Dallas, TX—It is necessary to consider skin efficacy in addition to joint efficacy when selecting treatment options for patients with psoriatic arthritis (PsA) who also have psoriasis, according to the results of a recent study that demonstrated a positive correlation between joint activity and skin severity.
Because the association between joint activity and skin severity is not well understood in this patient population, Talia Muram, MD, Senior Medical Advisor, Eli Lilly & Co, Indianapolis, IN, and colleagues assessed the relationship between the 2, and also sought to determine the effect that treatment for PsA has on skin severity and joint activity in patients with the disease who currently have, or have a history of, psoriasis. They reported their results in a poster presented at the Academy of Managed Care Pharmacy Nexus 2017 Conference.
“Managing patients with PsA disease requires a greater understanding of how joints and skin respond differently to therapy. Control of both joint and skin symptoms are important for overall disease management of these patients,” Dr Muram and colleagues stated.
Using the Corrona registry, an independent cohort of patients with PsA or spondyloarthritis, Dr Muram and colleagues accessed the data of 647 adult patients enrolled between March 21, 2013, and September 30, 2016, who had a diagnosis of PsA with a current or previous diagnosis of psoriasis, and who had 12-month follow-up data.
Patients were categorized as having no change in therapy, or as having a reduction, addition, or switch in their therapy. Changes in joint activity and skin severity were determined by changes in category of body surface area (BSA; ie, low, mild, moderate, or high), Clinical Disease Activity Index (CDAI; ie, low, moderate, or high), or both.
At baseline, CDAI and BSA were moderate or high in 42.3% and 33.7% of all patients, respectively. In addition, patients who had high joint activity were more likely to have high skin severity (P = .014) than those with moderate or low joint activity. A total of 194 (30%) patients had improvement in skin severity, whereas 100 (15%) patients had worsening skin severity. A total of 135 (21%) patients had improvement in joint activity, whereas 113 (18%) patients had worsening joint activity. In 226 (35%) patients, no changes were seen in both joint activity and skin severity.
There were no changes in therapy seen in >50% of patients who had worsened or improved skin severity or joint activity. Among those who did have worsening skin severity and joint activity, 9 (40.1%) patients had no change in therapy or an increase in therapy.
Dr Muram and colleagues reported that after the 12-month mark, most patients had no change in therapy, and no changes in skin severity or joint activity.
“The positive association between joint activity and skin severity suggests treatment decisions for PsA patients with PsO [psoriasis] need to take into account both skin and joint efficacy. Further study beyond 12 months is needed to fully assess the real-world impact of these treatment interventions,” they concluded.