15928 Reduced time to onset of psoriatic arthritis is associated with specific phenotypes and psoriatic characteristics

Abstract

Psoriatic arthritis (PsA) is a chronic inflammatory condition characterized by joint damage in approximately 20% of psoriasis (Ps) patients. Delaying treatment as little as six months after PsA onset can result in irreversible, erosive joint damage. The study objective was to identify factors associated with early onset PsA in people with psoriasis. Using data from November 2002 through January 2019 in the Utah Psoriasis Initiative (UPI) registry, we searched for patient characteristics associated with shorter latency periods between Ps and PsA onset. Our dataset includes 342 patients with rheumatologist-diagnosed PsA either prior to or subsequent to enrollment and 692 with cutaneous Ps without PsA until the last recorded follow-up time. Using a Cox regression model, we identified features associated with a shorter latency period between Ps and PsA onset. FDR-adjusted P values are reported here. There is an association between higher scores of three key clinical indicators of psoriasis severity and reduced latency period to PsA onset: erythema (P = .012, HR 1.179 [95% confidence interval 0.07-0.26]), induration (P < .001, HR 1.206 [010-0.27]), and desquamation (P = .019, HR 1.145 [0.05-0.22]). Other associated phenotypic features included fingernail involvement (P < .001, HR 1.904 [0.43-0.86]), any nail involvement (P < .001, HR 1.710 [0.31-0.77]), pustular psoriasis (P = .006, HR 2.026 [0.31-1.10]), psoriasis in the groin (P = .043, HR = 1.389 [0.09-0.57]), palmar plantar pustular psoriasis (P = .022, HR 2.299 [0.29-1.38]), higher body mass index (BMI) at age 18 (P = .024, HR 1.035 [0.01-0.06]), and depression (P = .013, HR 1.486 [0.16-0.63]). These phenotypic and demographic features may be indicators for an elevated risk of early onset PsA, and could be considered for PsA screening and referral strategies to a rheumatologist.