Smoking Delays Development of Psoriatic Arthritis

LOS ANGELES — A review of data on 281 psoriasis patients found that those who began smoking after psoriasis onset developed psoriatic arthritis later than did nonsmokers or people who smoked before their psoriasis appeared.

Previous data suggest that psoriatic arthritis typically occurs approximately 10 years after the onset of psoriasis. In this study, the interval between diagnoses of psoriasis and psoriatic arthritis was 13 years in nonsmokers, 8 years in people who smoked before developing psoriasis, and 23 years in people who began smoking after their psoriasis diagnosis, Dr. Tina Rakkhit said.

That “dramatically longer time” to the development of joint disease in people who take up smoking after developing psoriasis “is consistent with the notion that the biology of psoriasis can be modulated by smoking activity,” she said at the annual meeting of the Society for Investigational Dermatology.

Of course, that doesn't mean that physicians should advocate smoking in patients with psoriasis.

The health hazards of smoking are well known. If the physiologic underpinnings of these findings can be elucidated, however, this may lead to preventive therapies for psoriatic arthritis without the toxicities of smoking, said Dr. Rakkhit, a dermatologic research fellow at the University of Utah, Salt Lake City.

“Our data support the concept that agents without such detrimental effects could be used to delay and possibly prevent the onset of this significant comorbid state,” Dr. Rakkhit and her associates concluded.

The data came from the 812-person Utah Psoriasis Initiative, a prospective, phenotypic database.

The study excluded patients who developed psoriatic arthritis before being diagnosed with psoriasis, which generally accounts for 15% of people with the joint disease.

Because the Utah Psoriasis Initiative does not collect data on measures of joint disease, the investigators could not tell whether the delayed psoriatic arthritis was less or more severe than earlier-appearing joint disease.

Compared with the general population of Utah, 13% of whom smoke, 36% of the study cohort smoked at the time of their psoriasis diagnosis. In the United States, 20% of the population smokes.

Psoriatic arthritis appeared in nonsmokers at an average age of 26 years and in smokers at age 29 in the current study. Patients were diagnosed with psoriatic arthritis at an average age of 36 if they never smoked and at age 42 if they ever smoked.

The findings add to the intriguing medical literature on the relationships between smoking and inflammatory diseases. Other studies suggest that heavier smokers develop rheumatoid arthritis later, Dr. Rakkhit noted. Crohn's disease appears earlier in smokers, and patients who undergo surgical correction for Crohn's disease are more likely to have recurrent disease. The opposite is seen with ulcerative colitis, which mainly is a disease of nonsmokers and former smokers. Among patients undergoing immunosuppressive therapies, a shorter duration is more likely to suffice in smokers than in nonsmokers.

LOS ANGELES — A review of data on 281 psoriasis patients found that those who began smoking after psoriasis onset developed psoriatic arthritis later than did nonsmokers or people who smoked before their psoriasis appeared.

Previous data suggest that psoriatic arthritis typically occurs approximately 10 years after the onset of psoriasis. In this study, the interval between diagnoses of psoriasis and psoriatic arthritis was 13 years in nonsmokers, 8 years in people who smoked before developing psoriasis, and 23 years in people who began smoking after their psoriasis diagnosis, Dr. Tina Rakkhit said.

That “dramatically longer time” to the development of joint disease in people who take up smoking after developing psoriasis “is consistent with the notion that the biology of psoriasis can be modulated by smoking activity,” she said at the annual meeting of the Society for Investigational Dermatology.

Of course, that doesn't mean that physicians should advocate smoking in patients with psoriasis.

The health hazards of smoking are well known. If the physiologic underpinnings of these findings can be elucidated, however, this may lead to preventive therapies for psoriatic arthritis without the toxicities of smoking, said Dr. Rakkhit, a dermatologic research fellow at the University of Utah, Salt Lake City.

“Our data support the concept that agents without such detrimental effects could be used to delay and possibly prevent the onset of this significant comorbid state,” Dr. Rakkhit and her associates concluded.

The data came from the 812-person Utah Psoriasis Initiative, a prospective, phenotypic database.

The study excluded patients who developed psoriatic arthritis before being diagnosed with psoriasis, which generally accounts for 15% of people with the joint disease.

Because the Utah Psoriasis Initiative does not collect data on measures of joint disease, the investigators could not tell whether the delayed psoriatic arthritis was less or more severe than earlier-appearing joint disease.

Compared with the general population of Utah, 13% of whom smoke, 36% of the study cohort smoked at the time of their psoriasis diagnosis. In the United States, 20% of the population smokes.

Psoriatic arthritis appeared in nonsmokers at an average age of 26 years and in smokers at age 29 in the current study. Patients were diagnosed with psoriatic arthritis at an average age of 36 if they never smoked and at age 42 if they ever smoked.

The findings add to the intriguing medical literature on the relationships between smoking and inflammatory diseases. Other studies suggest that heavier smokers develop rheumatoid arthritis later, Dr. Rakkhit noted. Crohn's disease appears earlier in smokers, and patients who undergo surgical correction for Crohn's disease are more likely to have recurrent disease. The opposite is seen with ulcerative colitis, which mainly is a disease of nonsmokers and former smokers. Among patients undergoing immunosuppressive therapies, a shorter duration is more likely to suffice in smokers than in nonsmokers.

LOS ANGELES — A review of data on 281 psoriasis patients found that those who began smoking after psoriasis onset developed psoriatic arthritis later than did nonsmokers or people who smoked before their psoriasis appeared.

Previous data suggest that psoriatic arthritis typically occurs approximately 10 years after the onset of psoriasis. In this study, the interval between diagnoses of psoriasis and psoriatic arthritis was 13 years in nonsmokers, 8 years in people who smoked before developing psoriasis, and 23 years in people who began smoking after their psoriasis diagnosis, Dr. Tina Rakkhit said.

That “dramatically longer time” to the development of joint disease in people who take up smoking after developing psoriasis “is consistent with the notion that the biology of psoriasis can be modulated by smoking activity,” she said at the annual meeting of the Society for Investigational Dermatology.

Of course, that doesn't mean that physicians should advocate smoking in patients with psoriasis.

The health hazards of smoking are well known. If the physiologic underpinnings of these findings can be elucidated, however, this may lead to preventive therapies for psoriatic arthritis without the toxicities of smoking, said Dr. Rakkhit, a dermatologic research fellow at the University of Utah, Salt Lake City.

“Our data support the concept that agents without such detrimental effects could be used to delay and possibly prevent the onset of this significant comorbid state,” Dr. Rakkhit and her associates concluded.

The data came from the 812-person Utah Psoriasis Initiative, a prospective, phenotypic database.

The study excluded patients who developed psoriatic arthritis before being diagnosed with psoriasis, which generally accounts for 15% of people with the joint disease.

Because the Utah Psoriasis Initiative does not collect data on measures of joint disease, the investigators could not tell whether the delayed psoriatic arthritis was less or more severe than earlier-appearing joint disease.

Compared with the general population of Utah, 13% of whom smoke, 36% of the study cohort smoked at the time of their psoriasis diagnosis. In the United States, 20% of the population smokes.

Psoriatic arthritis appeared in nonsmokers at an average age of 26 years and in smokers at age 29 in the current study. Patients were diagnosed with psoriatic arthritis at an average age of 36 if they never smoked and at age 42 if they ever smoked.

The findings add to the intriguing medical literature on the relationships between smoking and inflammatory diseases. Other studies suggest that heavier smokers develop rheumatoid arthritis later, Dr. Rakkhit noted. Crohn's disease appears earlier in smokers, and patients who undergo surgical correction for Crohn's disease are more likely to have recurrent disease. The opposite is seen with ulcerative colitis, which mainly is a disease of nonsmokers and former smokers. Among patients undergoing immunosuppressive therapies, a shorter duration is more likely to suffice in smokers than in nonsmokers.