Predictors, Risk Factors, and Incidence Rates of Psoriatic Arthritis Development in Psoriasis Patients: A Systematic Literature Review and Meta-Analysis

doi:10.1007/s40744-021-00378-w

Review

. 2021 Dec;8(4):1519-1534.

doi: 10.1007/s40744-021-00378-w. Epub 2021 Oct 1.

Predictors, Risk Factors, and Incidence Rates of Psoriatic Arthritis Development in Psoriasis Patients: A Systematic Literature Review and Meta-Analysis

Alen Zabotti^{1

2}, Orazio De Lucia³, Garifallia Sakellariou⁴, Alberto Batticciotto⁵, Gilberto Cincinelli³, Ivan Giovannini⁶, Luca Idolazzi⁷, Gabriella Maioli³, Ilaria Tinazzi⁸, Daniel Aletaha⁹, Salvatore De Vita⁶, Antonio Marchesoni³, Josef Smolen⁹, Annamaria Iagnocco¹⁰, Dennis McGonagle¹¹, Roberto Caporali³

Affiliations

¹ Department of Medical and Biological Science, Rheumatology Clinic, University of Udine, Udine, Italy. zabottialen@gmail.com.
² Department of Specialist Medicine, Rheumatology Clinic, Azienda Sanitaria Universitaria Friuli Centrale, Piazzale S. Maria della Misericordia, 15, 33100, Udine, Italy. zabottialen@gmail.com.
³ Department of Rheumatology and Medical Sciences, ASST Centro Traumatologico Ortopedico G. Pini-CTO, Milan, Italy.
⁴ Division of Rheumatology, University of Pavia, Istituti Clinici Scientifici Maugeri, Pavia, Italy.
⁵ Rheumatology Unit, Department of Internal Medicine, ASST-Settelaghi. "Ospedale di Circolo-Fondazione Macchi", Varese, Italy.
⁶ Department of Medical and Biological Science, Rheumatology Clinic, University of Udine, Udine, Italy.
⁷ Rheumatology Unit, University of Verona, Ospedale Civile Maggiore, Verona, Italy.
⁸ Unit of Rheumatology, Negrar, IRCSS Ospedale Sacro Cuore Don Calabria, Verona, Italy.
⁹ Division of Rheumatology, Department of Medicine 3, Medical University of Vienna, Wien, Austria.
¹⁰ Dipartimento di Scienze Cliniche e Biologiche, Academic Rheumatology Centre, Università degli Studi di Torino, Torino, Italy.
¹¹ Leeds Institute of Rheumatic and Musculoskeletal Medicine (LIRMM), University of Leeds, Leeds, UK.

PMID: 34596875
PMCID: PMC8572278
DOI: 10.1007/s40744-021-00378-w

Review

Predictors, Risk Factors, and Incidence Rates of Psoriatic Arthritis Development in Psoriasis Patients: A Systematic Literature Review and Meta-Analysis

Alen Zabotti et al. Rheumatol Ther. 2021 Dec.

. 2021 Dec;8(4):1519-1534.

doi: 10.1007/s40744-021-00378-w. Epub 2021 Oct 1.

Authors

Affiliations

¹ Department of Medical and Biological Science, Rheumatology Clinic, University of Udine, Udine, Italy. zabottialen@gmail.com.
² Department of Specialist Medicine, Rheumatology Clinic, Azienda Sanitaria Universitaria Friuli Centrale, Piazzale S. Maria della Misericordia, 15, 33100, Udine, Italy. zabottialen@gmail.com.
³ Department of Rheumatology and Medical Sciences, ASST Centro Traumatologico Ortopedico G. Pini-CTO, Milan, Italy.
⁴ Division of Rheumatology, University of Pavia, Istituti Clinici Scientifici Maugeri, Pavia, Italy.
⁵ Rheumatology Unit, Department of Internal Medicine, ASST-Settelaghi. "Ospedale di Circolo-Fondazione Macchi", Varese, Italy.
⁶ Department of Medical and Biological Science, Rheumatology Clinic, University of Udine, Udine, Italy.
⁷ Rheumatology Unit, University of Verona, Ospedale Civile Maggiore, Verona, Italy.
⁸ Unit of Rheumatology, Negrar, IRCSS Ospedale Sacro Cuore Don Calabria, Verona, Italy.
⁹ Division of Rheumatology, Department of Medicine 3, Medical University of Vienna, Wien, Austria.
¹⁰ Dipartimento di Scienze Cliniche e Biologiche, Academic Rheumatology Centre, Università degli Studi di Torino, Torino, Italy.
¹¹ Leeds Institute of Rheumatic and Musculoskeletal Medicine (LIRMM), University of Leeds, Leeds, UK.

PMID: 34596875
PMCID: PMC8572278
DOI: 10.1007/s40744-021-00378-w

Abstract

Background: Agreement on how to identify psoriasis (PsO) patients at risk of developing psoriatic arthritis (PsA) is lacking.

Objective: To identify predictors, risk factors and incidence rate (IR) of PsA development in PsO patients through a systematic literature review (SLR) and meta-analyses (MA).

Methods: MEDLINE, Embase, and Cochrane databases were searched. Cohort studies were used to assess the predictors, while case-control studies for PsA risk factor determination.

Results: We screened 4698 articles for eligibility, and 110 underwent a full reading and 26 were finally included. Among skin and nail phenotypes, PsO severity and nail pitting were selected as predictors of PsA development. Furthermore, PsO patients with arthralgia (pooled RR 2.15 [1.16; 3.99]) and/or with imaging-MSK inflammation (pooled RR 3.72 [2.12; 6.51]) were at high risk of PsA. Higher categories of BMI and a family history of PsA were other predictors. In outpatient-based cohort studies, the IR of PsA per 100 patient-years varied from 1.34 to 17.4.

Limitations: Despite the strength of the overall results, the heterogeneity and the number of the cohort studies could be considered a limitation.

Conclusions: This study provides a tentative profile of the PsO patient at risk of PsA and will help the design of PsA prevention trials.

Keywords: Disease interception; Disease prevention; Early psoriatic arthritis; Psoriasis; Psoriatic arthritis; Systematic review.

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Figures

**Fig. 2**
Forest plot of the pooled estimates of the main potential predictors of PsA, nail involvement (A), musculoskeletal complaints (B), and inflammation and structural damage detected by imaging (C)

**Fig. 3**
Synthesis of the potential predictors of PsA development in PsO patients

See this image and copyright information in PMC

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References

1. Gladman DD, Antoni C, Mease P, Clegg DO, Nash P. Psoriatic arthritis: epidemiology, clinical features, course, and outcome. Ann Rheum Dis. 2005;64(Suppl 2):ii14–17. - PMC - PubMed
1. Christophers E, Barker JNWN, Griffiths CEM, Daudén E, Milligan G, Molta C, et al. The risk of psoriatic arthritis remains constant following initial diagnosis of psoriasis among patients seen in European dermatology clinics. J Eur Acad Dermatol Venereol. 2010;24:548–554. doi: 10.1111/j.1468-3083.2009.03463.x. - DOI - PubMed
1. Gossec L, Baraliakos X, Kerschbaumer A, de Wit M, McInnes I, Dougados M, et al. EULAR recommendations for the management of psoriatic arthritis with pharmacological therapies: 2019 update. Ann Rheum Dis. 2020;79:700–712. - PMC - PubMed
1. Scher JU, Ogdie A, Merola JF, Ritchlin C. Preventing psoriatic arthritis: focusing on patients with psoriasis at increased risk of transition. Nat Rev Rheumatol Nat Publ Group. 2019;15:153–166. doi: 10.1038/s41584-019-0175-0. - DOI - PubMed
1. Zabotti A, McGonagle DG, Giovannini I, Errichetti E, Zuliani F, Zanetti A, et al. Transition phase towards psoriatic arthritis: clinical and ultrasonographic characterisation of psoriatic arthralgia. RMD Open. 2019;5:e001067. doi: 10.1136/rmdopen-2019-001067. - DOI - PMC - PubMed

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[1] Gladman DD, Antoni C, Mease P, Clegg DO, Nash P. Psoriatic arthritis: epidemiology, clinical features, course, and outcome. Ann Rheum Dis. 2005;64(Suppl 2):ii14–17. - PMC - PubMed

[2] Gladman DD, Antoni C, Mease P, Clegg DO, Nash P. Psoriatic arthritis: epidemiology, clinical features, course, and outcome. Ann Rheum Dis. 2005;64(Suppl 2):ii14–17. - PMC - PubMed

[3] Christophers E, Barker JNWN, Griffiths CEM, Daudén E, Milligan G, Molta C, et al. The risk of psoriatic arthritis remains constant following initial diagnosis of psoriasis among patients seen in European dermatology clinics. J Eur Acad Dermatol Venereol. 2010;24:548–554. doi: 10.1111/j.1468-3083.2009.03463.x. - DOI - PubMed

[4] Christophers E, Barker JNWN, Griffiths CEM, Daudén E, Milligan G, Molta C, et al. The risk of psoriatic arthritis remains constant following initial diagnosis of psoriasis among patients seen in European dermatology clinics. J Eur Acad Dermatol Venereol. 2010;24:548–554. doi: 10.1111/j.1468-3083.2009.03463.x. - DOI - PubMed

[5] Gossec L, Baraliakos X, Kerschbaumer A, de Wit M, McInnes I, Dougados M, et al. EULAR recommendations for the management of psoriatic arthritis with pharmacological therapies: 2019 update. Ann Rheum Dis. 2020;79:700–712. - PMC - PubMed

[6] Gossec L, Baraliakos X, Kerschbaumer A, de Wit M, McInnes I, Dougados M, et al. EULAR recommendations for the management of psoriatic arthritis with pharmacological therapies: 2019 update. Ann Rheum Dis. 2020;79:700–712. - PMC - PubMed

[7] Scher JU, Ogdie A, Merola JF, Ritchlin C. Preventing psoriatic arthritis: focusing on patients with psoriasis at increased risk of transition. Nat Rev Rheumatol Nat Publ Group. 2019;15:153–166. doi: 10.1038/s41584-019-0175-0. - DOI - PubMed

[8] Scher JU, Ogdie A, Merola JF, Ritchlin C. Preventing psoriatic arthritis: focusing on patients with psoriasis at increased risk of transition. Nat Rev Rheumatol Nat Publ Group. 2019;15:153–166. doi: 10.1038/s41584-019-0175-0. - DOI - PubMed

[9] Zabotti A, McGonagle DG, Giovannini I, Errichetti E, Zuliani F, Zanetti A, et al. Transition phase towards psoriatic arthritis: clinical and ultrasonographic characterisation of psoriatic arthralgia. RMD Open. 2019;5:e001067. doi: 10.1136/rmdopen-2019-001067. - DOI - PMC - PubMed

[10] Zabotti A, McGonagle DG, Giovannini I, Errichetti E, Zuliani F, Zanetti A, et al. Transition phase towards psoriatic arthritis: clinical and ultrasonographic characterisation of psoriatic arthralgia. RMD Open. 2019;5:e001067. doi: 10.1136/rmdopen-2019-001067. - DOI - PMC - PubMed

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Predictors, Risk Factors, and Incidence Rates of Psoriatic Arthritis Development in Psoriasis Patients: A Systematic Literature Review and Meta-Analysis

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Predictors, Risk Factors, and Incidence Rates of Psoriatic Arthritis Development in Psoriasis Patients: A Systematic Literature Review and Meta-Analysis

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