394 Differential associations of psoriasis subtypes with autoimmune disorders in United States children and adults: A cross-sectional study

Psoriasis is a chronic, heterogeneous, inflammatory skin disease and there are multiple subtypes of psoriasis, including psoriasis vulgaris (PV), guttate psoriasis (GP), generalized pustular psoriasis (GPP) and palmoplantar pustular psoriasis (PPP); each with different clinical presentations and risk factors. Yet little is known about the association of different psoriasis subtypes with autoimmune disease.We analyzed data from NEDS 2015-2019, including a 20% cross-sectional sample of US emergency department visits (N=142,715,425). ICD-10 codes were used to identify four subtypes of psoriasis and nine autoimmune diseases.The prevalence (95% CI) of at least one autoimmune disease was significantly higher in patients with all psoriasis subtypes – GPP (7.5% [5.0%-9.9%]), PV (3.6% [2.5%-4.6%]), GP (1.4% [0.4%-2.3%]) and PPP (9.6% [0.0-22.4%]) vs. without psoriasis (0.98% [0.97%-0.98%]). In multivariable logistic regression model adjusted for age, sex and insurance status, GP was associated with ≥1 autoimmune disorder (adj. OR [95% CI]: 7.10 [4.93-10.23]), and particularly 8 of 9 autoimmune disorders examined including Crohn’s disease, vasculitis, and Sjogren's syndrome. GPP was associated with ≥1 autoimmune disorder (12.31 [9.71-15.61]) and 8 out of 9 autoimmune disorders examined including Crohn’s diseases, Sjogren's syndrome, and systemic lupus erythematosus. PV was associated with ≥1 autoimmune disorder (9.42 [8.15-10.89]) and 8 of 9 autoimmune disorders examined including Crohn’s diseases, Sjogren's syndrome, and ulcerative colitis. Among ED patients with psoriasis, those with at least one vs. no autoimmune disorder were more likely to be female (P<0.0001) and age 40-59 years (P=0.0035) and have encounters in Spring (P=0.0096). GPP, PV, GP and PPP were all associated with higher odds of multiple autoimmune diseases, though the profile of autoimmune disorders differed across psoriasis subtypes.