Screening for comorbidities that can alter the effectiveness of psoriatic arthritis treatment is an important component of disease management, according to findings from a review published in the Journal of Rheumatology.
Researchers conducted a systematic literature review to update the 2021 Group for Research and Assessment of Psoriatic Arthritis (GRAPPA) treatment recommendations regarding the management of patients with psoriatic arthritis and comorbidities. They assessed studies published from February to January 2021 and included 40 eligible papers of the 143 identified studies.
None of these 40 studies were randomized controlled trials; 21 were prospective cohort studies, 11 were retrospective cohort studies, 2 were case-control studies, 4 were before-and-after studies, and 2 were cross-sectional studies.
Common Comorbidities of Psoriatic Arthritis
Patients with psoriatic arthritis demonstrated an increased prevalence of cardiovascular disease (CVD), obesity and metabolic syndrome, and liver disease, especially nonalcoholic steatohepatitis (NASH), according to findings in the literature.
Health care providers are recommended to screen any patient with psoriatic arthritis for cardiovascular risk factors and encourage a healthy weight to improve psoriatic arthritis disease activity and impact on response to treatment. Providers should routinely monitor liver function tests in patients with psoriatic arthritis receiving certain medications and assess for fatty liver disease before selecting therapies that might impact the liver.
Studies were limited about the prevalence of hepatitis B (HBV), hepatitis C (HCV), human immunodeficiency virus (HIV), and tuberculosis (TB) in patients with psoriatic arthritis compared with the general population. Certain immunomodulatory therapies used to treat psoriatic arthritis may impact untreated HBV, HCV, and HIV, so it is important for providers to screen patients for these infections before initiating treatment. Biologics, especially tumor necrosis factor inhibitors (TNFi), increase the risk of developing active TB infection in patients with psoriatic arthritis. Screening for active or latent TB infections prior to starting biologic therapy is important.
Patients with psoriatic arthritis receiving treatment with interleukin (IL)-17 inhibitors demonstrated an increased risk for Candida infection, while those receiving TNFis often presented with more severe herpes zoster infections, the researchers noted. Patients with psoriatic arthritis had higher rates of developing herpes zoster infections than the general population.
Psoriatic Arthritis and Vaccines
Given the heightened risk for infection in patients with psoriatic arthritis, providers must advocate for vaccinations against influenza, pneumonia, herpes zoster, COVID-19, tetanus, HBV, and hepatitis A.
Mood disorders, especially depression, are more prevalent among patients with psoriatic arthritis and predict reduced joint remission. Providers should refer patients with psoriatic arthritis to a mental health provider to address mood changes, as it may interfere with quality of life and increase the likelihood of disability and loss of income.
Patients with psoriatic arthritis A have a low risk of developing malignancies, with similar rates of malignancy as that in the general population. However, certain studies reported an increased risk for nonmelanoma skin cancer in patients with psoriatic arthritis receiving immunomodulatory medications.
Fibromyalgia, chronic pain, and/or central sensitization affects between 20% and 30% of patients with psoriatic arthritis vs 6% of the general population. Prompt diagnosis and management of fibromyalgia or central sensitization may improve patient response to therapy and quality of life.
Limitations of the review included the strength of data supporting treatment recommendations, which may have been limited by a small number of study participants, limited follow-up, and lack of clinical trial designs.
“There is much work to do to improve our understanding of how best to screen for, manage, and prevent comorbidities in patients with [psoriatic arthritis],” the study authors said. “We hope that the recommendations from the comorbidity working group will assist clinicians in identifying important comorbidities and considering their effects on treatment selection.”
Disclosures: Some study authors declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of authors’ disclosures.
Campanholo CB, Maharaj AB, Corp N, et al. Management of psoriatic arthritis in patients with comorbidities: an updated literature review informing the 2021 GRAPPA treatment recommendations. J Rheumatol. Published online November 1, 2022. doi:10.3899/jrheum.220310
This article originally appeared on Rheumatology Advisor