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Biologics reduce PsA risk

Plaque Psorasis On Male Arm
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Evidence shows that the more severe the psoriasis, the greater the risk of developing psoriatic arthritis (PsA). One of the key questions is whether treating psoriasis with biological drugs such as TNF-alpha (TNF-α) inhibitors reduces the risk of developing PsA. (NB: TNF-α inhibitors help to block the inflammatory pathways that are central to the development of the skin and joint manifestations of psoriasis).  Over the past five-years, several studies have attempted to answer this question, but results to date are contradictory; some have shown lower rates of PsA in patients taking biologics, whilst others have shown higher rates

In this study, investigators compared the ten-year cumulative incidence of PsA in two groups of patients with severe psoriasis: one group was treated with TNF-α inhibitors (etanercept, infliximab, or adalimumab), whilst the other received narrow-band ultraviolet B Phototherapy.1 Of 946 patients, 497 received TNF-α treatment and 449 underwent Phototherapy.  All patients with a history of PsA or evidence of PsA at baseline were excluded.  Both groups of patients were carefully matched and adjusted for factors linked to PsA, including family history, Body Mass Index (BMI), PASI score and nail involvement. After matching, 297 patients were included in each group.

At the end of the follow-up period, a total of 98 (16.5%) patients developed PsA: 32 (10.7%) in the cohort treated with TNF-α medication and 66 (22.2%) in the Phototherapy group. The incidence rate of PsA cases per 100 psoriasis patients was 1.83 in the whole population and 1.18 and 2.48 in the TNF-α and Phototherapy group respectively. Overall, patients treated with biologics had less than half the risk of developing PsA compared with those treated with phototherapy.

Comment

This is an excellent paper which suggests that the use of biologic treatments in the long-term management of psoriasis cuts the risk of developing PsA by half. However, it does have some methodological limitations, and it is not a randomised-controlled trial – the gold standard for comparative studies of this kind. So, whilst this study makes a valuable contribution, many unanswered questions remain.

Reference

1 Piaserico S, Megna M, Bardazzi F, et al.  TNF-alpha Inhibitors Reduce the Incidence of Psoriatic Arthritis in Patients with Psoriasis: A Propensity Score-matched Cohort Study.  Rheumatology (Oxford). 2025