• Philip J Mease, Chitra Karki, Jacqueline B Palmer, Carol J Etzel, Arthur Kavanaugh, Christopher T Ritchlin, Wendi Malley, Vivian Herrera, Melody Tran, and Jeffrey D Greenberg.
• From the Swedish Medical Center and University of Washington (UW) Medicine, Seattle, Washington; Corrona LLC, Southborough, Massachusetts; Novartis Pharmaceuticals Corporation, East Hanover, New Jersey; The University of Texas MD Anderson Cancer Center, Houston, Texas; University of California (UC) at San Diego, La Jolla, California; University of Rochester Medical Center, Rochester; New York University (NYU) School of Medicine, New York, New York; Scott and White Health Plan, Temple, Texas, USA. pmease@philipmease.com.
• J Rheumatol. 2017 Aug 1; 44 (8): 1151-1158.

ObjectivePsoriatic arthritis (PsA) is commonly comorbid with psoriasis; the extent of skin lesions is a major contributor to psoriatic disease severity/burden. We evaluated whether extent of skin involvement with psoriasis [body surface area (BSA) > 3% vs ≤ 3%] affects overall clinical and patient-reported outcomes (PRO) in patients with PsA.MethodsUsing the Corrona PsA/Spondyloarthritis Registry, patient characteristics, disease activity, and PRO at registry enrollment were assessed for patients with PsA aged ≥ 18 years with BSA > 3% versus ≤ 3%. Regression models were used to evaluate associations of BSA level with outcome [modified minimal disease activity (MDA), Health Assessment Questionnaire (HAQ) score, patient-reported pain and fatigue, and the Work Productivity and Activity Impairment questionnaire score]. Adjustments were made for age, sex, race, body mass index, disease duration, and history of biologics, disease-modifying antirheumatic drug, and prednisone use.ResultsThis analysis included 1240 patients with PsA with known BSA level (n = 451, BSA > 3%; n = 789, BSA ≤ 3%). After adjusting for potential confounding variables, patients with BSA > 3% versus ≤ 3% had greater patient-reported pain and fatigue and higher HAQ scores (p = 2.33 × 10-8, p = 0.002, and p = 1.21 × 10-7, respectively), were 1.7× more likely not to be in modified MDA (95% CI 1.21-2.41, p = 0.002), and were 2.1× more likely to have overall work impairment (1.37-3.21, p = 0.0001).ConclusionThese Corrona Registry data show that substantial skin involvement (BSA > 3%) is associated with greater PsA disease burden, underscoring the importance of assessing and effectively managing psoriasis in patients with PsA because this may be a contributing factor in PsA severity.

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