Division of Translational Rheumatology, Immunology, Inflammation Medicine, Goethe University Frankfurt, Frankfurt am Main, Hessen, Germany
Clinical Research, Fraunhofer Institute for Translational Medicine and Pharmacology ITMP, Frankfurt am Main, Germany.
RMD Open. 2023 Sep;9(3). doi: 10.1136/rmdopen-2023-003166.
Psoriatic arthritis (PsA) is a chronic inflammatory immune-mediated disease that affects approximately 30% of psoriasis patients. In most cases, skin disease clearly precedes the musculoskeletal disease. Some studies suggest that targeted treatment may intercept the disease course and prevent psoriasis patients from developing PsA. A recent population-based retrospective analysis in 15 501 psoriasis patients evaluated the association between different biological treatment strategies and time to incident inflammatory arthritis based on data in a US electronic health records database. A cumulative incidence of 2.6 PsA cases per 100 person-years was determined. The multivariable regression analysis revealed a significantly lower risk of developing inflammatory arthritis in patients who had been prescribed interleukin (IL)-12/23 or IL-23 inhibitors compared with tumour necrosis factor (TNF) inhibitor-treated patients, whereas there was no significant difference in risk for patients prescribed inhibitors of IL-17 versus TNF. Although the analysis was based on a large set of clinical data and the findings were rigorously evaluated, there are some limitations in interpretation due to the study design. Prospective clinical trials are missing, and retrospective data analyses from clinical trials or population-based studies show conflicting results. Overall, the recent data on prevention of PsA in patients with psoriasis support the high need to characterise biomarkers of increased risk and perform prospective clinical trials to give a clear guidance on possibilities for disease interception in psoriatic disease.
银屑病关节炎（PsA）是一种慢性炎症性免疫介导的疾病，影响约 30%的银屑病患者。在大多数情况下，皮肤病明显先于骨骼肌肉疾病。一些研究表明，靶向治疗可能会阻断疾病进程，防止银屑病患者发展为 PsA。最近一项基于美国电子健康记录数据库的数据的 15501 例银屑病患者的基于人群的回顾性分析评估了不同生物治疗策略与炎症性关节炎发病时间之间的关系。确定每 100 人年有 2.6 例 PsA 病例的累积发生率。多变量回归分析显示，与接受肿瘤坏死因子（TNF）抑制剂治疗的患者相比，接受白细胞介素（IL）-12/23 或 IL-23 抑制剂治疗的患者发生炎症性关节炎的风险显著降低，而接受 IL-17 抑制剂与 TNF 抑制剂治疗的患者发生炎症性关节炎的风险无显著差异。尽管该分析基于大量临床数据，并且对研究结果进行了严格评估，但由于研究设计的原因，在解释上存在一些局限性。缺乏前瞻性临床试验，临床试验或基于人群的研究的回顾性数据分析显示出相互矛盾的结果。总的来说，最近关于预防银屑病患者发生 PsA 的数据支持高度需要确定风险增加的生物标志物，并进行前瞻性临床试验，以便为银屑病疾病的疾病干预提供明确的指导。
