Psoriatic Arthritis Imposes a Heavy Burden of Comorbidity and Hospitalization

Jun 12, 2018

Real-world health claims data demonstrate an elevated risk of cardiovascular and autoimmune diseases.

The incidence of cardiovascular comorbidities and autoimmune diseases is significantly higher among patients with psoriatic arthritis than among matched controls, a large, retrospective, US-based claims study has shown.

The increased incidence of comorbidities is accompanied by higher rates of all-cause and cardiovascular-related hospitalizations, according to results published in the Journal of Managed Care & Specialty Pharmacy.

“Understanding these comorbidity profiles may provide insight on the effect of comorbid conditions on disease management, treatment choices, and health care burden associated with psoriatic arthritis,” investigator Jeffrey Kaine, MD, of the Sarasota Arthritis Research Center in Florida, and colleagues wrote in the report.

Real-world data
Many previous studies of the comorbidity burden associated with psoriatic arthritis have been based on small sample sizes, and few used real-world data from claims databases, according to Dr. Kaine and co-authors.

Thus, the investigators sought to provide real-world comorbidity data and rates of health care utilization based on 14,898 patients with psoriatic arthritis and 35,037 matched controls from one commercial health analytics database and one Medicare database. Data from 2008 to 2015 were included.

Patients selected for the analysis had at least 1 inpatient or 2 outpatient psoriatic arthritis diagnoses. The researchers also limited the analysis to patients who had continuous medical or pharmacy coverage for 2 years or more prior to the date of the first psoriatic arthritis diagnosis.

Cardiovascular, autoimmune, and other comorbidities
Risk of cardiovascular disorders was higher among patients with psoriatic arthritis, with an incidence rate of 6.5 per 100 person-years, compared with 5.8 per 100 person-years for controls. Multivariate analysis showed that patients with psoriatic arthritis were 46% more likely than controls to receive a diagnosis of a new cardiovascular condition (hazard ratio [HR], 1.46; 95% confidence interval [CI], 1.37-1.56). Risk of hyperlipidemia, hypertension, coronary artery disease (CAD), peripheral vascular disease, and other specific cardiovascular disorders was also increased in the psoriatic arthritis patient group.

Autoimmune disease risk was substantially elevated in the psoriatic arthritis group versus controls, with an incidence rate of 8.4 and 1.6 per 100 person-years, respectively. New autoimmune disease claims were about 18 times more likely in the psoriatic arthritis group (HR, 18.26; 95% CI, 17.18-19.40). The most common new autoimmune claims were psoriasis, ankylosing spondylitis, and rheumatoid arthritis, with hazard ratios of 55.32, 29.29, and 28.22, respectively.

Other comorbidities typically associated with psoriatic arthritis were more common in that group than in controls, including anxiety, fatigue, depression, obesity, eczema, and gout.

The rate of hospitalization for any reason was significantly higher for patients with psoriatic arthritis than for controls: 24.9% versus 16.2%, respectively (P < .001). Similarly, the rate of hospitalizations for CAD as a primary discharge diagnosis were significantly higher for those with psoriasis, as was the rate of hospitalization for CAD as a secondary diagnosis.

Accumulating evidence
This study adds further evidence to the medical literature regarding the elevated risk of cardiovascular conditions in patients with psoriatic arthritis, according to Dr. Kaine and colleagues.

The 46% elevated risk of cardiovascular conditions found in this study is somewhat lower than the 55% increased risk of an incident cardiovascular condition for patients with psoriatic arthritis versus the general population found in one recent meta-analysis. However, that meta-analysis included 5 significantly heterogeneous studies, including 2 that were reported in abstract form only, and used a definition of cardiovascular disease that excluded hyperlipidemia and hypertension, Dr. Kaine and co-authors noted.

The current study by Dr. Kaine and colleagues also provides more evidence that psoriatic arthritis is associated with increased hospitalization. “Considering the chronic nature of the disease and heavy burden of comorbidities, higher health care resource utilization by PsA patients is expected,” the authors said.

References:

Kaine J, Song X, Kim G, Hur P, Palmer JB. Higher incidence rates of comorbidities in patients with psoriatic arthritis compared with the general population using U.S. administrative claims data. Manag Care Spec Pharm. 2018 Apr 25:1-11.

Polachek A, Touma Z, Anderson M, Eder L. Risk of cardiovascular morbidity in patients with psoriatic arthritis: a meta-analysis of observational studies.Arthritis Care Res. 2017;69:67-74.

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