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Patients with psoriasis are at increasing risk of psoriatic arthritis (PSA).
This article studies the impact of psoriasis treatment on the development of PSA.
Acosta-Felquer et al.
proposed a retrospective cohort study from the Argentine Health Maintenance Organization (HMO)
.
In this study, all patients with psoriasis who were not diagnosed with PsA at baseline observed in HMO between 2000 and 2018 were monitored for the development of PsA during follow-up
Therefore, the incidence of PsA in patients receiving local treatment is much higher than that in patients receiving bDMARDs or csDMARDs
In the third retrospective cohort study, Shalev-Rosenthal et al.
compared psoriasis patients who used bDMARDs with patients who did not use bDMARDs in HMO (but had received two systemic treatments or one systemic treatment and phototherapy)
.
The main result is the International Classification of Diseases (ICD9) code for PsA, ankylosing spondylitis, enthesitis, spondylopathy, or undifferentiated arthritis within 10 years after the start of treatment
Although the results of these studies are basically consistent with our hypothesis that the treatment of psoriasis increases the risk of PsA1, some caveats are needed in interpreting their conclusions
.
First, as is often the case in retrospective cohort studies comparing two or more therapies, patient groups are clearly not comparable
That is, the treatment of psoriasis increases the risk of PsA1, that is, the treatment of psoriasis increases the risk of PsA1,
Finally, relatively few results were observed in all three studies
.
This low number of results led to a larger confidence interval, which suggests that larger studies are needed to confirm their findings
In conclusion, there is still a considerable gap in our understanding of how systemic treatment of psoriasis may affect the progression of PsA
.
Although these three retrospective studies represent a positive step forward, there are still no prospective randomized controlled trials that provide conclusive data
Literature source: Merola JF, Ogdie A, Does psoriasis treatment affect PsA development? Nat Rev Rheumatol 2021 Oct 11.
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