TNF Inhibitors Linked to Lower PsA Risk in Severe Psoriasis

Medscape

14-07-2025

TOPLINE:
In patients with chronic plaque psoriasis, long-term treatment with TNF inhibitors was associated with a lower risk for psoriatic arthritis (PsA) than narrow-band ultraviolet B phototherapy.
METHODOLOGY:
In a longitudinal cohort study, researchers included 946 adult patients treated for chronic plaque psoriasis between September 2005 and September 2010.
Two propensity score-matched groups with 297 patients each were formed: those who received TNF inhibitors, including etanercept, infliximab, and adalimumab (mean age, 52.2 years; 65.7% men), and phototherapy using narrow-band ultraviolet B (mean age, 51.5 years; 64.6% men).
Patients underwent a rheumatologist assessment before therapy initiation.
The incidence of PsA was assessed over a mean follow-up duration of 9.1 and 8.9 years per person for those who received TNF inhibitors and phototherapy, respectively.
TAKEAWAY:
The incidence rate of PsA per 100 patients with psoriasis was 1.18 among those who received TNF inhibitors and 2.48 among those who received phototherapy (incidence rate ratio, 2.1; P = .0002).
Treatment with TNF inhibitors was associated with a significantly lower risk for PsA than phototherapy (adjusted hazard ratio [aHR], 0.32; P < .0001), which was noted across different psoriasis severities (on the basis of Psoriasis Area and Severity Index [PASI] scores).
Arthralgia was the strongest independent predictor of the risk for PsA (aHR, 7.68; P < .0001), followed by nail psoriasis (aHR, 1.93; P = .0004) and higher baseline PASI scores (aHR, 1.03 per point increase; P = .0096).
IN PRACTICE:
"A multidisciplinary approach involving dermatologists and rheumatologists in identifying and managing arthralgia could be crucial in modifying disease progression," the authors wrote.
SOURCE:
This study was led by Stefano Piaserico, MD, PhD, Department of Medicine, University of Padua, Padua, Italy. It was published online on July 03, 2025, in Rheumatology.
LIMITATIONS:
Unmeasured confounding factors may have influenced the outcomes. All the patients were recruited from psoriasis referral centres, potentially overrepresenting those with more severe or long-duration disease. Certain TNF inhibitors, such as certolizumab and golimumab, were not included.
DISCLOSURES:
This study did not receive any specific funding. Several authors reported serving as consultants, speakers, and/or advisors for and receiving honoraria from various pharmaceutical companies including AbbVie, Eli Lilly, and Novartis.
This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.