Joint pain in psoriasis, PsA driving analgesic opioid use

Analgesic opioid use was higher among individuals with psoriasis and those with concomitant psoriasis and psoriatic arthritis compared with the general population, according to findings from a cross-sectional study conducted in Denmark.

“Patients with psoriasis have an impaired quality of life and higher use of analgesics than the general population,” Nikolai Loft, MD, of the department of dermatology and allergy and the Copenhagen Research Group for Inflammatory Skin at Copenhagen University Hospital, Denmark, and colleagues wrote. “Whether such use is due to skin pain or a consequence of joint pain resulting from psoriatic arthritis (PsA) is unclear.”

The researchers evaluated 4,016 patients with psoriasis, including 847 with concomitant PsA, to determine symptoms, disease burden and use of analgesics. The findings in these groups were compared with 3,490 controls. Eligible participants were culled from the Danish Skin Cohort.

General health was assessed using the EuroQol 5-dimensions and 5-levels.

Thirty-four percent of patients with PsA reported moderate to severe itch compared with 30% for those without PsA (P = .022). Moderate to severe skin pain was reported in 30% patients in the concomitant psoriasis-PsA group and 21% of those in the non-PsA group (P < .0001). Sixty-nine percent of patients with PSA reported moderate to severe joint pain compared with 45% of those without PsA (P < .0001).

Patients with psoriasis experienced overall poorer general health than the general population as assessed by the EQ-5D-5L, 0.86 (IQR, 0.76-0.91) compared with 0.90 (IQR, 0.84-0.95) (P < .001). In addition, worse general health was also reported among patients with psoriasis who had PsA, itch, skin pain and/or joint pain.

Opioids were used by 9% of individuals in the general population in the previous 12 months. By comparison, 14.2% of patients with only psoriasis and 22.7% of those with psoriasis and concomitant PsA reported using opioids in the previous 12 months.

Further analysis demonstrated that joint pain was the only factor significantly associated with analgesic use (OR = 3.72; 2.69-5.14; P < .0001).

The researchers noted that the study was limited by the cross-sectional design.

“Patients with psoriasis (especially concomitant PsA) have a higher use of analgesics compared with the general population which appear to be a result of increased joint pain,” the researchers wrote.