Arthritis & Rheumatism, Volume 62,
November 2010 Abstract Supplement

Abstracts of the American College of
Rheumatology/Association of Rheumatology Health Professionals
Annual Scientific Meeting
Atlanta, Georgia November 6-11, 2010.


Comparison of Comorbid Disease Burden in Psoriasis and Psoriatic Arthritis (PsA).

Husted1,  Janice, Thavaneswaran4,  Arane, Chandran4,  Vinod, Eder4,  Lihi, Shanmugarajah4,  Sutha, Rosen2,  Cheryl F., Gladman3,  Dafna D.

Department of Health Studies & Gerentology, University of Waterloo
Division of Dermatology, Toronto Western Hospital
Toronto Western Hospital, Toronto, ON, Canada
University of Toronto Psoriatic Arthritis Clinic

Background:

The purpose of this study was to determine whether the presence of psoriatic arthritis (PsA) is associated with a higher comorbid disease burden compared to psoriasis without arthritis.

Methods:

In 2006, lifetime prevalence of comorbid physical and mental conditions was collected for 449 psoriasis patients (without PsA) and 611 PsA patients who attended clinics affiliated with teaching hospitals. All patients were confirmed to have psoriasis by a dermatologist. Patients classified as psoriasis had PsA excluded after evaluation by a rheumatologist. The information on comorbidities was ascertained by clinic physicians using a standard protocol. Descriptive statistics were used to compare frequency of: sociodemographic and illness characteristics; specific comorbid conditions; and health-related quality of life (HRQOL) between groups. We also calculated the Functional Comorbidity Index (FCI), a summary count of all comorbidities, modified for this study to exclude arthritis. Linear regression models were used to compare FCI scores between psoriasis and PsA, adjusting for age, sex, and psoriasis duration.

Results:

PsA patients were significantly older than psoriasis patients (mean age (SD) = 50.0 yrs (13.4) versus 46.6 yrs (13.1), p < 0.0001) and experienced a longer psoriasis duration (mean duration (SD) = 22.3 yrs (13.4) versus 16.2 yrs (14.1), p < 0.0001). Males comprised 58% of both patient groups. There was no significant difference in psoriasis severity as measured by the body surface area affected by psoriasis and PASI score. PsA patients reported lower HRQOL as measured by both SF-36 and HAQ, but higher HRQOL on the Dermatology Life Quality Index (DLQI). PsA patients, on average, reported a higher number of comorbidities than psoriasis patients (mean FCI score=1.44 (1.4), range=0, 7 versus 0.75 (0.9), range=0, 6, p < 0.0001). This difference remained significant after adjusting for covariates (age, sex and psoriasis duration). In PsA 39% of patients reported a history of cardiovascular disease, including hypertension compared to 19.6 % of patients with psoriasis (p < 0.0001, adjusted for covariates). Respiratory illnesses, depression, diabetes and cancer were the next leading comorbidities in PsA (22.5%, 27.0%, 17.0%, 12.1% and 8.5% of patients, respectively) and were more frequent than that observed in psoriasis (4.9%, 4.2%, 7.9%, 7.9% and 4.2 % of patients, respectively). With the exception of gastrointestinal disease, diabetes and cancer, these differences were statistically significant (p < 0.05). PsA patients had a significantly higher mean BMI than psoriasis patients (31.0 (16.5) versus 27.8 (5.5), p=0.0005, adjusted for covariates). However, the frequency of autoimmune disease was significantly higher in psoriasis than in PsA (6.3% versus 3.0%, p =0.0027, adjusted for covariates). Finally, the observed group differences in HRQOL remained after adjusting for FCI score and covariates.

Conclusion:

Patients with PsA have a higher comorbid disease burden (excluding arthritis) than patients with psoriasis without arthritis. This is associated with a reduced quality of life.

To cite this abstract, please use the following information:
Husted, Janice, Thavaneswaran, Arane, Chandran, Vinod, Eder, Lihi, Shanmugarajah, Sutha, Rosen, Cheryl F., et al; Comparison of Comorbid Disease Burden in Psoriasis and Psoriatic Arthritis (PsA). [abstract]. Arthritis Rheum 2010;62 Suppl 10 :1928
DOI: 10.1002/art.29693

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