Can Psoriasis Treatment Prevent PsA? Biologics, Phototherapy, and Other Treatments

In "Can Psoriasis Treatment Prevent PsA? Biologics, Phototherapy, and Other Treatments," Dr. Strober takes up whether some psoriasis treatments do more than clear skin.

Dr. Strober raises a central question: whether certain psoriasis therapies better forestall the development of psoriatic arthritis. He notes that many approaches can clear or improve skin, but some may do more to prevent joint disease. Comparing modalities, he explains that phototherapy clears skin less completely than biologics, a difference shown in prior data.

Because biologics clear skin better, he argues, they likely also address systemic inflammation more effectively. He cites one study reporting psoriatic arthritis rates of 1.2 cases per 100 patient-years on biologics versus 2.2 on phototherapy, nearly a 50 percent reduction. That analysis did not break results down by biologic type. Dr. Strober believes skin efficacy correlates with control of systemic inflammation affecting joints and ligaments.

He adds that biologics also outperform topicals and conventional DMARDs such as methotrexate in other studies, which does not surprise him given their broader anti-inflammatory reach. He therefore urges less bias toward phototherapy, methotrexate, and especially topicals in patients with more severe skin disease or poor topical response.

Dr. Strober then highlights an analysis (CorEvitas registry) he considers especially important. Biologic-naive patients starting a biologic were followed over five years and grouped by whether they reached a target of 1 percent body surface area or less. Those who achieved the target had a lower rate of psoriatic arthritis than those who did not. The Kaplan-Meier curves showed distinctly lower incidence among responders. He emphasizes that the lesson is not simply choosing the right drug. It is also achieving a strong response, which may itself help forestall psoriatic arthritis over the long term.

Up next, in "Inside the Risankizumab and PsA Risk Study: Claims Data on Targeted Immunomodulator Therapies," Dr. Strober walks through the real-world claims study at the heart of this presentation.