Treatment With TNF Inhibitors Does Not Reduce Risk of Developing Psoriatic Arthritis After Psoriasis

June 19, 2020
Laura Joszt, MA
Laura Joszt, MA

Laura is the editorial director of The American Journal of Managed Care® (AJMC®) and all its brands, including The American Journal of Accountable Care®, Evidence-Based Oncology™, and The Center for Biosimilars®. She has been working on AJMC® since 2014 and has been with AJMC®'s parent company, MJH Life Sciences, since 2011. She has an MA in business and economic reporting from New York University.

In 90% of patients, psoriasis precedes psoriatic arthritis by an average of 7 years, providing a window of opportunity for early intervention and possible prevention of psoriatic arthritis.

Approximately 30% of patients with psoriasis have psoriatic arthritis (PsA), a chronic inflammatory arthritis, and in 90% of patients, psoriasis precedes PsA. While tumor necrosis factor (TNF) inhibitors are used to treat both, TNF inhibitors do not appear to reduce the risk of developing PsA in patients with psoriasis, according to an abstract presented at the European Congress of Rheumatology of the European League Against Rheumatism.

The researchers noted that since psoriasis precedes PsA by an average of 7 years, there is a window of opportunity for early intervention and possible prevention of developing PsA. They compared the use of TNF inhibitors to reduce the risk of development PsA with treatment with methotrexate alone.

A total of 154 patients treated at the Center of Excellence for Psoriasis and Psoriatic Arthritis (CEPPA) of Oregon Health & Science University between January 2006 and June 2019 were evaluated. These patients had a diagnosis of psoriasis but did not have PsA at baseline. Patients completed a CEPPA questionnaire that asked about demographics, extent of psoriasis, psychosocial factors, quality of life measures, comorbidities, social history, and medication use.

Of the 154 patients, 85 started taking methotrexate and 69 initiated a TNF inhibitor. Less than one-fourth (22.7%; n = 35) developed incident PsA. Patients on TNF inhibitors had a mean duration of therapy of 3.95 years compared with 1.93 years for patients on methotrexate. The mean follow-up was also longer for patients on TNF inhibitors: 5.18 years vs 2.71 years.

After adjusting for propensity score and nail pitting, the researchers determined that TNF inhibitors did not significantly reduce the risk of PsA compared with methotrexate (HR, 0.68; 95% CI, 0.32-1.41).

“Here is the bottom line: TNF inhibitors did not significantly reduce the risk of psoriatic arthritis as compared to methotrexate,” said Atul Deodhar, MD, professor of medicine and medical director of Rheumatology Clinics at Oregon Health & Science University, in his presentation of the abstract.


Lininger N, Siegel SAR, Kiwalkar S, Winthrop K, Ortega Loayza A, Deodhar A. Do TNF inhibitors decrease risk of incident psoriatic arthritis in psoriasis patients compared to those treated with methotrexate alone? Presented at: EULAR 2020; June 3-6, 2020; Abstract FRI0555.