Mortality and causes of death in psoriatic arthritis

Objective. To evaluate the mortality associated with psoriatic arthritis (PsA) and causes of death.

Methods. Data were evaluated from several published studies identified by a literature search. A standardized mortality ratio was documented when available, as were causes of death derived from clinical databases, death certificates, and mortality databases. In some studies, mortality data was stratified by sex, age, and calendar year with time trend analysis.

Results. There were variable reports of increased mortality in PsA that may be explained by factors such as pattern of referral, the severity of arthritis and/or skin psoriasis, and treatment exposure. There appears to be a greater incidence of cardiovascular death in psoriatic disease, although further studies are needed to separate the effect of skin psoriasis from arthritis.

Conclusion. PsA is not a mild disease and mortality may be increased in more severe disease. Although cardiovascular risk is more substantiated in severe psoriasis than in arthritis, it would be remiss not to evaluate the cardiovascular risk profile in all patients with psoriatic disease. It is important to treat patients with PsA early and aggressively to prevent disease severity that may influence longevity.