P365 Psoriasis in Inflammatory Bowel Disease: Comparison of Extraintestinal Manifestations and Effect of Anti-TNF Therapies

Abstract Background Psoriatic lesions may develop in inflammatory bowel disease (IBD) patients as an extraintestinal manifestation or an adverse effect of anti-TNF therapy. The aim of this study was to compare the clinical characteristics of IBD patients with psoriasis between extraintestinal manifestations and the effect of anti-TNF therapies. Methods In this cross-sectional study, data was identified between March 2019, and October 2022. Demographic and clinical data of patients with IBD were recorded at baseline and during follow-up. All patients were questioned for psoriasis, and the "onset of psoriasis" was recorded as before or after anti-TNF therapies. Results In our tertiary center, a total of 1125 IBD patients were identified through the database (543 with CD, 549 with UC, and 33 with IBD unclassified (IBDU)) and a 336 (29.9%) had an exposure to adalimumab, 322 (28.6%) to infliximab, and 27 (2.4%) to certolizumab. In our cohort, a total of 37 (3.3%) patients, suffered from psoriasis, in which 18 (48.6%) patients on anti-TNF therapy (7 adalimumab, 10 infliximab and 1 certolizumab) developed a drug-induced psoriasis, while 19 (51.4%) patients had psoriasis as an extraintestinal manifestation before the anti-TNF therapies. In patients with all psoriasis, 24 (%64.9) were female and 28 (75.7%) had CD. CD was statistically significantly more common in patients with psoriasis induced by anti-TNF therapy (17 (94.4%) vs. 11 (57.9%), p=0.019). Anti-TNF therapy induced psoriasis had statistically significantly longer disease duration than psoriasis as an extraintestinal manifestation group (11.5 vs 6 median years, respectively p=0.005), while other baseline characteristics such as age, sex, smoking status, family history of IBD, disease location, behavior, perianal disease, and other extraintestinal involvements were similar. At baseline, serum hemoglobin (13 vs. 12 mg/dL; p=0.069), albumin (4.2 vs.4.3 g/dL; p=0.505), partial MAYO score (6 vs 7 median score; p=0.247) and CDAI (360 vs. 320 median score; p=0.339) were all comparable between the two groups, respectively. Whereas baseline CRP level in extraintestinal manifestation group was significantly higher than anti-TNF therapy induced group (66 vs. 2.8 mg/L; p=0.003). Conclusion In this study, we found that up to 3.3% of all IBD patients had psoriasis; half of these cases were anti-TNF therapy induced psoriasis, and the rates of psoriasis in CD patients and female patients were greater than those in UC and male patients. Anti-TNF therapy induced psoriasis had a statistically significantly longer disease duration and lower baseline CRP in comparison to psoriasis as an extraintestinal manifestation.