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Greater Disease Burden in Patients With Skin and Joint Symptoms for Psoriatic Arthritis


Patients who have both skin and joint symptoms with psoriatic arthritis have greater disease burden and worse quality of life compared with patients who have joint-only involvement.

Patients with psoriatic arthritis (PsA) can have the disease affect both skin and joints, but those patients with joint and skin symptoms have greater disease burden and worse quality of life (QOL) than patients with joint-only symptoms.

The authors noted that previous studies have shown patients with PsA have impaired QOL similar to patients with rheumatoid arthritis despite patients with PsA having less overall peripheral joint disease severity. PsA is also associated with a significant mental health impact.

“The relationship between the joint and skin components of PsA and their relative contribution to patient burden of disease has not been extensively researched, although several studies have shown that both articular and dermatologic manifestations contribute to overall patient burden in PsA patients,” the authors explained.

Rheumatologists, dermatologists, and their patients from Australia, Canada, France, Germany, Italy, Japan, Spain, the United Kingdom, and the United States participated in a large-scale, cross-sectional survey that captured current and historic data on patients with PsA, as well as patient-reported outcomes.

A total of 454 rheumatologists and 238 dermatologists responded to the survey for 3200 patients (1514 rheumatologist patients and 1686 dermatologist patients). Patients who had body surface are information available, as well as patients with no diagnosis of psoriasis were included in the analysis (n = 2703).

Overall, patients had mild disease severity, as reported by physicians, but overall disease severity was worse in patients with joint and skin symptoms compared with joint-only PsA. Patients with joint and skin involvement had a mean number of 4.0 affected joints compared with 1.8 for patients with joint-only PsA (P < .001).

Of the 2665 patients who had physician-reported flaring information, 62.3% of patients with joint and skin symptoms were experiencing a flare currently, within the last 12 months, or at periods longer than 12 months compared with 52.7% of patients with joint-only symptoms.

More than 41% of the 573 patients who provided an assessment of mental health burden associated with their disease indicated they currently experienced anxiety/depression as a result of PsA. Both joint and skin symptoms were mentioned as a cause of anxiety/depression for 56.1% of joint-only patients compared with 65.0% of joint and skin patients. Among both groups, being completely free of joint symptoms was prioritized over skin symptoms.

Physical function as measured by Health Assessment Questionnaire Disability Index was statistically significantly worse among patients with joint and skin symptoms, and QOL and health status, as assessed by EuroQol questionnaire and Psoriatic Arthritis Impact of Disease, were also statistically significantly worse for patients with joint and skin involvement. Patients with both also had significantly more work impairment.

“Severe skin symptoms and additional number of affected joints clearly have a detrimental impact on outcomes in the respective patient populations,” the authors wrote. “There is some evidence to suggest that greater skin severity in the ‘joint and skin’ group was associated with worse outcomes compared with greater number of joints affected in the ‘joint-only’ group although this was not a formalized comparison.”


Tillett W, Merola JF, Thaçi D, et al. Disease characteristics and the burden of joint and skin involvement amongst people with psoriatic arthritis: a population survey. Rheumatol Ther. Published online July 22, 2020. doi:10.1007/s40744-020-00221-8

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