Predictors, Risk Factors, and Incidence Rates of Psoriatic Arthritis Development in Psoriasis Patients: A Systematic Literature Review and Meta-Analysis

Rheumatol Ther https://doi.org/10.1007/s40744-021-00378-w REVIEW Predictors, Risk Factors, and Incidence Rates of Psoriatic Arthritis Development in Psoriasis Patients: A Systematic Literature Review and MetaAnalysis Alen Zabotti . Orazio De Lucia . Garifallia Sakellariou . Alberto Batticciotto . Gilberto Cincinelli . Ivan Giovannini . Luca Idolazzi . Gabriella Maioli . Ilaria Tinazzi . Daniel Aletaha . Salvatore De Vita . Antonio Marchesoni . Josef Smolen . Annamaria Iagnocco . Dennis McGonagle . Roberto Caporali Received: August 17, 2021 / Accepted: September 16, 2021  The Author(s) 2021 ABSTRACT Background: Agreement on how to identify psoriasis (PsO) patients at risk of developing psoriatic arthritis (PsA) is lacking. Objective: To identify predictors, risk factors and incidence rate (IR) of PsA development in PsO patients through a systematic literature review (SLR) and meta-analyses (MA). Supplementary Information The online version contains supplementary material available at https:// doi.org/10.1007/s40744-021-00378-w. A. Zabotti
I. Giovannini
S. De Vita Department of Medical and Biological Science, Rheumatology Clinic, University of Udine, Udine, Italy O. De Lucia
G. Cincinelli
G. Maioli
A. Marchesoni
R. Caporali Department of Rheumatology and Medical Sciences, ASST Centro Traumatologico Ortopedico G. PiniCTO, Milan, Italy G. Sakellariou Division of Rheumatology, University of Pavia, Istituti Clinici Scientifici Maugeri, Pavia, Italy A. Batticciotto Rheumatology Unit, Department of Internal Medicine, ASST-Settelaghi. ‘‘Ospedale di CircoloFondazione Macchi’’, Varese, Italy L. Idolazzi Rheumatology Unit, University of Verona, Ospedale Civile Maggiore, Verona, Italy Methods: MEDLINE, Embase, and Cochrane databases were searched. Cohort studies were used to assess the predictors, while case–control studies for PsA risk factor determination. Results: We screened 4698 articles for eligibility, and 110 underwent a full reading and 26 were finally included. Among skin and nail phenotypes, PsO severity and nail pitting were selected as predictors of PsA development. Furthermore, PsO patients with arthralgia (pooled RR 2.15 [1.16; 3.99]) and/or with imaging-MSK inflammation (pooled RR 3.72 [2.12; 6.51]) were at high risk of PsA. Higher categories of BMI and a family history of PsA were other predictors. In I. Tinazzi Unit of Rheumatology, Negrar, IRCSS Ospedale Sacro Cuore Don Calabria, Verona, Italy D. Aletaha
J. Smolen Division of Rheumatology, Department of Medicine 3, Medical University of Vienna, Wien, Austria A. Iagnocco Dipartimento di Scienze Cliniche e Biologiche, Academic Rheumatology Centre, Università degli Studi di Torino, Torino, Italy D. McGonagle Leeds Institute of Rheumatic and Musculoskeletal Medicine (LIRMM), University of Leeds, Leeds, UK A. Zabotti (&) Department of Specialist Medicine, Rheumatology Clinic, Azienda Sanitaria Universitaria Friuli Centrale, Piazzale S. Maria della Misericordia, 15, 33100 Udine, Italy e-mail: Rheumatol Ther outpatient-based cohort studies, the IR of PsA per 100 patient-years varied from 1.34 to 17.4. Limitations: Despite the strength of the overall results, the heterogeneity and the number of the cohort studies could be considered a limitation. Conclusions: This study provides a tentative profile of the PsO patient at risk of PsA and will help the design of PsA prevention trials. Keywords: Psoriasis; Psoriatic arthritis; Systematic review; Early psoriatic arthritis; Disease interception; Disease prevention Abbreviations BMI Body mass index CASPAR Classification criteria for psoriatic arthritis HR Hazzard ratio HR-pQCT High-resolution peripheral quantitative computed tomography IR Incidence rate MA Meta-analysis MOOSE Meta-analysis Of Observational Studies in Epidemiology MRI Magnetic resonance imaging MSK Musculoskeletal MSK-US Musculoskeletal ultrasound NOS Newcastle Ottawa Scale PASI Psoriasis Area Severity Index PsA Psoriatic arthritis PsO Psoriasis RR Relative risk SRL Systematic literature review Key Summary Points Identifying PsO patients at increased risk for transition to PsA is challenging. This SRL provides a synthesis of predictors and risk factors of PsA development in PsO patients. These results are crucial for the characterization of the preclinical phases of PsA and for the design of prevention and interception trials. INTRODUCTION Psoriatic arthritis (PsA) manifests clinically in several ways including peripheral synovitis, enthesitis, dactylitis, and axial involvement [1]. PsA mostly develops in patients with an established diagnosis of psoriasis (PsO) [1], and its incidence increases with time after the onset of PsO, reaching up to 20% after 30 years [2]. The identification of predictors of PsA development in PsO patients is a recognized unmet need in the EULAR recommendations [3]. Recently, through a Delphi consensus, three preclinical PsA phases have been proposed, namely preclinical, subclinical, and prodromal PsA [4]. The recognition of PsO patients at high risk for transition to PsA could offer the opportunity for (i) early PsA diagnosis through a dedicated follow-up in PsO patients at higher risk for transition [5] and (ii) interception of PsA without extra costs, since a PsO patient in transition could need a tailored therapy that could work both for skin and joints. Interpreting studies on PsA development in PsO patients is challenging, particularly for the distinction between risk factors (including both causality and an etiological function) and predictors (when present, they make the development of the disease more likely, regardless of whether that factor has a causal role) [6]. Accurate prediction of PsA development will facilitate clinical decisionmaking and help design trials for PsA interception by identifying patients at higher risk of transition. This systematic literature review (SLR) and meta-analysis (MA) focuses on predictors, risk factors, and incidence rates of PsA development in PsO patients. MATERIALS AND METHODS The SLR was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement (PRISMA) [7] and to the Meta-analysis of Observational Studies in Epidemiology (MOOSE) [8]. Two pairs of reviewers (ODL, GC, IG, GM) independently contributed to study selection, data extraction, and quality assessment. Any disagreement was resolved by consensus or by a fifth reviewer Rheumatol Ther (AZ). This SLR is based on previously conducted studies and does not contain any studies with human participants or animals performed by any of the authors; therefore, ethical approval was not required. consumption, etc.). We excluded abstracts, letters, and editorials. Literature Search Study characteristics and data were extracted on a standardized form. Information from primary studies was captured through summary of findings tables. The risk of bias and methodological quality of the included studies were assessed with (...truncated)