Psoriasis With Coexistent Lupus Erythematosus Rare, Mainly Impacts Women

The development of psoriasis with coexistent lupus erythematosus (LE) is rare, largely occurs in women, and is more likely to lead to involvement from both of the conditions. These findings were reported in a cross-sectional study published in the International Journal of Rheumatic Diseases analyzing the clinical characteristics, quality of life, and condition management of patients with both psoriasis and LE.

The study was designed to assess the quality of life for psoriasis patients both with and without LE to improve clinician awareness regarding the disparate needs of patients with these conditions.

“Psoriasis patients with coexistent LE were uncommon, displayed a female preponderance, were more likely to have joint involvement, and had greater quality of life impairment than those without LE,” the study authors wrote. “LE preceded psoriasis in most of these patients, and systemic LE was the most common subtype.”

The study evaluated patients with psoriasis who were added to the Malaysian Psoriasis Registry (MPR) between January 2007 and December 2018. The investigators included data from 21,735 patients with psoriasis, of whom 0.16% (34) of had both LE and psoriasis. Data on patients with psoriasis were gathered from the MPR at enrollment, whereas data for patients with both conditions were gathered when the concomitant LE was first reported.

The MPR registry includes demographic information, disease severity, comorbidity, and type-of-treatment data. Patients in the registry took the health-related quality of life (HRQoL) assessment and the Dermatology Life Quality Index (DLQI) questionnaire, which was used as part of the assessment.

The study found that among the 34 coexistent cases, in 16 cases (65%) the LE preceded psoriasis. The study also showed that patients with psoriasis who also developed LE reported earlier ages of psoriasis onset compared with those who did not develop LE (27.56 ± 11.51 vs 33.31 ± 16.94 years, P = 0.006). The data showed significant female preponderance among the 34 cases, with a male to female ratio of 1:5.8 (P < 0.001) for patients with both conditions vs individuals without LE.

The study also found that patients with both psoriasis and LE had higher psoriatic arthropathy rates vs individuals without LE (26.5% vs 13.0%, P = 0.02) and substantially greater rates of impaired quality of life (DLQI >10; 57.6% vs 40.3%, P = 0.04).

The investigators also observed higher incidences of lupus nephritis in patients with psoriasis and LE (72.7% vs 40%). The study showed that hematological abnormalities were higher among patients with LE preceding psoriasis vs individuals with psoriasis preceding LE (50% vs 20%).

They researchers found that hydroxychloroquine triggered psoriasis onset for 24.1% (7) of patients in the study. They also observed that individuals with LE were more likely to have been administered systemic psoriasis treatment compared with individuals without reported LE (30.3% vs 14.2%, P = 0.008).

“Psoriasis patients with coexistent LE in the MPR were uncommon (0.16%), displayed a female preponderance, and were more likely to have joint involvement, an earlier age of psoriasis onset and to suffer greater impairment to their quality of life compared with psoriasis patients without LE,” the study authors wrote. “Lupus erythematosus preceded psoriasis in more than half of the patients in our cohort, and SLE was the most common subtype of LE reported.”

Reference

Gan, TS, Ghazali, NI, Voo, SYM, et al. Clinical characteristics, management, and quality of life of psoriasis patients with coexistent lupus erythematosus: Data from the Malaysian Psoriasis Registry. Int J Rheum Dis. 2022; 00: 1- 10. doi: 10.1111/1756-185X.14492. Accessed December 6, 2022.