Disease Burden and Comorbidities in Patients with Psoriatic Arthritis and Concomitant Obesity – A Pooled Analysis of 3 Clinical Trials

Objectives The relationship between psoriatic arthritis (PsA) and obesity is complex and may be bidirectional. Obesity can increase the risk of developing PsA, and weight loss interventions in patients with PsA may lead to reducing disease activity. This analysis pooled data from SPIRIT-P1, SPIRIT-P2, and SPIRIT-H2H clinical trials with biologic-naïve and biologic-experienced adult patients with active PsA.

Methods Patient characteristics, disease burden, and comorbidities at baseline (BL) were analyzed across the following body mass index (BMI, kg/m2) groups: <25 (normal), ≥25 to <30 (overweight), and ≥30 (obesity). The non-parametric Mann-Whitney U test was used to statistically compare differences between obesity or overweight groups to the normal group, with p-value ≤0.05 signaling statistical differences.

Results Among 1284 patients, 42.6% had a BMI of ≥30 (obesity). Patients with obesity had higher mean (standard deviation) tender joint counts (23.0 [14.7]), swollen joint counts (12.1 [9.2]), Disease Activity index in PsA (49.1 [23.0]), Disease Activity Score 28-CRP (5.1 [1.0]), fatigue numeric rating scale score (6.2 [2.3]), Health Assessment Questionnaire-Disability Index score (1.3 [0.6]), and 36-Item Short Form Health Survey (SF-36) Physical Component Summary score (34.0 [9.0]) compared to the normal group, with statistical significance (p≤0.05). Similar numerical trends were observed for overweight groups compared to normal group at BL, but without statistical significance (Table 1). SF-36 Mental Component Summary scores were statistically significant for obesity (46.2 [12.3]) and overweight (47.0 [11.8]) groups compared to normal group. Current enthesitis diagnosis was higher in obesity (66.2%) and overweight (58.1%) groups compared to the normal group (54.4%). Patients with higher BMI showed a greater prevalence of comorbidities at BL: cardiovascular disease (obesity 55.4%, overweight 36.0%, normal 18.1%), hypertension (obesity 51.9%, overweight 30.8%, normal 11.4%), hyperlipidemia (obesity 5.5%, overweight 5.0%, normal 1.7%), diabetes (obesity 19.4%, overweight 12.8%, normal 3.4%), and metabolic dysfunction-associated liver disease (obesity 1.5%, overweight 0.7%, normal 0.7%).

Conclusion Active PsA patients enrolled in the SPIRIT program with obesity or overweight experienced higher BL cardiometabolic burdens like hypertension, hyperlipidemia, diabetes, cardiovascular disease, and metabolic dysfunction-associated liver disease, along with higher disease burden as evident by disease activity and patient-reported outcome measures. These underscore the broader unmet healthcare needs in PsA patients with increased BMI. With new options to manage both active PsA and comorbidities, there may be an opportunity for rheumatologists to intervene to provide holistic care, shifting from disease management to health improvement.