Patients with psoriasis and coexisting psoriatic arthritis (PsA) may have greater jaw functional limitation compared with those without arthritis, whereas poor sleep quality may be more closely associated with skin disease severity and systemic treatment status.
In a prospective, controlled cross-sectional study, investigators recruited 178 participants, including 105 patients with psoriasis and 73 age- and sex-matched controls. Among patients with psoriasis, 42 were receiving no systemic therapy, 20 were receiving conventional nonbiologic systemic therapy, and 43 were receiving biologic agents targeting interleukin (IL)-17 or IL-23. Patients receiving biologics had been treated for at least 12 weeks.
Temporomandibular joint function was assessed using the 20-item Jaw Functional Limitation Scale (JFLS-20), which measures limitations in chewing, jaw mobility, speech, and facial expression. Sleep quality was evaluated using the Pittsburgh Sleep Quality Index (PSQI), with scores greater than 5 indicating poor sleep quality. Cutaneous disease severity was measured using the Psoriasis Area and Severity Index (PASI). The investigators compared outcomes across treatment groups and according to PsA status, adjusting for age, sex, body mass index, disease duration, disease severity, PsA status, and treatment group.
Patients with PsA had greater jaw functional limitation compared with those without PsA, with mean JFLS-20 scores of 0.80 vs. 0.45. In adjusted analyses, PsA status remained independently associated with greater jaw functional limitation, whereas cutaneous disease severity and biologic treatment status were not independently associated with jaw function.
Jaw functional limitation was not significantly greater in the overall psoriasis population compared with healthy controls. Mean JFLS-20 scores were 0.52 among healthy controls, 0.54 among patients receiving no systemic therapy, 0.59 among those receiving nonbiologic systemic therapy, and 0.51 among those receiving biologics. Jaw functional limitation was concentrated among patients with PsA rather than being a generalized feature of psoriasis.
Poor sleep quality was reported among 60% of patients receiving no systemic therapy vs. 60% receiving nonbiologic systemic therapy, 7% receiving biologics, and 10% among healthy controls. Mean PSQI scores were 6.05, 5.70, 4.23, and 4.05, respectively, with higher scores indicating poorer sleep quality.
Patients receiving biologics had lower cutaneous disease activity. Mean PASI scores were 1.57 in the biologic group vs. 7.19 among patients receiving no systemic therapy and 6.89 among those receiving nonbiologic systemic therapy. Greater psoriasis severity was moderately correlated with poorer sleep quality. In adjusted analyses, higher PASI scores remained independently associated with poorer sleep quality, while biologic treatment status was associated with better sleep quality. PsA status was not independently associated with sleep quality.
Among 26 patients with PsA, 12 were receiving biologics and 14 were not. Patients receiving biologics had lower mean jaw limitation scores than those not receiving biologics (0.67 vs. 0.92), along with lower mean PSQI scores (4.25 vs. 7.00). However, the exploratory comparisons could not establish whether biologic treatment accounted for the observed differences.
Among the 43 patients receiving biologics, 26 were treated with IL-17 or IL-17A/F inhibitors, including secukinumab, ixekizumab, or bimekizumab; and 17 received IL-23 inhibitors, including risankizumab or guselkumab. No statistically significant differences were observed between these treatment classes in psoriasis severity, jaw functional limitation, or sleep quality.
The investigators acknowledged several limitations, including the single-center, cross-sectional design, relatively small sample, and reliance on patient-reported questionnaires without objective dental examinations, imaging, or sleep monitoring. Factors influencing sleep were not assessed in detail. Multiple exploratory subgroup comparisons were conducted without adjustment for multiple testing. Additionally, patients receiving biologics had lower disease activity, making it difficult to distinguish treatment-related associations from differences in disease severity or treatment response. The biologic cohort excluded patients receiving tumor necrosis factor inhibitors, limiting generalizability to other biologic therapies.
“This PsA-associated temporomandibular functional limitation is the principal novel finding of the study,” wrote lead study author Ömer Karakoyun, of Gazi Yaşargil Training and Research Hospital in Türkiye, and colleagues.
The study authors reported no conflicts of interest.
Source: Skin Health and Disease
