Comparative risk of psoriatic arthritis in psoriasis patients on immunomodulators

<b>Background:</b> Psoriatic arthritis (PsA) is a rapidly progressive arthritis that is difficult to prevent and treat. The comparative risk of PsA development in psoriasis patients prescribed PsA-approved immunomodulators is unknown. <b>Methods:</b> We assessed the 3-year risk of PsA in psoriasis patients on immunomodulators of IL-12, 17, 23, tumor necrosis factor alpha, JAK1, and JAK3. Using the TriNetX Research Network, we identified patients with psoriasis and the use of an immunomodulatory agent. The immunomodulatory agents assessed included adalimumab, infliximab, ixekizumab, secukinumab, tildrakizumab, certolizumab pegol, risankizumab, etanercept, guselkumab, and ustekinumab. <b>Results:</b> Overall, IL-23 inhibitors risankizumab, guselkumab, and ustekinumab had the greatest decreased risk of PsA. <b>Conclusion:</b> Physicians can consider risankizumab, guselkumab, and ustekinumab as treatment options for psoriasis patients with PsA risk factors to mitigate disease progression and improve patients' quality of life.