{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,22]],"date-time":"2026-09-22T16:36:49Z","timestamp":1790095009560,"version":"4.0.1"},"reference-count":19,"publisher":"BMJ","issue":"2","license":[{"start":{"date-parts":[[2026,5,7]],"date-time":"2026-05-07T00:00:00Z","timestamp":1778112000000},"content-version":"unspecified","delay-in-days":36,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"funder":[{"name":"Eli Lilly"}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["RMD Open"],"accepted":{"date-parts":[[2026,4,17]]},"published-print":{"date-parts":[[2026,4]]},"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Patients with psoriasis (PsO) are at increased risk of developing psoriatic arthritis (PsA). Emerging evidence suggests that biologic therapies may differentially influence the development of PsA; however, there are no data on the relative ability of second-line biological therapy to prevent PsA.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Aim<\/jats:title>\n                    <jats:p>To evaluate the impact of biologic therapy on the risk of incident PsA in patients with PsO with a focus on second-line biologic therapy.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We identified 2819 patients who initiated biologic therapy for PsO between 2002 and 2022, including Tumor Necrosis Factor (TNF) inhibitors, interleukin (IL)-17 inhibitors, IL-23p19 inhibitors and IL-12\/23 inhibitors. The primary outcome was incident PsA. Kaplan-Meier survival analysis and Cox proportional hazards models were used to evaluate arthritis-free survival and HRs for the development of PsA. Risk was assessed separately for first-line and second-line biologic therapy.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Among 2819 patients with PsO initiating first-line biologic therapy, 400 (14.2%) developed PsA. In multivariable Cox regression, first-line anti-IL-23p19 agents were significantly associated with a lower risk of developing PsA compared with TNF inhibitors (HR 0.13; 95%\u2009CI 0.02 to 0.96; p=0.045). Among 1246 patients receiving second-line biologics, 125 (10.0%) developed PsA. Notably, in second-line therapy, only IL-17 inhibitors were independently associated with a statistically significant reduction in PsA risk versus TNF inhibitors (HR 0.37; 95%\u2009CI 0.16 to 0.85; p=0.019), with trends observed for anti-IL-12\/23 (HR 0.14; 95%\u2009CI 0.02 to 1.05; p=0.056) and anti-IL-23p19 (HR 0.46; 95%\u2009CI 0.20 to 1.07; p=0.070).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>This is the first study to evaluate second-line biological therapy in relation to PsA risk. IL-17 inhibitor therapy was significantly associated with a reduced risk of incident PsA compared with TNF inhibitors.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/rmdopen-2025-006687","type":"journal-article","created":{"date-parts":[[2026,5,7]],"date-time":"2026-05-07T15:15:29Z","timestamp":1778166929000},"page":"e006687","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":1,"title":["Impact of biologic class and treatment line on psoriatic arthritis risk in psoriasis: a population-based cohort study"],"prefix":"10.1136","volume":"12","author":[{"given":"Abdulla","family":"Watad","sequence":"first","affiliation":[{"name":"Department of Internal Medicine B & Zabludowicz Center for Autoimmune Diseases, Sheba Medical Center, Tel Hashomer, Israel"},{"name":"Gray Faculty of Medical and Health Sciences, Tel Aviv University, Tel-Aviv, Israel"},{"name":"Section of Musculoskeletal Disease, NIHR Leeds Musculoskeletal Biomedical Research Centre, Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Chapel Allerton Hospital, Leeds, UK"},{"name":"Rheumatology Unit, Sheba Medical Center, Tel Aviv, Israel"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yoav","family":"Elizur","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine B & Zabludowicz Center for Autoimmune Diseases, Sheba Medical Center, Tel Hashomer, Israel"},{"name":"Gray Faculty of Medical and Health Sciences, Tel Aviv University, Tel-Aviv, Israel"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3806-7529","authenticated-orcid":false,"given":"Or","family":"Hen","sequence":"additional","affiliation":[{"name":"Gray Faculty of Medical and Health Sciences, Tel Aviv University, Tel-Aviv, Israel"},{"name":"Department of Internal Medicine C, Sheba Medical Center, Tel Aviv, Israel"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Paula","family":"David","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine B & Zabludowicz Center for Autoimmune Diseases, Sheba Medical Center, Tel Hashomer, Israel"},{"name":"Gray Faculty of Medical and Health Sciences, Tel Aviv University, Tel-Aviv, Israel"},{"name":"Section of Musculoskeletal Disease, NIHR Leeds Musculoskeletal Biomedical Research Centre, Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Chapel Allerton Hospital, Leeds, UK"},{"name":"Rheumatology Unit, Sheba Medical Center, Tel Aviv, Israel"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0412-1729","authenticated-orcid":false,"given":"Yonatan Shneor","family":"Patt","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine B & Zabludowicz Center for Autoimmune Diseases, Sheba Medical Center, Tel Hashomer, Israel"},{"name":"Gray Faculty of Medical and Health Sciences, Tel Aviv University, Tel-Aviv, Israel"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Omer","family":"Gendelman","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine B & Zabludowicz Center for Autoimmune Diseases, Sheba Medical Center, Tel Hashomer, Israel"},{"name":"Gray Faculty of Medical and Health Sciences, Tel Aviv University, Tel-Aviv, Israel"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Amit","family":"Nachman","sequence":"additional","affiliation":[{"name":"Clalit Health Services, Tel Aviv, Israel"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0573-464X","authenticated-orcid":false,"given":"Alen","family":"Zabotti","sequence":"additional","affiliation":[{"name":"Division of Rheumatology, Azienda Sanitaria Universitaria del Friuli Centrale, Santa Maria della Misericordia Hospital, Udine, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Merav","family":"Lidar","sequence":"additional","affiliation":[{"name":"Gray Faculty of Medical and Health Sciences, Tel Aviv University, Tel-Aviv, Israel"},{"name":"Rheumatology Unit, Sheba Medical Center, Tel Aviv, Israel"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7715-8226","authenticated-orcid":false,"given":"Dennis","family":"McGonagle","sequence":"additional","affiliation":[{"name":"Section of Musculoskeletal Disease, NIHR Leeds Musculoskeletal Biomedical Research Centre, Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Chapel Allerton Hospital, Leeds, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Howard","family":"Amital","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine B & Zabludowicz Center for Autoimmune Diseases, Sheba Medical Center, Tel Hashomer, Israel"},{"name":"Gray 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biological immunotherapy for psoriasis and time to incident inflammatory arthritis: a retrospective cohort study","volume":"5","author":"Singla","year":"2023","journal-title":"The Lancet Rheumatology"},{"key":"2026050708151636000_12.2.e006687.13","doi-asserted-by":"crossref","first-page":"435","DOI":"10.1016\/j.ard.2025.01.006","article-title":"Risk of developing psoriatic arthritis in patients with psoriasis initiating treatment with different classes of biologics","volume":"84","author":"Gisondi","year":"2025","journal-title":"Ann Rheum Dis"},{"key":"2026050708151636000_12.2.e006687.14","doi-asserted-by":"crossref","DOI":"10.1007\/s11926-018-0751-3","article-title":"Enthesitis: Much More Than Focal Insertion Point Inflammation","volume":"20","author":"Watad","year":"2018","journal-title":"Curr Rheumatol Rep"},{"key":"2026050708151636000_12.2.e006687.15","doi-asserted-by":"crossref","DOI":"10.3389\/fimmu.2024.1331217","article-title":"IL-23 past, present, and future: a roadmap to advancing IL-23 science and therapy","volume":"15","author":"Krueger","year":"2024","journal-title":"Front Immunol"},{"key":"2026050708151636000_12.2.e006687.16","first-page":"2958","article-title":"Efficacy and safety of IL-17 inhibitors for patients with psoriatic arthritis: a systematic review and meta-analysis","volume":"25","author":"Gao","year":"2021","journal-title":"Eur Rev Med Pharmacol Sci"},{"key":"2026050708151636000_12.2.e006687.17","doi-asserted-by":"publisher","DOI":"10.1136\/annrheumdis-2019-215356"},{"key":"2026050708151636000_12.2.e006687.18","doi-asserted-by":"crossref","first-page":"53","DOI":"10.1016\/j.jaad.2023.02.059","article-title":"Variables associated with joint involvement and development of a prediction rule for arthritis in patients with psoriasis. 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