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People with psoriatic arthritis (PsA) appear to be at increased risk of endometriosis, whereas those with psoriasis do not appear to face heightened risk.

That's according to a new study in the .

Of 4,112 incident cases of laparoscopically-confirmed endometriosis included in the study, 697 had been diagnosed with psoriasis. Of these, 110 presented with concomitant PsA.

PsA was associated with a 2-fold higher risk of endometriosis (HR 2.01, 95% CI 1.23-3.30). No association emerged between psoriasis and endometriosis risk (HR 0.93, 95% CI 0.68-1.26).

Conversely, endometriosis was not associated with a higher risk of subsequent psoriasis (HR 1.28, 95% CI 0.95-1.72). The risk of PsA was higher but did not reach statistical significance because of the small sample size and broad confidence intervals (HR 1.77, 95% CI 0.89-3.52).

Holly Harris, MPH, ScD, a health researcher and associate professor of epidemiology at Fred Hutchinson Cancer Research Center in Seattle, served as first author on the paper. Here, she discusses study with the Reading Room. The exchange has been edited for length and clarity.

What was the impetus for studying endometriosis in people with psoriasis and concomitant PsA?

Harris: There really has been very little research published looking at endometriosis, psoriasis, and PsA.

We were able to look at this among people with psoriasis and PsA. Over time, are they more likely to be diagnosed with endometriosis? That was our primary aim.

We also looked for the opposite association among people who had been diagnosed with endometriosis. Are they more likely to be diagnosed with psoriasis or PsA over time?

How would you summarize your findings?

Harris: I think we had some really insightful results. We found that if you had a history of psoriasis, you are not more likely to be diagnosed with endometriosis. And the same held true in reverse: if you had endometriosis, you are not more likely to be diagnosed with psoriasis.

However, if you have PsA, you are more likely to be diagnosed with endometriosis in the future. There also was the suggestion that among people with endometriosis, a PsA diagnosis was more likely. But that latter finding did not meet our statistical significance criteria.

Did anything surprise you about the findings?

Harris: It was interesting to see a different result for psoriasis versus PsA. This suggests there might be some kind of pain pathway involved, and it gives us an area to potentially look at in the future.

What might you suggest for dermatologists in regard to this topic?

Harris: I think the message is to take women's reports of pain seriously.

If you have a patient who already has the condition and is having pain, it doesn't necessarily mean you shouldn't look for other conditions.

For many people with endometriosis, there's a delay of about 7 years between symptom onset and diagnosis. So there's a substantial period when they aren't receiving the appropriate diagnostics. I think there's an opportunity for dermatologists to tell their patients with PSA, 'you're having this other type of pain, maybe you should look into this.' Then, if need be, they could help them find a specialist in another area.

Implications for practice

• People with PsA appear to face an increased risk of endometriosis.
• People with psoriasis do not appear to face the same heightened risk.