Incidence and prevalence of hidradenitis suppurativa across spondyloarthritis-related diseases
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Importance
Hidradenitis suppurativa (HS) has been associated with spondyloarthritis (SpA) and inflammatory bowel disease (IBD) and proposed as a potential manifestation of these conditions. However, the relative rarity of HS, combined with the diverse methodologies used in previous studies, leaves several uncertainties surrounding its epidemiology within this disease spectrum.
Objective
To describe the prevalence and incidence of HS across pathologically related diseases within the spondyloarthritis (SpA) family, namely psoriasis, psoriatic arthritis (PsA), axial spondyloarthritis (axSpA), uveitis, Crohn’s disease, and ulcerative colitis.
Design
Cohort study conducted using data between January 2005 and January 2025.
Setting
The study used data from electronic health records of over 135 million individuals across more than 100 healthcare organizations in North America.
Participants
Six disease populations ranging from 46,928 to 191,605 individuals.
Exposures
Populations of psoriasis, PsA, axial spondyloarthritis, uveitis, Crohn’s disease, and ulcerative colitis.
Main outcomes and measures
Prevalence and incidence per 100,000 patient-years of HS.
Results
The prevalence of HS was 0.4% in psoriasis and PsA, higher than axSpA (0.2%), Crohn’s disease (0.3%) or ulcerative colitis (0.2%). HS incidence was higher in psoriasis (124/100,000 patient-years) and PsA (119/100,000 patient-years) than other SpA-related disease (range 69 to 88/100,000 patient-years), with the exception of Crohn’s disease (177//100,000 patient-years).
Conclusions and Relevance
This study highlights a significant epidemiological association between HS and SpA-related diseases, particularly psoriatic disease and Crohn’s disease. Clinicians providing care to these patient groups should consider enquiring about HS symptoms, although overall incidence rates are low. Further research is needed into the shared pathophysiology of HS and psoriatic disease.
Key points
Question
What is the prevalence and incidence of hidradenitis suppurativa (HS) in conditions with shared immunopathology such as psoriatic disease, axial spondyloarthritis, uveitis, and inflammatory bowel disease?
Findings
This cohort study found high prevalence and incidence of HS among individuals with psoriatic disease and confirmed previously reported high incidence in Crohn’s disease. Incidence rates of HS in other diseases of the spondyloarthritis family, such as axial spondyloarthritis, were lower.
Meaning
Clinicians providing care for people with psoriatic disease should consider enquiring about HS symptoms, although overall incidence rates are low.
