Priority 4 from the Psoriatic Arthritis PSP

UNCERTAINTY: Is a person with psoriatic arthritis at risk of developing other health conditions? If so, which ones? Why?  (JLA PSP Priority 4)
Overall ranking 4
JLA question ID 0108/4
Explanatory note We know that people with psoriatic arthritis are at an increased risk for certain other health conditions such as diabetes, heart disease and depression. However, there is limited evidence about these other health conditions and why some people appear to be at more risk than others. Future studies should aim to generate clear evidence to answer the uncertainties about all related health conditions, why some people with psoriatic arthritis develop other health conditions and others don't. Suppose individuals could be identified as at risk of developing other health conditions, such as heart disease. Can treatments (drug or non-drug) change their risk? Also, to understand the long-term impact of developing another health condition, both on psoriatic arthritis and the person's general wellbeing. 

This question has been partially addressed in the evidence base from the following systematic reviews:
Turk, 2020. Evidence that Uveitis is less frequent in adult-onset PsA compared to child-onset PsA, but the differences were not significant
Peluso, 2018. Psoriatic arthritis appeared significantly associated with subclinical atherosclerosis and endothelial dysfunction and, in turn, with an increased cardiovascular risk. Thus, patients with psoriatic arthritis may benefit from a periodic assessment of surrogate markers of cardiovascular risk. This could help to establish more specific cardiovascular prevention strategies for these patients
Gergianaki 2019. COPD is more common in patients with PsA; yet, the association, vice versa, warrants further investigation. Nevertheless, COPD/Rheumatic diseases coexistence has significant prognostic value for worst outcomes; therefore, awareness is required to track early identification, especially in primary care
Erre, 2018. Coronary Flow reserve is significanalty imparred in Rheumatic disieases including PsA. Patients with prevalent autoimmune features (e.g., systemic lupus erythematosus) showed a significantly lower CFR when compared to patients with mixed autoimmune and autoinflammatory features (e.g., psoriatic arthritis)
Colaco, 2020. General cardiovascular risk prediction algorithms mostly underestimate and at times overestimate cardiovascular risk in rheumatic patients. We did not find studies that evaluated models for psoriasis or AS, which further demonstrates a need for research in these populations
Chen, 2020. Patients with psoriatic disease may be more likely to develop fractures compared with non-psoriatic controls. This higher risk for fracture may not necessarily be associated with lower bone mineral density nor a higher risk for osteoporosis
Blake, 2020. Patients with psoriatic disease reveal defined body composition changes that are independent of obesity and tmetabolic syndrome, including higher overall body fat, visceral fat and sarcopenia. Patients with psoriatic disease should be screened for abnormal adipose effects beyond their weight and body mass index (BMI). There is no consensus on the optimal assessment method of body composition for this diverse group; hence there is a need for validation of existing modalities and standardization of assessment tools
Li, 2020. Evidence to suggest an overall positive bidirectional association between uveitis and psoriatic disease (psoriasis and PsA), warranting increased awareness among clinicians involved in the management of these two conditions. Therefore, there remains a need for more detailed studies of the possible common pathogenesis of psoriatic disease and uveitis
Kamalaraj, 2019. Evidence that both depression and anxiety in patients with psoriatic arthritis, which is similar or slightly higher than the general population and comparable to that seen in other rheumatic diseases. The effects of treatment for psoriatic arthritis on comorbid depression and anxiety remain unclear
Baumrin, 2019. Herpes Zoster risk depends on disease severity and treatment class. Recombinant zoster vaccine should be given to all psoriasis and PsA patients >50 years old and younger patients at increased risk
Gupta, 2021. The most prevalent comorbiditiesin PsA were hypertension (pooled prevalence 34%), metabolic syndrome (29%), obesity (27%), hyperlipidaemia (24%) and any cardiovascular diseases (19%). Eleven studies consistently showed higher prevalence of comorbidities in PsA than controls. Five studies showed that comorbid patients had more severe disease, poorer quality of life, and increased discontinuation of treatment. Comorbidities, particularly cardiometabolic disorders, were highly prevalent in PsA and more common than in healthy controls. Comorbidities were associated with adverse disease features, but more research is needed

Health Research Classification System category Inflammatory and immune system
Extra information provided by this PSP
Original uncertainty examples Many people I know with psoriatic arthritis have several other comorbidities in common such as high blood pressure, low Vit D,  IBD/IBS, osteoarthritis, fibromyalgia/CFS etc.What research is being done to see if there is a general link between psoriatic arthritis and such comorbidities and if the disease/treatment has any effect on them (makes them worse or better)?  
Submitted by 72 uncertainties submitted 
PSP information
PSP unique ID 0108
PSP name Psoriatic Arthritis
Total number of uncertainties identified by this PSP. 46  (To see a full list of all uncertainties identified, please see the detailed spreadsheet held on the JLA website)
Date of priority setting workshop 12 July 2021