Autoimmune features in psoriatic arthritis

Year 2026, Volume: 17 Issue: 57 , 34 - 42 , 16.04.2026

Reyhan Kose Cobanoglu , Utku Sentosun , Irem Asik Bal , Gokhan Sargin

https://doi.org/10.17944/interdiscip.1762262

https://izlik.org/JA73ND58YE

Abstract

Objective: Psoriatic arthritis (PsA), traditionally classified as a seronegative spondyloarthropathy, is increasingly recognized to exhibit autoimmune characteristics. We aimed to investigate the prevalence of anti-nuclear antibody (ANA) and co-existing autoimmune diseases (co-AIDs), and assess their potential impact on clinical features in a real-life PsA cohort.
Method: This retrospective, single-centre study included PsA patients followed at a tertiary university hospital between 2019 and 2024, classified according to CASPAR criteria. Demographic, clinical, and laboratory data, including co-AIDs, autoantibodies (when available), and disease activity scores, were obtained from medical records. Patients were stratified by ANA status and presence of co-AIDs. Statistical analyses were performed using chi-square/Fisher’s exact tests and t-test or Mann–Whitney U test and multivariable logistic regression models as appropriate, with a significance threshold of p < 0.05.
Results: Among 219 PsA patients (62.1% female, mean age 45.8±12.4), 23.7% had at least one co-AID. The most common were autoimmune thyroid disorders (16.8%), followed by rheumatoid arthritis (2.3%), autoimmune hepatitis (0.9%), and antiphospholipid syndrome (0.9%). ANA positivity was observed in 35% of 100 tested patients; 72% had titres ≥1:100 and 57% showed a granular pattern. ANA-positive patients more frequently exhibited peripheral-predominant disease, though other clinical characteristics were similar. Co-AIDs were more common in females, obese patients, and those with a family history of rheumatic disease.
Conclusion: In this real-world PsA cohort, co-AID frequency was found to be generally comparable to population rates, except for increased frequency of antiphospholipid syndrome and autoimmune hepatitis. ANA positivity was relatively common, though its clinical significance remains uncertain. Screening for autoimmune conditions may be considered in PsA patients, particularly women, those with obesity, and individuals with a rheumatic family history.

Keywords

psoriatic arthritis , autoimmunity , autoantibodies , antinuclear antibody

References

• Coates LC, Helliwell PS. Psoriatic arthritis: state of the art review. Clin Med (Lond). 2017 Feb;17(1):65-70. doi: 10.7861/clinmedicine.17-1-65.
• Azuaga AB, Ramírez J, Cañete JD. Psoriatic Arthritis: Pathogenesis and Targeted Therapies. Int J Mol Sci. 2023 Mar 3;24(5):4901. doi: 10.3390/ijms24054901.
• Emmungil H, İlgen U, Direskeneli RH. Autoimmunity in psoriatic arthritis: pathophysiological and clinical aspects. Turk J Med Sci. 2021 Aug 30;51(4):1601-1614. doi: 10.3906/sag-2011-235.
• Vastarella M, Megna M, Lupoli GA, Napolitano M, Gallo L, Balato A, et al. Is there any association between psoriasis, psoriatic arthritis and thyroid autoimmunity? Australas J Dermatol. 2021 May;62(2):e207-e211. doi: 10.1111/ajd.13484. Epub 2020 Oct 18.
• Jung JM, Kim YJ, Lee WJ, Won CH, Lee MW, Chang SE. Risk of incident autoimmune diseases in patients with newly diagnosed psoriatic disease: a nationwide population-based study. Sci Rep. 2023 Oct 5;13(1):16738. doi: 10.1038/s41598-023-43778-4. Erratum in: Sci Rep. 2023 Nov 7;13(1):19278. doi: 10.1038/s41598-023-46498-x.
• Bu J, Ding R, Zhou L, Chen X, Shen E. Epidemiology of Psoriasis and Comorbid Diseases: A Narrative Review. Front Immunol. 2022 Jun 10;13:880201. doi: 10.3389/fimmu.2022.880201.
• Taylor W, Gladman D, Helliwell P, Marchesoni A, Mease P, Mielants H; CASPAR Study Group. Classification criteria for psoriatic arthritis: development of new criteria from a large international study. Arthritis Rheum. 2006 Aug;54(8):2665-73. doi: 10.1002/art.21972.
• Lambert JR, Scott G, Wright V. Psoriatic arthritis and anti-nuclear factor. Br J Dermatol. 1977 Jan;96(1):11-4. doi: 10.1111/j.1365-2133.1977.tb05178.x.
• Panayi GS. Immunology of psoriasis and psoriatic arthritis. Baillieres Clin Rheumatol. 1994 May;8(2):419-27. doi: 10.1016/s0950-3579(94)80026-x.
• Wu JJ, Nguyen TU, Poon KY, Herrinton LJ. The association of psoriasis with autoimmune diseases. J Am Acad Dermatol. 2012 Nov;67(5):924-30. doi: 10.1016/j.jaad.2012.04.039. Epub 2012 Jun 2.
• Duan K, Wang J, Chen S, Chen T, Wang J, Wang S, et al. Causal associations between both psoriasis and psoriatic arthritis and multiple autoimmune diseases: a bidirectional two-sample Mendelian randomization study. Front Immunol. 2024 Jul 25;15:1422626. doi: 10.3389/fimmu.2024.1422626.
• Atmis V, Bülbül B, Bahşi R, Gümüşsoy M, Yalçin A, Doğan Z, et al. Iodine concentration and prevalence of thyroid disease in older people after salt iodization in Turkey. East Mediterr Health J. 2021 Feb 25;27(2):151-158. doi: 10.26719/2021.27.2.151.
• Antonelli A, Delle Sedie A, Fallahi P, Ferrari SM, Maccheroni M, Ferrannini E, et al. High prevalence of thyroid autoimmunity and hypothyroidism in patients with psoriatic arthritis. J Rheumatol. 2006 Oct;33(10):2026-8.
• Vassilatou E, Papadavid E, Papastamatakis P, Alexakos D, Koumaki D, Katsimbri P, et al. No association of psoriasis with autoimmune thyroiditis. J Eur Acad Dermatol Venereol. 2017 Jan;31(1):102-106. doi: 10.1111/jdv.13767. Epub 2016 Jun 21.
• Uke P, Maharaj A, Adebajo A. A review on the epidemiology of rheumatoid arthritis: An update and trends from current literature. Best Pract Res Clin Rheumatol. 2025 Mar;39(1):102036. doi: 10.1016/j.berh.2025.102036. Epub 2025 Feb 11.
• Chen KL, Chiu HY, Lin JH, Ye JD, Cho YH, et al. Prevalence, clinical features and treatment pattern of patients with concurrent diagnoses of rheumatoid arthritis and psoriatic disease: results of a 14-year retrospective study in a tertiary referral center. Ther Adv Chronic Dis. 2019 May 13;10:2040622319847900. doi: 10.1177/2040622319847900.
• GBD 2021 Diabetes Collaborators. Global, regional, and national burden of diabetes from 1990 to 2021, with projections of prevalence to 2050: a systematic analysis for the Global Burden of Disease Study 2021. Lancet. 2023 Jul 15;402(10397):203-234. doi: 10.1016/S0140-6736(23)01301-6. Epub 2023 Jun 22. Erratum in: Lancet. 2023 Sep 30;402(10408):1132. doi: 10.1016/S0140-6736(23)02044-5. Erratum in: Lancet. 2025 Jan 18;405(10474):202. doi: 10.1016/S0140-6736(25)00053-4.
• King JA, Jeong J, Underwood FE, Quan J, Panaccione N, Windsor JW, et al. Incidence of Celiac Disease Is Increasing Over Time: A Systematic Review and Meta-analysis. Am J Gastroenterol. 2020 Apr;115(4):507-525. doi: 10.14309/ajg.0000000000000523.
• Maurer M, Weller K, Bindslev-Jensen C, Giménez-Arnau A, Bousquet PJ, Bousquet J, et al. Unmet clinical needs in chronic spontaneous urticaria. A GA²LEN task force report. Allergy. 2011 Mar;66(3):317-30. doi: 10.1111/j.1398-9995.2010.02496.x. Epub 2010 Nov 17.
• Kabasakal Y, Kitapcioglu G, Turk T, Oder G, Durusoy R, Mete N, et al. The prevalence of Sjögren’s syndrome in adult women. Scand J Rheumatol. 2006 Sep-Oct;35(5):379-83. doi: 10.1080/03009740600759704.
• Garcia D, Erkan D. Diagnosis and Management of the Antiphospholipid Syndrome. N Engl J Med. 2018 May 24;378(21):2010-2021. doi: 10.1056/NEJMra1705454.
• Demir N, Ekin N, Torgutalp M, Wahlin S, Efe C. Two decades of research on autoimmune liver disease in Turkey. Turk J Gastroenterol. 2020 Dec;31(12):877-882. doi: 10.5152/tjg.2020.19866.
• Jensen P, Egeberg A, Gislason G, Hansen PR, Thyssen JP, Skov L. Increased Risk of Autoimmune Hepatitis in Patients with Psoriasis: A Danish Nationwide Cohort Study. J Invest Dermatol. 2016 Jul;136(7):1515-1517. doi: 10.1016/j.jid.2016.02.812. Epub 2016 Mar 14.
• Boyman O, Conrad C, Tonel G, Gilliet M, Nestle FO. The pathogenic role of tissue-resident immune cells in psoriasis. Trends Immunol. 2007;28(2):51-57. doi:10.1016/j.it.2006.12.005
• Johnson SR, Schentag CT, Gladman DD. Autoantibodies in biological agent naive patients with psoriatic arthritis. Ann Rheum Dis. 2005 May;64(5):770-2. doi: 10.1136/ard.2004.031286.
• Tan EM, Feltkamp TE, Smolen JS, Butcher B, Dawkins R, Fritzler MJ, et al. Range of antinuclear antibodies in “healthy” individuals. Arthritis Rheum. 1997 Sep;40(9):1601-11. doi: 10.1002/art.1780400909.
• Silvy F, Bertin D, Bardin N, Auger I, Guzian MC, Mattei JP, et al. Antinuclear Antibodies in Patients with Psoriatic Arthritis Treated or Not with Biologics. PLoS One. 2015 Jul 31;10(7):e0134218. doi: 10.1371/journal.pone.0134218.
• Pirowska MM, Goździalska A, Lipko-Godlewska S, Obtułowicz A, Sułowicz J, Podolec K, et al. Autoimmunogenicity during anti-TNF therapy in patients with psoriasis and psoriatic arthritis. Postepy Dermatol Alergol. 2015 Aug;32(4):250-4. doi: 10.5114/pdia.2015.53320. Epub 2015 Aug 12.
• Rubtsov AV, Rubtsova K, Kappler JW, Marrack P. Genetic and hormonal factors in female-biased autoimmunity. Autoimmun Rev. 2010 May;9(7):494-8. doi: 10.1016/j.autrev.2010.02.008. Epub 2010 Feb 6.