Abstract
OBJECTIVE: The debate persists regarding whether patients with psoriatic arthritis (PsA) face an increased risk of mortality. We aimed to ascertain the magnitude of all-cause mortality risk in patients with PsA compared to the general population through a systematic review and meta-analysis. METHODS: We conducted a comprehensive search of PubMed, EMBASE, and the Cochrane Library for studies published from inception to June 2025. STATA meta-analysis software was used to calculate the pooled risk estimates for mortality, represented as the standardized mortality ratio (SMR). RESULTS: Among the 4,502 articles identified in our research, 20 studies were included in the analysis. Overall, our findings revealed a 1.12-fold increased risk of death among patients with PsA compared to the general population (meta-SMR: 1.12, 95% CI 1.09-1.15). Subgroup analyses showed that mortality risks were elevated in Asian countries (meta-SMR: 1.28, 95% CI 1.04-1.57), in population-based studies (meta-SMR: 1.13, 95% CI 1.02-1.25), and among studies including over 1,000 patients (meta-SMR: 1.12, 95% CI 1.01-1.25). Malignancy, cardiovascular and cerebrovascular diseases, and infection/respiratory diseases emerged as the most frequent causes of mortality. CONCLUSION: Our analysis suggested modestly elevated mortality in patients with PsA compared to the general population, though heterogeneity warrants cautious interpretation. Malignancy, cardiovascular and cerebrovascular diseases, and infection/respiratory disease were frequent causes of mortality and warrant further investigation. SYSTEMATIC REVIEW REGISTRATION: https://www.crd.york.ac.uk/prospero/, identifier CRD42021275209.