Psoriatic Arthritis: Related Diseases, Associated Comorbidities

Research has shown that patients with psoriasitic arthritis can be at a higher risk for a number of major systemic comorbidities.48 Psoriasis is a systemic inflammatory disorder characterized by hyperproliferation of epidermal keratinocytes.2 As many as 40% of individuals with psoriasis will develop psoriatic arthritis, a seronegative spondyloarthropathy that typically affects the peripheral joints, within 20 years.7

Psoriatic arthritis is associated with a number of serious comorbidities:

  • Other autoimmune disease80
  • Inflammatory bowel disorders (eg, Crohn's disease)48
  • Cardiovascular disease48
  • Diabetes and other components of metabolic syndrome, stemming from a high incidence of obesity80
  • Cancer80

In addition, psoriatic arthritis has a significant negative impact on patient functionality, psychology, and quality of life. Recent studies illustrate the overall impact on patients suffering from psoriatic arthritis. In one study, psoriatic arthritis was significantly associated with loss of work productivity.80, 97, 98, 99

Proinflammatory Mediators: Psoriatic Arthritis

Chronic inflammation associated with psoriatic arthritis can lead to changes in the joints.57 Proinflammatory mediators that drive psoriatic arthritis are released by various cell types, including innate immune and adaptive immune cells, and resident nonimmune cells.1, 44

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Glossary:

Inflammatory

Pertaining to, characterized by, causing, resulting from, or becoming affected by inflammation.

Phosphodiesterase 4 (PDE4)

A key enzyme involved in the cytokine production of inflammatory cells. PDE4 is an intracellular enzyme that promotes inflammation by degrading intracellular levels of cyclic adenosine monophosphate (cAMP), a naturally occurring second messenger that helps maintain immune homeostasis by modulating the production of pro‑ and anti‑inflammatory mediators.

Psoriasis

A common dermatologic condition characterized by the eruption of circumscribed, discrete and confluent, reddish, silvery‑scaled maculopapules; the lesions occur predominantly on the elbows, knees, scalp, and trunk, and microscopically show characteristic parakeratosis and elongation of rete ridges with shortening of epidermal keratinocyte transit time due to decreased cyclic guanosine monophosphate

Psoriatic Arthritis

A form of polyarthritis (ie, affecting more than one joint) that occurs in patients with psoriasis; the arthritis resembles rheumatoid arthritis but is seronegative for rheumatoid factor and often involves the digits.

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References:

  1. 1 Bäumer W, Hoppmann J, Rundfeldt C, Kietzmann M. Highly selective phosphodiesterase 4 inhibitors for the treatment of allergic skin diseases and psoriasis. Inflamm Allergy Drug Targets. 2007;6:17‑26.
  2. 2 Joshi R. Immunopathogenesis of psoriasis. Indian J Dermatol Venereol Leprol. 2004;70:10‑12.
  3. 7 Winterfield LS, Menter A, Gordon K, Gottlieb A. Psoriasis treatment: current and emerging directed therapies. Ann Rheum Dis. 2005;64 Suppl 2:ii87‑ii90.
  4. 44 Ritchlin C, Haas‑Smith SA, Hicks D, Cappuccio J, Osterland CK, Looney RJ. Patterns of cytokine production in psoriatic synovium. J Rheumatol. 1998;25:1544‑1552.
  5. 48 Khraishi M, MacDonald D, Rampakakis E, Vaillancourt J, Sampalis JS. Prevalence of patient‑reported comorbidities in early and established psoriatic arthritis cohorts. Clin Rheumatol. 2011;30:877‑885.
  6. 57 Gottlieb A, Korman NJ, Gordon KB, et al. Guidelines of care for the management of psoriasis and psoriatic arthritis: Section 2. Psoriatic arthritis: overview and guidelines of care for treatment with an emphasis on the biologics. J Am Acad Dermatol. 2008;58:851‑864.
  7. 80 Husted JA, Thavaneswaran A, Chandran V, Gladman DD. Incremental effects of comorbidity on quality of life in patients with psoriatic arthritis. The Journal of rheumatology. Aug 2013;40(8):1349-1356.
  8. 97 Tillett W, de-Vries C, McHugh NJ. Work disability in psoriatic arthritis: a systematic review. Rheumatology (Oxford). 2012;51(2):275-283.
  9. 98 Lee S, Mendelsohn A, Sarnes E. The burden of psoriatic arthritis: a literature review from a global health systems perspective. P T. 2010;35(12):680-689.
  10. 99 Singh JA, Strand V. Spondyloarthritis is associated with poor function and physical health-related quality of life. J Rheumatol. 2009;36(5):1012-1020.