comorbidities; Electronic health records; Psoriasis; Psoriatic arthritis.

Plain language summary

Psoriasis is a disease that causes scaly, red skin patches that are itchy or painful. About one-third of people who have psoriasis also develop joint pain. This combination of skin symptoms and joint disease is known as psoriatic arthritis. Having psoriatic arthritis can have a greater effect on people’s quality of life than having psoriasis alone. People with psoriasis or psoriatic arthritis often have other medical conditions that are not related to their skin or joints. We know that some conditions, such as obesity and high blood pressure, are more common in people with psoriatic arthritis than in those who only have psoriasis. However, more evidence is needed to understand if this pattern is also seen with other medical conditions. We used a large database of medical insurance claims and electronic health records to see what other medical conditions people with psoriatic arthritis or psoriasis had. We found that people with psoriatic arthritis were more likely to have other medical conditions than those with only psoriasis, including high blood pressure, obesity, diabetes, heart disease, and mental health conditions. These differences became larger over the years covered by this study (2007–2018). The results of this study show that people with psoriatic arthritis are more likely to have additional medical conditions than those who have psoriasis alone. Therefore, it is very important that doctors understand how to reduce the risk of joint disease in their patients with psoriasis.

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Figures

Fig. 1
Fig. 1
Study design. aThere was no minimum follow-up period. bOverall comorbidity rates (cases/1000 person-years) were recorded during follow-up until earliest occurrence of PsA diagnosis, disenrollment from the health plan, death, or after 5 years. PsA was confirmed by claims-based diagnosis, EHR-based diagnosis, or provider note for psoriatic arthritis/arthropathy. cRates of comorbidities (events/person-year), recorded in claims or EHR, were reported during follow-up until earliest occurrence of end of data, disenrollment, death, or 5 years. EHR electronic health records, PsA psoriatic arthritis, PSO psoriasis
Fig. 2
Fig. 2
Patient disposition flow chart. EHR electronic health record, PsA psoriatic arthritis, PSO psoriasis
Fig. 3
Fig. 3
Overall comorbidity rates during follow-up. Patients were followed up for 5 years or until earliest occurrence of PsA, disenrollment from the study, or death. Comorbidities were defined as the occurrence of medical services or EHR diagnoses based on ICD-9-CM or ICD-10-CM codes. Overall comorbidity rates during the follow-up period are shown. Repeat events within patients were not counted. Error bars indicate 95% confidence intervals. Crude ratios of comorbidity rates in patients in the PSO-PsA group relative to the PSO-only group are indicated above the bars. aStreptococcus, earache, bronchitis, tonsillitis, or respiratory infection. EHR electronic health record; ICD-9-CM/ICD-10-CM International Classification of Disease, 9th/10th Revision, Clinical Modification; PsA psoriatic arthritis, PSO psoriasis
Fig. 4
Fig. 4
Overall comorbidity rates during follow-up in patients without metabolic syndrome or depression during baseline. Patients were followed up for 5 years or until earliest occurrence of PsA, disenrollment from the study, or death. Comorbidities were defined as the occurrence of medical services or EHR diagnoses based on ICD-9-CM or ICD-10-CM codes. Overall comorbidity rates during the follow-up period are shown in a patients without metabolic syndrome at baseline and b patients without depression at baseline. Repeat events within patients were not counted. Error bars indicate 95% confidence intervals. Crude ratios of comorbidity rates in patients in the PSO-PsA group relative to PSO-only are indicated above the bars. aNo baseline hypertension, hyperlipidemia, diabetes, or cardiovascular disease. EHR electronic health record; ICD-9-CM/ICD-10-CM International Classification of Disease, 9th/10th Revision, Clinical Modification; PsA psoriatic arthritis, PSO psoriasis
Fig. 5
Fig. 5
Ratios of metabolic syndrome and depression/anxiety rates in patients with vs without PsA during follow-up. Follow-up ended on earliest occurrence of end of data, disenrollment, death or end of 5-year follow-up period. Values are reported by annual time interval during follow-up. Ratios of rates of claims (events/person-year) for metabolic syndrome, depression, and anxiety in patients in the PSO-PsA group during follow-up compared with patients in the PSO-only group are shown. Comorbidity events were defined as the occurrence of medical services or EHR diagnoses based on ICD-9-CM or ICD-10-CM codes. All events were counted for each comorbidity, including repeat events within patients. EHR electronic health record, ICD-9-CM/ICD-10-CM International Classification of Disease, 9th/10th Revision, Clinical Modification; PsA psoriatic arthritis, PSO psoriasis
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