Psoriatic arthritis associated with hearing impairment

March 25, 2019

According to a recent study, patients with psoriatic arthritis may be at a greater risk for adult hearing loss than individuals without psoriatic arthritis.

Psoriasis is a common skin condition effective 3% of the population.  A large portion of patients suffering from psoriasis have concurrent psoriatic arthritis. Patients with psoriatic arthritis can suffer from articular manifestations as well as extra-articular manifestations such as mucous membrane lesions as well as aortic root dilatation similar to other inflammatory arthritides. There have been small studies suggesting an association between inflammatory arthritis and hearing loss; however, the prevalence of hearing loss in psoriatic arthritis has not been expored.

A group of researchers led by Dr. Yevgeniy R. Semenov from the department of dermatology at Washington University School of Medicine aimed to learn the prevalence of hearing loss in patients with psoriatic arthritis. Their research was published in the Journal of Rheumatology January of 2019.

The researchers accessed The United States Health and Nutrition Examination Survey (NHANES). This is a national database composed of patient surveys. The participants are selected based on demographic profiles selected to represent the profile of the patients in the US. The study population took part in dermatology surveys from 2003-2006 and 2009-2010.     

Patients who had psoriatic arthritis were compared to patients with psoriasis but not psoriatic arthritis and patients without psoriasis or psoriatic arthritis. Self-reported hearing function was ascertained using a Likert scale (“Which of the following best describes hearing without hearing aid? Would you say your hearing is good, that you have a little trouble, a lot of trouble, or are you deaf?”).   
    
10,747 patients from NHANES were included for analysis. The prevalence of psoriatic arthritis in the study population was 1.1%, psoriasis without psoriatic arthritis was 1.6%, and 97% didn’t have psoriasis or psoriatic arthritis. Overall patients with psoriatic arthritis were less likely to rate their hearing as excellent and more likely to report difficulty in their hearing function. Furthermore, quantitative audiometric testing had an average of 12-dB increase in PTA hearing thresholds compared to controls. 

This was the first multicentered study evaluating hearing in psoriatic arthritis. Findings suggest that patients with psoriatic arthritis have mild hearing loss compared with their age-matched controls who do not. The mechanism of hearing loss in psoriatic arthritis has not been elucidated but the authors postulate that immune-mediated inflammation damages the inner ear leading to decreased hearing.

Understanding that patients with psoriatic arthritis may be at risk for hearing loss is important to clinicians. Patients with psoriatic arthritis are already at risk for depression and the addition of hearing loss can increase this risk. Therefore, understanding a potentially modifiable risk factor for depression in psoriatic arthritis patients is important for physicians. 

Reference:

Semenov, Yevgeniy R., et al. "Association Between Psoriasis with Arthritis and Hearing Impairment in US Adults: Data from the National Health and Nutrition Examination Survey." The Journal of Rheumatology (2019): jrheum-171228.