AB0788 LUPUS CO-MORBIDITY IN PATIENTS WITH PSORIATIC ARTHRITIS: A POPULATION-BASED CASE-CONTROLLED STUDY
Authors: Danielle Korkus, Tal Gazitt, Ilan Feldhamer, Idit Lavi, Amir Haddad, Erez Batat, Sari Greenberg-Dotan, Arnon Cohen, Devy Zisman
Journal: Annals of the Rheumatic Diseases (2019)

<h3>Background</h3> Patients with psoriasis and psoriatic arthritis (PsA) can develop a variety of comorbidities including metabolic syndrome, diabetes, hypertension, cardiovascular diseases and depression. Comorbidities, in turn, may influence the therapeutic regimen and affect treatment results. Previous studies show a high incidence of coexistence of psoriasis and systemic lupus erythematosus (SLE). Unlike psoriasis, the coexistence of PsA and SLE has been reported only in case reports. <h3>Objectives</h3> To assess the prevalence of SLE in a PsA patient cohort and to compare it to the general population using the database of a large health care provider. <h3>Methods</h3> The study, which was conducted from 2002-2017, is a retrospective study on a PsA cohort consisting of 4,836 PsA patients matched for age and sex with 24,180 randomly selected control patients. Data on this cohort was derived from the database of more than 4.3 million people enrolled in the largest health care provider in Israel, Clalit Health Services. The database was used to extract demographic data, such as age, sex, ethnicity and socioeconomic status; clinical and laboratory manifestations of SLE; medication dispensed and SLE-inducing medications. T-test was used to compare continuous variables and a Chi-square test was used for categorical variables. All tests were 2-sided; p values of &lt;0.05 were considered statistically significant. <h3>Results</h3> The PsA study group consisted of 4,836 subjects, at a median age of 56+/-15, 2603 (53.8%) of whom were females. The control group consisted of 24,180 subjects matched for age and sex. 18 patients (0.37%) in the PsA study group, and 39 patients (0.16%) in the control group where diagnosed with SLE (p=0.002). SLE patients without co-existing PsA had higher anti-double stranded DNA (anti-dsDNA) positivity (92.3% vs 66.7%, p=0.022) and positive anti-cardiolipin (ACL) antibodies (46.2% vs 16.7%, p=0.041). No other significant differences were observed between the two groups in terms of clinical and laboratory manifestations of SLE. PsA patients with concomitant SLE compare to PsA patients without SLE were more often female (100% vs 53.7%, p&lt;0.0001), had more osteoporosis (38.9% vs 12.8%, p=0.005) and were more likely to be treated with beta blockers (27.8% vs 9.8% p=0.027). Usage of medications with known potential to induce SLE prior to diagnosis of SLE was higher in the study group of PsA patients (11 out of 18 patients) than in the control group, but there was no difference in SLE manifestations between these two groups. Culprit medications associated with later onset of SLE included proton pump inhibitors (PPI) [0.27% in the PsA cohort vs 0.1% in the control group (p=0.004)], beta blockers [0.33% vs 0.16% (p=0.011)], angiotensin converting enzyme inhibitors (ACE-I) [0.35% vs 0.13% (p=0.001)], thiazide diuretics [0.35% vs 0.1% (p=0.001)], anti- tumor necrosis factor (anti-TNF) agents [0.4% vs 0.2% (p=0.002)]. <h3>Conclusion</h3> A 2.3 fold increase in the prevalence of SLE in PsA patients than in the control group was found in our study population. There were no significant differences in the clinical and laboratory manifestations of SLE between these two groups. The positive correlates between SLE and PsA may point to common underlying pathogenetic pathways and may affect treatment choices and medication development. More research is needed for a better understanding of this diseases association. <h3>Disclosure of interests</h3> Danielle Korkus: None declared, Tal Gazitt: None declared, Ilan Feldhamer: None declared, Idit Lavi: None declared, amir Haddad: None declared, Erez Batat: None declared, Sari Greenberg-Dotan: None declared, arnon Cohen Grant/research support from: Prof. Arnon Cohen received research grants from Janssen, Novartis and abbVie and Sanofi, Consultant for: Prof. Arnon Cohen served as a consultant, advisor for abbVie; amgen; Boehringer ingelheim; Dexcel pharma; Janssen, Lilly; Neopharm; Novartis, Perrigo; Pfizer; Rafa; Sanofi, Speakers bureau: Prof. Arnon Cohen served as speaker for abbVie; amgen; Boehringer ingelheim; Dexcel pharma; Janssen, Lilly; Neopharm; Novartis, Perrigo; Pfizer; Rafa; Sanofi, Devy Zisman Grant/research support from: Dr D Zisman received research grants from Pfizer, Janssen, Consultant for: Dr D Zisman served as a consultant, for Pfizer, abbvie, Novartis, Ellie-Lilly, Sanofi, Speakers bureau: Dr D Zisman served as a speaker for abbVie, Janssen, Lilly, Novartis, Pfizer, Sanofi