Are patients with psoriatic arthritis at higher risk of death?

Patients with psoriatic arthritis (PsA) do not appear to be at increased risk of mortality from all causes, reveals a study. Moreover, the specific proportionate mortality rate (PMR) in this cohort is similar to that of the general population.

The authors identified PsA patients from the Clalit Health Services databases between 2003‒2018 and matched them to four controls by age, sex, ethnicity, and index date. They extracted patient demographics, comorbidities, and treatments, as well as obtained mortality data from the Israeli Notification of Death certificate.

PMR of the leading causes of death was calculated and compared to that of the general population. Finally, the authors estimated the crude and the multivariate adjusted hazard ratio (HR) for the association between PsA and all-cause mortality and for factors associated with mortality within the PsA group using Cox proportional hazard regression models.

A total of 5,275 PsA patients and 21,011 controls were included and followed for a mean of 7.2 years. Of the participants (mean age 51.7 years), more than half were female (53 percent). Approximately one in three (38.2 percent) PsA patients were on biologics.

Overall, 471 (8.9 percent) patients in the PsA group died compared to 1,668 (7.9 percent) in the control group. The association between PsA and all-cause mortality had a crude HR of 1.16 (95 percent confidence interval [CI], 1.04‒1.29) and 1.02 (95 percent CI, 0.90‒1.15) on multivariate analysis.

The leading cause of death was malignancy (26 percent), followed by ischaemic heart disease (15.8 percent), and this was consistent with the leading causes of death in the general population.

Furthermore, the positive predictors for mortality were as follows: older age, male sex, lower socioeconomic status, increased body mass index, increased Charlson comorbidity index scores, and history of psoriasis or hospitalization in 1 year prior to study entry.