Concomitant PsA, Atopic Dermatitis Could Help Predict Treatment Response

Results of a recent retrospective analysis revealed a connection between psoriatic arthritis (PsA) and concomitant atopic dermatitis, which may impact the efficacy of certain treatments and aid in the selection of an optimal biologic agent, according to research published in Journal of Personalized Medicine.¹

“The application of the last evidence and guidelines for the management of patients with PsA indicates that comorbidities and associated conditions may affect the choice of biologic agent, promoting personalized treatment plans for these patients,” wrote a group of Romanian investigators. “Therefore, the association of psoriasis—psoriatic arthritis—atopic dermatitis remains particularly challenging as it could have a major role in selecting the optimal drug to target both skin conditions and the joint involvement.”

Although the prevalence of psoriasis and atopic dermatitis range from 3 – 10% of the population and are considered 2 of the most common inflammatory skin diseases, the co-occurrence of both conditions is not as common (1.3%). Atopic dermatitis, a condition defined as a chronic, itchy, inflammatory disease of the skin, has a comparatively higher global prevalence among young patients, although this rate levels out in adulthood. Interestingly, however, when they do coexist, they are more difficult to control therapeutically as they are driven by opposing immunological mechanisms.²

In the analysis, 64 patients with PsA treated with a variety of biological agents, including tumor necrosis factor (TNF) and interleukin (IL)-17 inhibitors, were followed in an academic outpatient rheumatology department for up to 10 years. Eligible patients fulfilled the ClASsification criteria for Psoriatic ARthritis (CASPAR) criteria for PsA and had active follow-up visits to the department between January and December 2023.

Patients were initially placed into 2 categories: those with and those without concomitant atopic disorders, including atopic dermatitis, allergic rhinitis, and allergic asthma. They were then further subdivided into patients with atopic disease other than atopic dermatitis (non-AD PsA) and patients with atopic dermatitis and concomitant PsA.

The objective was to assess atopic dermatitis in patients with active PsA receiving biologic treatment, with an emphasis on its prevalence as well as possible therapeutic implications.

Most patients were male (57.8%), the mean age was 57 ± 6.8 years, the mean duration of PsA was 16.22 ± 9.18 years, and nearly all subjects had peripheral disease subtype with polyarticular involvement (94%). Most (89%) patients were treated with ≥ 1 TNF inhibitor.

Among the sample, atopic diseases were exhibited in approximately one third of cases (29.6%) and included atopic dermatitis (10 cases; 52.6%), atopic rhinitis (6 cases; 31.6%), and allergic asthma (3 cases; 15.8%). Of the cases of atopic dermatitis, morphological patterns included eczemas (6 cases), chronic prurigo (3 cases), and a chronic lichen simplex (1 case).

Those with coexisting PsA and atopic dermatitis—which was equally distributed among genders—reported late-onset skin atopy, resided in urban settings (38 cases; 59.4%), were younger (mean age 51 ± 6.5 years), and needed to switch to a higher number of biologics to achieve control of their disease.

Investigators emphasized the importance of future research including larger cohorts of patients with PsA receiving biologics to evaluate therapeutic response using atopic dermatitis as a criterion for treatment selection.

“Screening patients with psoriasis and PsA for atopy and for atopic dermatitis could play an important role in creating a more specific profile of respondents to a particular therapeutic class and give these patients the chance for better control and a longer therapeutic response.”

References

1. ^{Strugariu G, Pomîrleanu C, Russu M, et al. Long-Term Outcomes of Patients with Biologically Treated Psoriatic Arthritis and Atopic Dermatitis-A Single-Center Experience. J Pers Med. 2024;14(4):427. Published 2024 Apr 17. doi:10.3390/jpm14040427}
2. ^{Tsoi, L.C.; Rodriguez, E.; Degenhardt, F.; Baurecht, H.; Wehkamp, U.; Volks, N.; Szymczak, S.; Swindell, W.R.; Sarkar, M.K.; Raja, K.; et al. Atopic dermatitis is an IL-13edominant disease with greater molecular heterogeneity compared to psoriasis. J. Investig. Dermatol. 2019, 139, 1480–1489.}