Chronic kidney disease in psoriatic arthritis patients elevates joint damage and NSAIDs use: Study

A comprehensive study published in the journal of BMJ Rheumatic & Musculoskeletal Diseases focused on the prevalence and risk factors of chronic kidney disease (CKD) among patients with psoriatic arthritis (PsA) and found important outcomes that could impact treatment and management strategies. 

This research was conducted on a large group of 1,336 patients results and revealed that 123 individuals, accounting for 9.2% of the total study group, were diagnosed with CKD. Also, 20.3% of these patients already had CKD at the time of clinic entry, while the remaining 79.7% developed the condition during a median follow-up period of 8.2 years. This substantial duration brought out the chronic nature of kidney complications associated with PsA and emphasized the need for vigilant long-term monitoring of renal health in these patients.

The progression of kidney damage was also documented, with 18.3% of patients who developed CKD experiencing a doubling of their baseline creatinine levels. Also, half of these patients saw a sustained reduction of 40% or more in their baseline estimated glomerular filtration rate (eGFR), indicating significant impairment of kidney function. 2 patients progressed to severe CKD, with an eGFR dropping below 15 mL/min/1.73 m², a level often associated with the need for dialysis or other intensive interventions.

The study employed multivariate Cox regression models to pinpoint risk factors contributing to the development of CKD. The key findings included a marked increase in risk for patients with diabetes mellitus (hazard ratio [HR] 2.58, p<0.001) and those with a history of kidney stones (HR 2.14, p=0.01). The number of damaged joints as indicated by radiographic evidence was also a predictor (HR 1.02, p=0.02). Higher uric acid levels, with each 50-unit increase linked to a 21% rise in CKD risk (HR 1.21, p<0.001), were another significant factor.

While the regular use of non-steroidal anti-inflammatory drugs (NSAIDs) was associated with an increased risk (HR 1.77, p=0.02), this study identified methotrexate as potentially protective against CKD (HR 0.51, p=0.01). The outcomes of this research challenges conventional apprehensions regarding renal effects of methotrexate and may prompt further investigation into its protective mechanisms. Overall, CKD represents a prominent health concern among PsA patients and is linked to common comorbid conditions, joint damage, and medication use.

Source:

Kharouf, F., Gao, S., Al-Matar, S., Cook, R. J., Chandran, V., & Gladman, D. D. (2024). Chronic kidney disease in patients with psoriatic arthritis: a cohort study. In RMD Open (Vol. 10, Issue 4, p. e004636). BMJ. https://doi.org/10.1136/rmdopen-2024-004636