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Updated: Aug 13, 2026
Measuring Psoriasis Severity at Home
Published on: March 1, 2024
Biologic DMARD class influences progression from psoriasis to PsA: A real-world cohort study
Nikolaos Kougkas1, Eleni Sotiriou2, Dimitrios Deligeorgakis1
1Fourth Department of Internal Medicine, Aristotle University of Thessaloniki, School of Medicine, Hippokration University Hospital, Thessaloniki, Greece.
Objectives:
To evaluate whether the risk of progression from psoriasis to psoriatic arthritis (PsA) is affected by the class of bDMARD used for treatment of psoriasis, in a real-world cohort with a large follow-up.
Methods:
We conducted a retrospective study in two university dermatology-rheumatology centers. Consecutive adults with psoriasis receiving bDMARDs for ≥6 months between 2008 and 2025 were included. Patients were followed until PsA diagnosis, last visit, or study end. The primary outcome was incidence of PsA.
Results:
Among 393 patients, 86 (22%) developed PsA during follow-up. In the single-class bDMARD exposure analysis (n = 257), PsA occurred more frequently in patients treated with tumour necrosis factor inhibitors (TNFi) than in those receiving IL-17, IL-23, or IL-12/23 inhibitors. After adjustments, all non-TNFi bDMARDs were associated with significantly lower odds (OR range 0.16-0.25) and hazards (HR range 0.17-0.30) of PsA compared with TNFi. Similar findings were observed when patients were grouped according to the bDMARD class used for the longest duration. In patients analyzed by first bDMARD received (n = 137), PsA prevalence and adjusted hazards did not differ between bDMARD classes.
Conclusion:
In this long-term real-life cohort of patients with psoriasis, treatment with non-TNFi bDMARDs-particularly IL-17 and IL-23 inhibitors-was associated with lower risk of incident PsA compared with TNFi. These findings support PsA interception and warrant prospective studies to determine whether biologic class selection can modify disease progression.
