Introduction: Psoriatic arthritis (PsA) is an inflammatory condition associated with psoriasis (PsO), with variable prevalence ranging from 6% to 42%. Despite the known link between PsO and PsA, reliable biomarkers for predicting PsA onset remain elusive. Recent research has identified risk determinants including obesity, onychopathy, PsO severity, and familial predisposition. Detecting PsO patients at risk of developing PsA is crucial given the disparity in treatment efficacy post-PsA establishment.

Objective: This study evaluates the rate of PsA among PsO patients undergoing targeted biologic therapy as first- or second-line therapy.

Material and Methods: We conducted a retrospective cohort study utilizing TriNetX database and identified PsO patients receiving biologic therapy. Propensity score matching was applied to adjust for potential confounders. Patients were followed for 5 years, and the incidence rate of PsA was determined. Statistical analyses were performed to estimate relative risks and hazard ratios.

Results: Among 1,175,000 PsO patients, 41,990 received first-line biologic therapy. Following matching, patients initiating IL12/23i or IL23i exhibited a lower PsA incidence rate vs TNFi. Second-line IL12/23i and IL23i treatment also showed a lower PsA risk vs TNFi. IL17i did not significantly differ from TNFi in PsA risk.

Conclusion: This study highlights differential PsA risk among PsO patients on biologic therapy, suggesting potential benefits of IL12/23i and IL23i in PsA prevention. Prospective studies are needed to confirm these findings and optimize PsA prevention strategies.