P107 Gastrointestinal symptoms in US patients with moderate-severe psoriasis and psoriatic arthritis
Authors: Michael Kappelman , Timothy Hoops , Soumya Chakravarty , Jill Abell , Bhaskar Srivastava , Leone Perkins , Steven Fakharzadeh , Steven Feldman , Anthony Turkiewicz 
Published: July 2019

BACKGROUND:
In patients with psoriasis (PsO), increasing severity and the presence of psoriatic arthritis (PsA) elevate the risk of developing inflammatory bowel disease (IBD). A patient survey evaluated the prevalence of gastrointestinal (GI) signs and symptoms consistent with IBD in patients with PsO, including patients who self-reported or subsequently screened positive for PsA.

METHODS:
An internet-based survey of an opt-in market research panel was conducted from January to February 2017. Patients with moderate-severe plaque PsO (self-reported as diagnosed by a physician, prescribed/recommended treatment or hospitalized for PsO within past year, and ≥3% body surface area at peak severity) and healthy controls (HCs) with self-reported common comorbidities were included. All patients who self-reported a previous GI diagnosis (IBD, irritable bowel syndrome, Crohn's disease, ulcerative and microscopic colitis, celiac disease, diverticulitis, and chronic pancreatitis), immune-mediated disorders, or undergoing cancer treatment were excluded. PsO patients were further categorized as PsA(+) (self-reported PsA diagnosis), PsA(−) PASE(+) (no PsA diagnosis but screened positive using the PsA Screening and Evaluation [PASE] questionnaire), or PsA(−) PASE(−). GI signs and symptoms, including severity, frequency, and duration, were compared across groups. Modified CalproQuest (CPQ) scores, which have recently been proposed as a predictive tool to identify those patients with likely elevated fecal calprotectin levels and increased risk for IBD, were calculated based on GI signs and symptoms responses.

RESULTS:
This analysis included a total of 740 patients with moderate-severe PsO (181 PsA(+), 293 PsA(−) PASE(+), and 266 PsA(−) PASE(−)) and 1,411 HCs. Demographics were generally comparable among groups. Compared with HCs, GI signs and symptoms and positive CPQ scores were more prevalent overall in PsO patients. Belly pain, fullness, diarrhea and positive CalproQuest were reported in 10.5%, 25.3%, 12.2% and 5.7% of HC vs 13.9%, 18.0%, 15.0%, and 5.6% in PsA(−) PASE(−) patients; 40.3% (P = 0.002), 51.4% (P = 0.002), 17.7% (P = 0.038) and 14.4% (P = 0.002) of PsA(+) patients; and 30.0% (P = 0.002), 55.3% (P = 0.002), 28.0% (P = 0.002) and 19.8% (P = 0.002) of PsA(−) PASE(+) patients. Mucus in stool, blood in stool, and unintentional weight loss were reported in 2.4%, 1.9%, and 11.8% of HC vs 2.3%, 2.3%, and 12.0% of PsA(−) PASE(−) patients; 3.3% (P = 0.465), 5.5% (P = 0.003), 31.5% (P = 0.002) of PsA(+) patients; and 6.8% (P = 0.002), 4.8% (P = 0.004), and 39.6% (P = 0.002) of PsA(−) PASE(+) patients. Compared with PsA(−) PASE(−) patients, GI signs and symptoms and positive CPQ scores were numerically more prevalent in PsA(+) and PsA(−) PASE(+) patients. Compared with PsA(+) patients, GI signs and symptoms (except for numerical differences in belly pain and blood in stool) and positive CPQ scores were numerically more prevalent in PsA(−) PASE(+) patients.

CONCLUSION(S):
GI signs and symptoms and positive CPQ scores were more common in patients with PsO with a self-reported PsA diagnosis than in PsO patients without PsA or HCs. Patients with PsO who were not diagnosed with PsA but who screened positive using the PASE questionnaire also had higher rates of GI signs and symptoms and positive CPQ scores than PsO patients or HCs. These data suggest that physicians caring for patients with PsO and/or PsA should consider assessing for GI signs and symptoms and further evaluate for IBD as appropriate.