Psoriatic arthritis patients of diverse racial or ethnic backgrounds have more skin psoriasis, pain, and radiographic axial disease
Presenter: Rebecca Haberman, MD, assistant professor, Division of Rheumatology, Department of Medicine, NYU Grossman School of Medicine, New York, NY
PsA Patients of Diverse Ethnic and Racial Backgrounds Experience More Skin Psoriasis, Increased Pain, and Higher Rates of Radiographic Axial Disease. Abstract 1639. Presented Nov 13, 2023.
Non-White patients with psoriatic arthritis (PsA) have more skin psoriasis, pain, and higher rates of radiographic axial disease than White patients, according to results of a study of more than 800 patients in a large, diverse metropolitan area.
The findings, presented at ACR Convergence 2023, suggest that patients may have a different disease experience depending on their race and ethnicity, said researcher Rebecca Haberman, MD, Assistant Professor, Division of Rheumatology, Department of Medicine, NYU Grossman School of Medicine, New York, NY.
“In clinical practice, we need to think more about the skin burden in our patients of various ethnicities and races, especially as skin psoriasis may not present ‘classically,’” Dr Haberman said in an interview. “Additionally, we should be on the lookout for inflammatory axial involvement in our non-White patients, particularly those of Hispanic heritage.”
In the study, Dr Haberman and co-investigators collected data on PsA-specific symptoms along with self-reported race and ethnicity from a cohort of 817 consecutive patients with PsA seen at the NYU Psoriatic Arthritis Center. They were all enrolled in an observational, longitudinal registry that tracks demographics, medical history, and medications, as well as psoriatic disease phenotype and activity.
Overall, approximately 78% of the patients were non-Hispanic White, 7% Asian, and 2% Black, while about 10% identified as other races or multiracial. In addition, approximately 12% identified as Hispanic.
Compared with non-Hispanic White patients, the non-White patients tended to be younger, were more likely to have concomitant metabolic disease and diabetes, and were less likely to have anxiety, Dr Haberman reported in an oral presentation at the ACR meeting.
Unexpectedly, the non-White patients with PsA were also more likely to have radiographic axial disease, including 25.4% of those patients as compared to 16.3% of White patients (P = .005).
Also higher in the non-White patients were tender joint counts, at 4.0 versus 3.0 for White patients (P = .03), despite similar swollen joint counts and proportion of patients receiving medication for PsA. Hispanic patients had significantly higher tender joint counts, higher RAPID3 scores, and more moderate-severe psoriasis than White patients.
Finally, women had significantly higher RAPID3 scores as compared to men, despite similar tender and swollen joint counts and similar skin involvement.
In the study, nearly 23% were non-White patients with PsA, which is a relatively more diverse cohort than other registries and clinical trials, Dr Haberman said. As a result, clinicians and researchers need to consider these differences in PsA presentation and outcomes as experienced by different racial, ethnic, and sex groups.
“Especially for those of different racial and ethnic backgrounds and sexes, we have to keep in mind that patients may not present classically, and, therefore, treatments may need to be tailored to that presentation,” she said.
Because skin psoriasis may not present classically in Non-White populations, engaging with a dermatologic partner in getting the correct diagnosis may be key. Additionally, we found that radiographic axial disease is not uncommon, she added.
Research will continue, Dr Haberman said, and the next steps are to understand how socioeconomic status also may interact with these outcomes.
Disclosures
Rebecca Haberman, MD, reported consultant/research funds from Janssen and UCB and no disclosures related to this specific presentation.
References
Armstrong AW, Mehta MD, Schupp CW, Gondo GC, Bell SJ, Griffiths CEM. Psoriasis Prevalence in Adults in the United States. JAMA Dermatol 2021; 157(8):940-946. doi:10.1001/jamadermatol.2021.2007.
Abrouk M, Lee K, Brodsky M, et al. Ethnicity affects the presenting severity of psoriasis. J Am Acad Dermatol 2017; 77(1):180-182. doi:10.1016/j.jaad.2017.02.042.
Shwe S, Nguyen C, Bhutani T. Racial disparities in clinical trials of biologic treatments for psoriatic arthritis. J Am Acad Dermatol 2022; 87(4):910-912. doi:10.1016/j.jaad.2021.08.038.