Psoriasis, Psoriatic Arthritis and Risk of Gout in the US
Psoriasis, Psoriatic Arthritis and Risk of Gout in the US
Background and objective Individuals with psoriasis have increased blood levels of uric acid. However, there is no prospective data on the association between psoriasis and uric acid levels and subsequent development of gout. In this study, we examined the risk of gout among individuals with psoriasis and psoriatic arthritis (PsA) in two cohorts of men and women, the Health Professionals Follow-up Study (HPFS) (1986–2010) and Nurses' Health Study (NHS) (1998–2010).
Methods 27 751 men and 71 059 women were included in the analysis. Lifetime history of physician-diagnosed incident psoriasis and PsA was confirmed by validated supplementary questionnaires. Incident gout diagnoses were confirmed based on the American College of Rheumatology survey criteria. We used Cox proportional hazards models controlling for potential risk factors to calculate the HRs with 95% CIs of incident gout while simultaneously adjusting for several common risk factors.
Results We documented 2217 incident cases of gout during follow-up. Psoriasis was associated with an increased risk of subsequent gout with a multivariate HR of 1.71 (95% CI 1.36 to 2.15) in the pooled analysis. Risk of gout was substantially augmented among those with psoriasis and concomitant PsA (pooled multivariate HR: 4.95, 95% CI 2.72 to 9.01) when compared to participants without psoriasis.
Conclusions In this prospective study of US women and men, psoriasis and PsA were associated with an increased risk of gout.
Psoriasis is a chronic inflammatory skin disorder which may occur in isolation or together with psoriatic arthritis (PsA), an inflammatory seronegative arthritis. Psoriasis is a common disorder with a prevalence of 2–3%, and PsA has been reported to occur in upwards of 25% of those with a diagnosis of psoriasis. Gout is an inflammatory crystal arthropathy caused by persistent hyperuricaemia (elevation of serum uric acid levels) that deposits uric acid in the joints and soft tissues around the joints, leading to painful episodes of crystal-induced arthritis. The condition can become chronic and lead to joint erosions, damage and marked disability. PsA and gout may occur in the same individual, sometimes concurrently, in those with a history of psoriasis.
Several studies have shown a correlation between psoriasis, PsA and elevated serum uric acid levels, with one study further demonstrating a correlation between uric acid levels and psoriasis severity on the psoriasis activity and severity index (PASI). Elevated serum uric acid levels correlate with systemic inflammatory markers and, in psoriasis, may be related to increased cell turnover as well as the known systemic inflammation associated with the disease state. Uric acid has been shown to stimulate inflammatory pathways resulting in the secretion of chemokines and inflammatory markers. Coexisting psoriasis and gout has been documented in several case reports; however, no prospective data about the relation between a prior history of psoriasis and the risk of subsequent gout are available to date.
To address this issue, we investigated the association between psoriasis, with and without concomitant arthritis, and risk of subsequent gout using data from a cohort of men in the Health Professionals Follow-up Study (HPFS) and a cohort of women in the Nurses' Health Study (NHS).
Abstract and Introduction
Abstract
Background and objective Individuals with psoriasis have increased blood levels of uric acid. However, there is no prospective data on the association between psoriasis and uric acid levels and subsequent development of gout. In this study, we examined the risk of gout among individuals with psoriasis and psoriatic arthritis (PsA) in two cohorts of men and women, the Health Professionals Follow-up Study (HPFS) (1986–2010) and Nurses' Health Study (NHS) (1998–2010).
Methods 27 751 men and 71 059 women were included in the analysis. Lifetime history of physician-diagnosed incident psoriasis and PsA was confirmed by validated supplementary questionnaires. Incident gout diagnoses were confirmed based on the American College of Rheumatology survey criteria. We used Cox proportional hazards models controlling for potential risk factors to calculate the HRs with 95% CIs of incident gout while simultaneously adjusting for several common risk factors.
Results We documented 2217 incident cases of gout during follow-up. Psoriasis was associated with an increased risk of subsequent gout with a multivariate HR of 1.71 (95% CI 1.36 to 2.15) in the pooled analysis. Risk of gout was substantially augmented among those with psoriasis and concomitant PsA (pooled multivariate HR: 4.95, 95% CI 2.72 to 9.01) when compared to participants without psoriasis.
Conclusions In this prospective study of US women and men, psoriasis and PsA were associated with an increased risk of gout.
Introduction
Psoriasis is a chronic inflammatory skin disorder which may occur in isolation or together with psoriatic arthritis (PsA), an inflammatory seronegative arthritis. Psoriasis is a common disorder with a prevalence of 2–3%, and PsA has been reported to occur in upwards of 25% of those with a diagnosis of psoriasis. Gout is an inflammatory crystal arthropathy caused by persistent hyperuricaemia (elevation of serum uric acid levels) that deposits uric acid in the joints and soft tissues around the joints, leading to painful episodes of crystal-induced arthritis. The condition can become chronic and lead to joint erosions, damage and marked disability. PsA and gout may occur in the same individual, sometimes concurrently, in those with a history of psoriasis.
Several studies have shown a correlation between psoriasis, PsA and elevated serum uric acid levels, with one study further demonstrating a correlation between uric acid levels and psoriasis severity on the psoriasis activity and severity index (PASI). Elevated serum uric acid levels correlate with systemic inflammatory markers and, in psoriasis, may be related to increased cell turnover as well as the known systemic inflammation associated with the disease state. Uric acid has been shown to stimulate inflammatory pathways resulting in the secretion of chemokines and inflammatory markers. Coexisting psoriasis and gout has been documented in several case reports; however, no prospective data about the relation between a prior history of psoriasis and the risk of subsequent gout are available to date.
To address this issue, we investigated the association between psoriasis, with and without concomitant arthritis, and risk of subsequent gout using data from a cohort of men in the Health Professionals Follow-up Study (HPFS) and a cohort of women in the Nurses' Health Study (NHS).
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