Comorbidities, Clinical Symptoms of Psoriatic Arthritis Differ Between Patients With and Without Hyperuricemia

RMD Open published a study that evaluated the association between hyperuricemia/gout and clinical presentation and disease severity in patients with psoriatic arthritis (PsA). Moreover, the investigators of the study examined the effect of the IL-17A inhibitor secukinumab on clinical response, radiographic progression, and quality of life in patients with PsA with hyperuricemia and without hyperuricemia (normouricemia).

The study, a comprehensive post-hoc analysis that utilized pooled data from the FUTURE 2-5 and MAXIMISE studies, stratified patients into 2 groups based on baseline serum urica acid (SUA) levels, with a threshold of 360 µmol/L. Additionally, sensitivity analyses were performed using SUA thresholds of 300 µmol/L and 420 µmol/L. Demographic, clinical, radiological characteristics, and comorbidities data were collected to provide a holistic understanding of the patient population.

At baseline, patients with hyperuricemia exhibited distinct clinical characteristics compared with those without hyperuricemia. The hyperuricemic group was predominantly male, showed a higher prevalence of hypertension, reported more clinical dactylitis, had a higher incidence of psoriasis, and presented with more severe skin disease.

Despite these differences, a similar proportion of patients in both the normouricemic and hyperuricemic cohorts achieved positive outcomes, including American College of Rheumatology responses, resolution of enthesitis and dactylitis, inhibition of structural damage progression, and improvement in health-related quality of life across all secukinumab doses at week 52.

The researchers recognize that the conclusions drawn from this dataset are subject to several limitations, including the post-hoc nature of the analyses, the FUTURE 2–5 studies’ inclusion criteria designed primarily for PsA trials, excluding patients with uncontrolled comorbidities, the absence of assessment for axial manifestations except in the MAXIMISE study, and the absence of a placebo group in studies beyond week 16 (FUTURE 2-5) and week 12 (MAXIMISE).

In their conclusion, the investigators wrote, “Recognition of these patients [with PsA and concomitant hyperuricemia] at an early stage could be beneficial for personalized treatment and improved management of their comorbidities.”