Association of Behçet disease with psoriasis and psoriatic arthritis

Behçet disease (BD) is a debilitating multi-systemic vasculitis with a litany of muco-cutaneous manifestations and potentially lethal complications. Meanwhile, psoriasis (PSO) is a cutaneous and systemic inflammatory disorder marked by hyperplastic epidermis and silvery scales, which may be accompanied by a distinct form of arthropathy called psoriatic arthritis (PsA). While the clinical pictures of these two are quite different, they feature some important similarities, most of which may stem from the autoinflammatory components of BD and PSO. Therefore, the aim of this study was to investigate the prospective link between BD and cutaneous and articular manifestations of psoriasis. BD, PSO, and PsA cohorts were extracted using the National Health Insurance Service of Korea database. Using χ² tests, prevalence of PSO and PsA with respect to BD status was analysed. Relative to non-BD individuals, those with personal history of BD were nearly three times more likely to be diagnosed with PSO. The adjusted odds ratio (aOR) was 2.36 [95% confidence interval (CI), 1.91-2.93, p < 0.001]. Elevated PSO risk was more pronounced in the male BD cohort (aOR = 1.19, 95% CI 1.16-1.23, p < 0.001). In age-group sub-analysis, individuals over 65 years with PSO were one and a half times more likely to be affected with BD, relative to those under 65. The adjusted OR for the older group was 1.51 (95% CI 1.43-1.59, p < 0.001). BD individuals with "healthy" body weight were significantly less likely to be affected by PSO (aOR = 0.59, 95% CI 0.57-0.62, p < 0.001). On the other hand, there was a correlation between BMI and the risk of BD, with the "moderately obese (30-35 kg/m²)" group having an aOR of 1.24 (95% CI 1.12-1.38, p < 0.001). BD patients were also twice more likely to be associated with PsA (aOR = 2.19, 95% CI 1.42-3.38, p < 0.001). However, in contrast to the case of psoriatic disease itself, females were exposed to a greater risk of developing BD compared to the male PsA cohort (aOR = 2.02, 95% CI 1.88-2.16, p < 0.001). As with PSO, older BD patients were exposed to a significantly higher risk of developing PsA (aOR = 3.13, 95% CI 2.90-3.40, p < 0.001). Behçet disease may place an individual at a significantly increased risk of psoriasis, and still greater hazard of being affected with psoriatic arthritis. This added risk was pronounced in the male cohort, and tended to impact senile population, and this phenomenon may be related with the relatively poor prognosis of BD in males and PSO in older patients.