Premature Mortality Not Associated With Chronic or Increasing Pain Among Patients With Psoriatic Arthritis

hand with psoriatic arthritis, psoriasis
Hand of a psoriasis patient close-up. Psoriatic arthritis. Joint deformation and inflammation on the skin. Photo with dark vignetting.Soft focus.
Researchers sought to determine if a higher cumulative pain intensity is associated with premature mortality risk in patients with PsA.

Recent glucocorticoid use and comorbidities are associated with increased premature mortality among patients with psoriatic arthritis (PsA). These findings, from a nested case-control study, were published in Rheumatology.

This study analyzed data from the nationwide cohort of patients (N=8019) with PsA included in the Danish Database for Biological Therapies in Rheumatology (DANBIO) register collected between 2006 and 2018 in Denmark. Patients who had died during the study period (n=276) were randomly matched with up to 5 living patients (n=1187) with PsA. Patients were assessed for pain, medications, and comorbidities.

Deceased and living patients were aged median 72.2 (interquartile range [IQR], 62.5-80.9) and 70.7 (IQR, 62.2-78.6) years, 55.1% and 53.9% were women, 49.6% and 13.2% were prescribed glucocorticoids during the previous year, 51.8% and 25.3% had cardiovascular disease, 45.7% and 9.9% had cancer, 25.7% and 10.6% had diabetes mellitus, 24.3% and 9.0% had chronic pulmonary disease, and median pain visual analog scale (VAS) was 46 (IQR, 27-60) and 37 (IQR, 22-55), respectively.

Increasing pain VAS scores did not associate with increased mortality (adjusted odds ratio [aOR], 0.99; 95% CI, 0.95-1.04), nor did increasing pain over the previous 5 years (aOR, 0.99, 95% CI, 0.93-1.04).

Increased mortality was associated with cancer (OR, 7.17; 95% CI, 4.70-10.94), glucocorticoid use during the previous year (OR, 5.60; 95% CI, 3.71-8.45), cardiovascular disease (OR, 3.04; 95% CI, 2.06-4.49), lowest (OR, 2.90; 95% CI, 1.61-5.22), lower (OR, 2.90; 95% CI, 1.62-5.19), and median (OR, 2.73; 95% CI, 1.51-4.93) age-adjusted income quantiles, diabetes mellitus (OR, 1.86; 95% CI, 1.19-2.90), and chronic obstructive pulmonary disease (OR, 1.72; 95% CI, 1.06-2.80).

These findings were potentially limited by the amount of missing data, such as smoking status, BMI, or diagnoses of fibromyalgia.

The study authors concluded pain intensity among patients with PsA did not increase risk for excess mortality. Coexisting conditions, glucocorticoid use, and socioeconomic status were significant predictors for mortality.


Vela J, Cordtz R L, Kristensen S, et al. Is pain associated with premature mortality in patients with psoriatic arthritis? A nested case-control study using the DANBIO Register. Rheumatology. 2021;keab192. doi:10.1093/rheumatology/keab192.