New-Onset Psoriatic Arthritis under Biologics in Psoriasis Patients: An Increasing Challenge?

Matteo Megna,Gabriella Fabbrocini,Lucia Gallo,Sara Cacciapuoti,Luca Potestio,Giuseppina Fontanella,Sonia Sofia Ocampo-Garza,Angelo Ruggiero

doi:10.3390/biomedicines9101482

Abstract

Psoriasis and psoriatic arthritis (PsA) development is sustained by tumor necrosis factor (TNF)α, interleukin (IL)17, and IL23; hence, biologics targeting those cytokines represent useful therapeutic weapons for both conditions. Nevertheless, biologics strongly reduce PsA risk; several studies reported the possibility of new-onset PsA during biologic therapy for psoriasis. The aim of this 1-year prospective study is to evaluate the prevalence of paradoxical PsA in psoriasis patients under biologic therapy and review the existing literature. For each patient, age, sex, psoriasis duration, psoriasis severity, comorbidities, and previous and current psoriasis treatments were collected, and each subject was screened for PsA using the Early ARthritis for Psoriatic patient (EARP) questionnaire every 3 months for 1 year. New-onset PsA was diagnosed in 10 (8.5%) out of 118 patients (three male, 30.0%; mean age 44.5 years) involving every different biologic class (anti-TNF, anti-IL12/23, anti-IL17, and anti-IL23). No significant risk factor for new-onset PsA was identified; no significant difference was found comparing patients who developed PsA and subjects who did not develop PsA regarding psoriasis severity, past/current therapies, and comorbidities. Clinicians must keep in mind the possibility of PsA onset also in patients undergoing biologics so that PsA screening should be strongly recommended at each follow-up.

Highlights

Psoriasis is a chronic inflammatory disease affecting about 1–3% of adults and 0.1–0.3%of children in Western Europe [1]
The present study aims to evaluate the incidence of new-onset psoriatic arthritis (PsA) in patients with plaque psoriasis on anti-TNFα, anti-IL12/23, anti-IL23 or anti-IL17 therapy attending our Dermatology Unit and undergoing at least 1-year follow-up
Our study revealed that 8.5% (10 out of 118) psoriasis patients under biologics developed PsA during one-year follow-up, showing that new-onset PsA is possible for each existing class of biologics, without any drug predilection and with the peripheral form representing most of the cases

Summary

Introduction

Of children in Western Europe [1] It is commonly characterized by the presence of welldelineated papulosquamous plaques surrounded by normal skin and covered by silvery scales [2,3]. Psoriatic disease is limited to the skin; several comorbidities may be associated with psoriasis such as cardiovascular disease, inflammatory bowel disease, nonalcoholic fatty liver disease, obesity, diabetes mellitus, and psoriatic arthritis (PsA) [7]. In this context, the development of target therapies selectively blocking cytokines involved in psoriatic disease pathogenesis such as biologics has revolutionized both psoriasis and PsA treatment [8]

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Conclusion