Are Psoriasis, Psoriatic Arthritis and Endometriosis Associated?

Women with psoriasis (PsO) and concomitant psoriatic arthritis (PsA) were at a higher risk of endometriosis diagnosis, whereas patients with PsO alone did not have an increased risk, a new study found. The findings of the study are published in the American Journal of Epidemiology.

“This is the first study to examine the bi-directional association between psoriasis, psoriatic arthritis, and endometriosis,” the authors wrote. “These are important findings as early diagnosis and treatment of the index condition, both endometriosis and psoriatic arthritis, may help to minimize the emergence of subsequent comorbidities, ultimately improve the quality of life of patients.”

The researchers obtained data from the Nurses’ Health Study II cohort between 1991 and 2013. The team confirmed 4,112 women diagnosed with laparoscopically confirmed endometriosis (mean age at diagnosis = 40.3 years); 697 patients were diagnosed with PsO (mean age at diagnosis = 43.6 years) of which 110 were diagnosed with concomitant PsA.

The primary objective of this bidirectional study was to establish the association between chronic inflammatory disorders such as endometriosis, PsO, and PsA. The study provided evidence that “a history of psoriasis with concomitant PsA was associated with a 2-fold higher risk of endometriosis (hazard ratio (HR) = 2.01, 95% CI: 1.23, 3.30); however, no association was observed between psoriasis without PsA and endometriosis risk (HR = 0.93, 95% CI: 0.68, 1.26).”

Through a second set of analyses, when endometriosis was defined as the exposure, the study confirmed it was not associated with PsO alone, but was suggestively associated with PsA.

The prospective association between these inflammatory related conditions is crucial in determining the course of treatment, the investigators noted. Early diagnosis and prompt treatment of the primary condition could help in decreasing the risk of other subsequent comorbidities. However, the authors advised, “Future studies are needed to explore whether specific phenotypes of endometriosis are more strongly associated with psoriatic arthritis and whether any treatments for psoriatic arthritis increase or decrease the likelihood of endometriosis diagnosis.”

—Priyam Vora

Reference:
Harris H, Korkes K, Li T et al. Endometriosis, Psoriasis, and Psoriatic Arthritis: A Prospective Cohort Study. American Journal of Epidemiology. 2022;191:1050-1060. DOI: https://doi.org/10.1093/aje/kwac009