Arthritis Precedes Psoriasis More Often Than Expected

New research has found that symptoms of psoriatic arthritis (PsA) often precede psoriasis (PsO) development and psoriasis skin lesions.1

“PsA occurs in about 30% of patients with PsO, and an additional 5%–15% of psoriasis patients may have undiagnosed PsA. The current dogma is that PsO skin lesions generally occur before the emergence of arthritis. Recognizing arthritis as PsO in patients who do not yet have cutaneous PsO may be challenging, however. Physicians may diagnose patients with PsA in the absence of psoriasis as having other forms of arthritis,” lead investigator Hannah Y. Gantz, MD candidate, Center for Dermatology Research, Department of Dermatology, Wake Forest University School of Medicine, Winston-Salem, North Carolina, and colleagues wrote.1

Gantz and colleagues conducted a single-center retrospective chart identifying applicable patients from the 2023 calendar year using electronic health records at a large tertiary care medical center. Participants had inflammatory or non-inflammatory arthritic conditions prior to the diagnosis of PsO, atopic dermatitis, or rosacea screened with ICD-10 codes.

The investigators identified 2780 patients with rosacea, 1672 with PsO, and 5195 patients with atopic dermatitis, of whom 436 had preceding arthritis (239 with PsO [14.3%]; 189 with rosacea [6.8%]; and 126 with eczema [2.4%, P <.0001]).

Notably, patients with PsO had higher rates of both inflammatory (5.1%) and non-inflammatory (9.2%) arthritis than patients with rosacea (1.0% and 5.8%, respectively) and atopic dermatitis (0.5% and 1.9%, respectively) did, both overall and when stratified by age. Gantz and colleagues also found that patients with rosacea had a mean 3.2 years between of joint symptom onset prior to the onset of skin lesions while patients with PsO had a median of 2.7 years between and patients with atopic dermatitis had a median of 3.1 years between.1

Gantz and colleagues noted that the study came with inherent limitations due to its retrospective nature and single-center EHR source. The study also lacked data on the family history of psoriasis and PsA and which specialist patients may have seen first. Furthermore, some of the arthritic conditions were not diagnosed by a rheumatologist and body mass index was not included in the analysis.

“We anticipated that inflammatory arthritis would be diagnosed more commonly prior to patients developing psoriasis than prior to rosacea or atopic dermatitis, but both inflammatory and non-inflammatory arthritis were diagnosed more commonly prior to psoriasis compared to controls. We suspect that patients receiving the diagnosis of non-inflammatory arthritis prior to psoriasis may have had unrecognized PsA. Alternatively, it is possible that individuals genetically predisposed to psoriasis may have an increased risk of osteoarthritis or other forms of non-inflammatory arthritis due to metabolic syndrome or some other cause. The coexistence of psoriasis and osteoarthritis is not uncommon, as both conditions are highly prevalent in the general population,” Gantz and colleagues concluded.1

REFERENCES

1. Gantz HY, Yi RC, Ruley AJ, et al. Challenging the Dogma That Psoriasis Skin Lesions Occur Before Arthritis. Int J Dermatol. Published online May 21, 2025. doi:10.1111/ijd.17862

2. V. Tiwari and L. H. Brent, “ Psoriatic Arthritis,” in StatPearls (StatPearls Publishing, 2024), https://www.ncbi.nlm.nih.gov/books/NBK547710/