Biologic Therapy May Lower Risk of Psoriatic Arthritis in Patients With Psoriasis, Study Finds

Published in Rheumatology, a recent monocentric cohort study of over 1000 patients with psoriasis (PsO) has found that biologic therapy is significantly associated with a reduced likelihood of developing psoriatic arthritis (PsA). The findings offer important clinical implications for dermatologists managing patients with moderate-to-severe psoriasis, especially those at elevated risk for joint involvement.

The study evaluated 1023 patients with PsO who underwent rheumatologic assessment, with clinical and therapeutic data analyzed using chi-squared tests and multivariate logistic regression models. Patients who had ever received biologic treatment showed a markedly lower prevalence of PsA (8.9%) compared to those who had not (26.1%), with a statistically significant difference (P < 0.001).

After adjusting for major PsA risk factors, biologic treatment remained a strong independent protective factor against PsA development. In the full cohort, biologic use was associated with a 77% reduction in odds of developing PsA (adjusted odds ratio [adjOR] 0.228, P < 0.01). The protective effect was even more pronounced in patients with disease onset after 2005 (adjOR 0.264) and 2014 (adjOR 0.179), reflecting the impact of more recent biologic therapies.

“These results support a significant association between biologic treatment and a reduced likelihood of psoriatic arthritis, particularly in recent treatment eras,” the authors wrote.

When stratified by biologic class, all major categories showed protective associations. Tumor necrosis factor inhibitors had an adjOR of 0.206, interleukin-17 (IL-17) inhibitors had an adjOR of 0.051, and IL-23 or 12/23 inhibitors had an adjOR of 0.167—all statistically significant (P < 0.01). These findings suggest broad utility across multiple biologic mechanisms in lowering PsA risk.

The study also explored patterns of articular involvement. Patients treated with biologics had a significantly lower prevalence of pure peripheral PsA (adjOR 0.182) and peripheral PsA with axial involvement (adjOR 0.115, P < 0.04 for both).

“This study provides meaningful and concordant evidence supporting the significant role of different classes of biologics in reducing the likelihood of peripheral and axial PsA development,” the authors concluded.

Reference
Floris A, Mugheddu C, Sichi L, et al. Treatment of psoriasis with different classes of biologics reduces the likelihood of peripheral and axial psoriatic arthritis development. Rheumatology (Oxford). 2025;64(3):1131-1137. doi:10.1093/rheumatology/keae257