gms | German Medical Science

Background: Co-morbid diseases are common in patients with psoriatic arthritis (PsA) and are an important consideration when choosing treatment options. We used retrospective observational data from the Strategy for Psoriatic Arthritis In Germany (SPAIG) study [1] to characterise common co-morbidities in patients with PsA and evaluate the association between co-morbidities and selection of initial therapy.

Methods: This retrospective, multicentre, observational study included adult patients diagnosed with PsA according to the Classification Criteria for Psoriatic Arthritis [2] with active disease at diagnosis, who received DMARD treatment for at least 6 of the previous 12 months. Patients were enrolled between 1 May and 30 November 2017 and data were collected on patient disease characteristics, co-morbidities and treatment (initial and during the last 12 months). Multinomial logistic regression analysis was used to evaluate associations between baseline characteristics and initial choice of therapy.

Results: A total of 316 patients were included in the final analysis set. Most patients (223; 70.6%) reported co-morbidities and almost half (152; 48.1%) had more than one co-morbidity. The most frequently reported co-morbidities were a history of hypertension (46.8%), diabetes (13.9%) and anxiety/depression (12.7%). Initial therapies appeared to be influenced by co-morbidities and disease characteristics (Table 1 [Tab. 1], Table 2 [Tab. 2]). Compared with non-DMARDs, patients were significantly less likely to have received initial treatment with conventional synthetic/targeted synthetic DMARDs (cs/tsDMARDs) or with biologic DMARDs (bDMARDs) if they had high tender joint counts at study enrolment (end of observation period). Patients were also less likely to receive cs/tsDMARDS if they had chronic obstructive pulmonary disease, and were significantly more likely to be treated with cs/tsDMARDs if they had a high BMI or anxiety/depression. Patients were significantly more likely to receive bDMARD initial therapy (compared with non-DMARDs) if they had a history of hypertension or musculoskeletal disease (non-PsA manifestations).

Conclusion: Our data document the burden of co-morbidities in patients with PsA in routine daily practice and provide insights into the association between co-morbidities and treatment selection.