Early methotrexate treatment for psoriatic arthritis prevention in psoriasis patients - A retrospective cohort study

Objectives: Early initiation of biologic therapies for psoriasis has been explored to prevent or delay the onset of psoriatic arthritis (PsA). This has renewed interest in the potential role of methotrexate (MTX) in mitigating PsA risk in newly diagnosed psoriasis patients. The aim of this study was to evaluate the impact of early MTX initiation on PsA incidence in individuals with psoriasis.

Methods: A retrospective, longitudinal cohort study of psoriasis patients treated at a tertiary center from 2014 to 2024 was conducted. Patients were categorized into early MTX (MTX initiation within 2 years of psoriasis onset), late MTX (> 2 years after onset), and a control group (non-DMARD treatment). PsA incidence was calculated as events per 100 patient years, and a time-dependent Cox proportional hazard model was used to compare PsA risk across groups. Sensitivity analyses were performed to validate results.

Results: A total of 629 patients were followed for a mean of 13.03 years, accumulating 8498.5 person-years. The overall PsA risk was 3.51 events per 100 patient years. The early MTX group had a significantly lower PsA incidence (1.07 events/100 patient years) compared to both the control (4.45 events/100 patient years, adjusted HR: 0.24, P<0.001) and late MTX groups (2.66 events/100 patient years, adjusted HR: 0.36, P<0.01). This effect persisted in patients naïve to biologics and with a minimum follow-up of 10 years.

Conclusions: Early initiation of methotrexate in patients with moderate to severe psoriasis may reduce the risk of developing PsA.