People with the common skin condition psoriasis more commonly have tendon problems and up to a third will develop psoriatic arthritis (PsA), which is characterised by inflammation of tendons and joints. While there has been progress in understanding the underlying immune mechanisms in psoriasis and PsA, it remains unclear why some people with psoriasis develop tendon problems and PsA while others do not.
Fluoroquinolones are a group of antibiotics commonly used to treat a number of infections. There is now compelling evidence that these antibiotics can be associated with an increased risk of future tendon injuries and rupture, resulting in the major drug regulators releasing a specific warning about this. These antibiotics have been shown lead to changes and stress responses in tendons.
We propose that fluoroquinolone antibiotics may be an unidentified trigger for the development of tendon problems and PsA in people with psoriasis, who are at increased risk due to their underlying inflammatory skin condition. We will use CPRD prescription and GP data to identify if people with psoriasis who have been prescribed fluoroquinolone antibiotics are more likely to develop tendon problems or PsA than those who have not been prescribed these antibiotics.
If confirmed, this would mean that fluoroquinolones should be avoided in people with psoriasis to help prevent these problems.
People with psoriasis have an increased risk of tendon problems and up to a third will develop psoriatic arthritis (PsA) which is characterised by inflammation of tendons and joints. There have been advances in understanding the underlying immunology of these conditions which has led to effective treatments. However, many patients do not respond to these therapies and it remains unclear why some people with psoriasis develop these tendon problems and PsA while many others do not. It is likely that factors other than immune dysfunction may also play an important role in precipitating these musculoskeletal issues in people with psoriasis. Fluoroquinolone antibiotics have been shown to have a direct effect on tendons and are associated with an increased risk of tendon injury and rupture in the general population but again it is not known why this only affects some people.
We hypothesis that fluoroquinolone antibiotics may be a trigger for tendinopathy and also PsA in people with psoriasis, who are already at increased risk of these as a result of their inflammatory skin condition.
Using the linked longitudinal prescription and GP data, we will use logistic regression models to evaluate whether people with an existing diagnosis of psoriasis (without PsA) who have received fluoroquinolones are at increased risk of subsequently developing tendon problems in general and PsA in particular compared to people with psoriasis (without PsA) who have never received these antibiotics. We will also adjust for potential covariates and confounders.
If this association is confirmed, this would have important policy implications as fluoroquinolones should then be avoided in people with psoriasis, while a history of previous fluoroquinolone exposure may also help identify those at increased risk of PsA, prompting earlier referral to specialist services and treatment, leading to improved outcomes for patients.
1. Tendinopathy or any tendon related disorder;
2. Psoriatic arthritis (PsA)
Bhautesh Jani - Chief Investigator - University of Glasgow
Bhautesh Jani - Corresponding Applicant - University of Glasgow
Barbara Nicholl - Collaborator - University of Glasgow
Frances Mair - Collaborator - University of Glasgow
Fraser Morton - Collaborator - University of Glasgow
Jill Pell - Collaborator - University of Glasgow
Mohammad H Derakhshan - Collaborator - University of Glasgow
Philip McLoone - Collaborator - University of Glasgow
Srinivasa Vittal Katikireddi - Collaborator - University of Glasgow
Stefan Siebert - Collaborator - University of Glasgow
Robert Pearsall - Collaborator - LANARKSHIRE
HES Admitted Patient Care;ONS Death Registration Data;Patient Level Index of Multiple Deprivation