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Toussirot E, Winzenrieth R, Aubin F, Wendling D, Vauchy C, Desmarets M. Areal bone mineral density, trabecular bone score and 3D-DXA analysis of proximal femur in psoriatic disease. Front Med (Lausanne) 2024; 11:1341077. [PMID: 38352141 PMCID: PMC10861729 DOI: 10.3389/fmed.2024.1341077] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2023] [Accepted: 01/16/2024] [Indexed: 02/16/2024] Open
Abstract
Objectives To evaluate bone mineral density (BMD) and bone quality, with assessment of the cortical and trabecular compartments, in patients with psoriasis (PsO) alone or with psoriatic arthritis (PsA). Methods Patients with PsA and patients with PsO alone were evaluated and compared to control subjects matched for age, sex and body mass index category. Areal BMD (aBMD) was determined for the lumbar spine, femoral neck, total hip and total body using dual-energy X-ray absorptiometry (DXA). Bone quality was evaluated by using trabecular bone score (TBS) at the lumbar spine, and by 3D DXA-based analysis (3D Shaper) for the proximal femur. Results One hundred ninety-six subjects including 52 patients with PsA and 52 patients with PsO and their respective paired controls were analyzed. Patients with PsA had comparable aBMD, TBS and 3D DXA analysis parameters compared to their paired controls. After adjustment for confounders, patients with PsO alone were characterized by a higher aBMD at the left femur and higher cortical 3D DXA derived parameters (total hip cortical surface BMD and total hip cortical thickness) than their paired controls. TBS was decreased in PsO compared to their controls. Conclusion Patients with PsA had normal bone mass and bone quality parameters. Patients with PsO were characterized by higher femoral neck bone density by DXA and cortical parameters by 3D DXA-based analysis, supporting no increased risk for hip fracture. Conversely, bone texture by TBS assessment was decreased in patients with PsO, which may be associated with impaired vertebral bone resistance.
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Affiliation(s)
- Eric Toussirot
- INSERM CIC-1431, Centre d’Investigation Clinique, Pôle Recherche, CHU de Besançon, Besançon, France
- Rhumatologie, Pôle PACTE (Pathologies Aiguës Chroniques Transplantation Éducation), CHU de Besançon, Besançon, France
- Département Universitaire de Thérapeutique, Université de Franche-Comté, Besançon, France
- UMR 1098 RIGHT, INSERM, Établissement Français du Sang, Université de Franche-Comté, Besançon, France
| | | | - François Aubin
- UMR 1098 RIGHT, INSERM, Établissement Français du Sang, Université de Franche-Comté, Besançon, France
- Dermatologie, Pôle PACTE (Pathologies Aiguës Chroniques Transplantation Éducation), CHU de Besançon, Besançon, France
| | - Daniel Wendling
- Rhumatologie, Pôle PACTE (Pathologies Aiguës Chroniques Transplantation Éducation), CHU de Besançon, Besançon, France
- EA 4266 EPILAB, Université de Franche-Comté, Besançon, France
| | - Charline Vauchy
- INSERM CIC-1431, Centre d’Investigation Clinique, Pôle Recherche, CHU de Besançon, Besançon, France
- UMR 1098 RIGHT, INSERM, Établissement Français du Sang, Université de Franche-Comté, Besançon, France
| | - Maxime Desmarets
- INSERM CIC-1431, Centre d’Investigation Clinique, Pôle Recherche, CHU de Besançon, Besançon, France
- UMR 1098 RIGHT, INSERM, Établissement Français du Sang, Université de Franche-Comté, Besançon, France
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Saalbach A, Kunz M. Impact of Chronic Inflammation in Psoriasis on Bone Metabolism. Front Immunol 2022; 13:925503. [PMID: 35812457 PMCID: PMC9259794 DOI: 10.3389/fimmu.2022.925503] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2022] [Accepted: 05/25/2022] [Indexed: 11/30/2022] Open
Abstract
Psoriasis is a chronic inflammatory disease of the skin and joints associated with several comorbidities such as arthritis, diabetes mellitus and metabolic syndrome, including obesity, hypertension and dyslipidaemia, Crohn's disease, uveitis and psychiatric and psychological diseases. Psoriasis has been described as an independent risk factor for cardiovascular diseases and thus patients with psoriasis should be monitored for the development of cardiovascular disease or metabolic syndrome. However, there is mounting evidence that psoriasis also affects the development of osteoporosis, an important metabolic disease with enormous clinical and socioeconomic impact. At present, there are still controversial opinions about the role of psoriasis in osteoporosis. A more in depth analysis of this phenomenon is of great importance for affected patients since, until now, bone metabolism is not routinely examined in psoriatic patients, which might have important long-term consequences for patients and the health system. In the present review, we summarize current knowledge on the impact of psoriatic inflammation on bone metabolism and osteoporosis.
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Affiliation(s)
- Anja Saalbach
- Department of Dermatology, Venereology and Allergology, University of Leipzig Medical Center, Leipzig, Germany
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Gunacar DN, Goller Bulut D, Ustaoglu G, Yildirim EA. In vivo evaluation of mandibular trabecular and cortical bone quality in psoriasis vulgaris. Oral Surg Oral Med Oral Pathol Oral Radiol 2022; 133:604-611. [PMID: 35248512 DOI: 10.1016/j.oooo.2021.12.132] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2021] [Revised: 12/02/2021] [Accepted: 12/22/2021] [Indexed: 11/19/2022]
Abstract
OBJECTIVE The aim of this study was to evaluate the effects of psoriasis vulgaris on mandibular structure by calculating fractal dimension (FD) and radiomorphometric indices. STUDY DESIGN Panoramic radiographs of 58 patients with psoriasis and 58 healthy participants were assessed. FD was used to analyze trabecular bone architecture in the condyle, angle, and 2 sites in the alveolar bone. Five radiomorphometric indices based on cortical thickness and the mandibular cortical index (MCI) for structure were used to assess cortical bone porosity. Comparisons were made between sites in trabecular and cortical bone. Quantitative and categorical data were statistically analyzed with the significance level at P < .05. RESULTS FD was significantly lower in the patients with psoriasis than in the controls in the alveolar bone sites (P ≤ .035). Differences between measurement sites were insignificant in psoriasis (P ≥ .617), but the FD values of some measurement sides in the control group differed significantly (P ≤ .004). All quantitative radiomorphometric indices were significantly lower in patients with psoriasis (P ≤ .034) with significant differences between some sites in both groups. No significant difference was found in MCI frequency distribution between the groups (P = .782). CONCLUSIONS Trabecular architecture and cortical thickness were negatively affected in patients with psoriasis, but no differences in cortical porosity were detected between groups.
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Affiliation(s)
- Dilara Nil Gunacar
- Assistant Professor, Faculty of Dentistry, Department of Dentomaxillofacial Radiology, Recep Tayyip Erdoğan University, Rize, Turkey.
| | - Duygu Goller Bulut
- Associate Professor, Faculty of Dentistry, Department of Dentomaxillofacial Radiology, Bolu Abant Izzet Baysal University, Bolu, Turkey
| | - Gülbahar Ustaoglu
- Associate Professor, Faculty of Dentistry, Department of Periodontology, Bolu Abant Izzet Baysal University, Bolu, Turkey
| | - Esra Ates Yildirim
- Research Assistant, Faculty of Dentistry, Department of Periodontology, Bolu Abant Izzet Baysal University, Bolu, Turkey
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Mentzel J, Kynast T, Kohlmann J, Kirsten H, Blüher M, Simon JC, Kunz M, Saalbach A. Reduced Serum Levels of Bone Formation Marker P1NP in Psoriasis. Front Med (Lausanne) 2021; 8:730164. [PMID: 34660638 PMCID: PMC8517119 DOI: 10.3389/fmed.2021.730164] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2021] [Accepted: 09/03/2021] [Indexed: 11/13/2022] Open
Abstract
Psoriasis is a chronic inflammatory disease of the skin and joints. More recent data emphasize an association with dysregulated glucose and fatty acid metabolism, obesity, elevated blood pressure and cardiac disease, summarized as metabolic syndrome. TNF-α and IL-17, central players in the pathogenesis of psoriasis, are known to impair bone formation. Therefore, the relation between psoriasis and bone metabolism parameters was investigated. Two serum markers of either bone formation-N-terminal propeptide of type I procollagen (P1NP) or bone resorption-C-terminal telopeptide of type I collagen (CTX-I)-were analyzed in a cohort of patients with psoriasis vulgaris. In patients with psoriasis, P1NP serum levels were reduced compared to gender-, age-, and body mass index-matched healthy controls. CTX-I levels were indistinguishable between patients with psoriasis and controls. Consistently, induction of psoriasis-like skin inflammation in mice decreases bone volume and activity of osteoblasts. Moreover, efficient anti-psoriatic treatment improved psoriasis severity, but did not reverse decreased P1NP level suggesting that independent of efficient skin treatment psoriasis did affect bone metabolism and might favor the development of osteoporosis. Taken together, evidence is provided that bone metabolism might be affected by psoriatic inflammation, which may have consequences for future patient counseling and disease monitoring.
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Affiliation(s)
- Julia Mentzel
- Department of Dermatology, Venereology and Allergology, University Medical Center Leipzig, Leipzig, Germany
| | - Tabea Kynast
- Department of Dermatology, Venereology and Allergology, University Medical Center Leipzig, Leipzig, Germany
| | - Johannes Kohlmann
- Department of Dermatology, Venereology and Allergology, University Medical Center Leipzig, Leipzig, Germany
| | - Holger Kirsten
- Institute for Medical Informatics, Statistics, Epidemiology, Medical Faculty of Leipzig University, Leipzig, Germany
| | - Matthias Blüher
- Medical Department III, Endocrinology, Nephrology, Rheumatology, University Medical Center Leipzig, Leipzig, Germany
| | - Jan C Simon
- Department of Dermatology, Venereology and Allergology, University Medical Center Leipzig, Leipzig, Germany
| | - Manfred Kunz
- Department of Dermatology, Venereology and Allergology, University Medical Center Leipzig, Leipzig, Germany
| | - Anja Saalbach
- Department of Dermatology, Venereology and Allergology, University Medical Center Leipzig, Leipzig, Germany
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Puche-Larrubia MÁ, Ladehesa-Pineda L, Font-Ugalde P, Escudero-Contreras A, Moltó A, López-Medina C, Collantes-Estévez E. Distribution of comorbidities in spondyloarthritis with regard to the phenotype and psoriasis: data from the ASAS-COMOSPA study. Ther Adv Musculoskelet Dis 2021; 13:1759720X211045263. [PMID: 34567275 PMCID: PMC8458671 DOI: 10.1177/1759720x211045263] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2021] [Accepted: 08/23/2021] [Indexed: 01/09/2023] Open
Abstract
INTRODUCTION The aim of the study was to compare the prevalence of comorbidities between patients with axial and peripheral phenotypes and to evaluate the role of psoriasis in such comorbidities. METHODS Patients from the cross-sectional Assessment in SpondyloArthritis Inter-national Society (ASAS)-COMOSPA study were classified as having either the axial (presence of sacroiliitis on X-ray or MRI) or peripheral phenotype (absence of sacroiliitis AND presence of peripheral involvement). Patients with each phenotype were divided into two groups depending on the presence or history of psoriasis. Pair-wise comparisons among the four groups (axial/peripheral phenotype with/without psoriasis) were conducted through univariate logistic regressions and generalized linear mixed models using disease duration and sex as fixed effects and country as random effect. RESULTS A total of 3291 patients were included in this analysis. The peripheral involvement with psoriasis phenotype showed the highest prevalence of hypertension (44.9%), dyslipidaemia (34%) and diabetes (8.8%), while the axial involvement without psoriasis phenotype exhibited the lowest prevalence of dyslipidaemia (14.2%), diabetes (4.1%) and stroke (0.9%). Among patients with psoriasis, the axial phenotype showed a significantly lower prevalence of hypertension (OR: 0.51, 95% CI: 0.35-0.75) and lower prevalence of Framingham score ⩾15 (OR: 0.57, 95% CI: 0.38-0.85) than patients with peripheral involvement after adjusting for disease duration, sex and country. Among patients with the axial phenotype, patients with psoriasis showed a higher prevalence of hypertension (OR 1.76, 1.40-2.20), dyslipidaemia (OR: 1.99, 95% CI: 1.56-2.53), diabetes (OR: 2.05, 95% CI: 1.39-3.02) and Framingham score ⩾15 (OR: 2.00, 95% CI: 1.57-2.55) than non-psoriatic patients. No differences were found across groups concerning bone metabolism disorders. CONCLUSION Both the peripheral phenotype and psoriasis are independently associated with an increased prevalence of cardiovascular risk factors. No differences were found for bone metabolism disorders.
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Affiliation(s)
- M. Ángeles Puche-Larrubia
- Department of Rheumatology Reina Sofia University Hospital, Maimonides Biomedical Research Institute of Cordoba (IMIBIC), Cordoba, Spain
| | - Lourdes Ladehesa-Pineda
- Department of Rheumatology Reina Sofia University Hospital, Maimonides Biomedical Research Institute of Cordoba (IMIBIC), Cordoba, Spain
| | - Pilar Font-Ugalde
- Department of Rheumatology Reina Sofia University Hospital, Maimonides Biomedical Research Institute of Cordoba (IMIBIC), Cordoba, Spain
- University of Cordoba, Cordoba, Spain
| | - Alejandro Escudero-Contreras
- Department of Rheumatology Reina Sofia University Hospital, Maimonides Biomedical Research Institute of Cordoba (IMIBIC), Cordoba, Spain
- University of Cordoba, Cordoba, Spain
| | - Anna Moltó
- Rheumatology Department, Cochin Hospital, Paris, France; Clinical Epidemiology and Biostatistics, INSERM U 1153, Paris, France
| | - Clementina López-Medina
- Department of Rheumatology, Reina Sofia University Hospital, Maimonides Biomedical Research Institute of Cordoba (IMIBIC), Avda. Menendez Pidal, s/n, 14004 Córdoba, Spain
- University of Cordoba, Cordoba, Spain
- Rheumatology Department, Cochin Hospital, Paris, France; Clinical Epidemiology and Biostatistics, INSERM U 1153, Paris, France
| | - Eduardo Collantes-Estévez
- Department of Rheumatology Reina Sofia University Hospital, Maimonides Biomedical Research Institute of Cordoba (IMIBIC), Cordoba, Spain
- University of Cordoba, Cordoba, Spain
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Lee JW, Min C, Bang CH, Kwon BC, Choi HG. Psoriasis is associated with an increased risk of osteoporosis: follow-up and nested case-control studies using a national sample cohort. Osteoporos Int 2021; 32:529-538. [PMID: 33151377 DOI: 10.1007/s00198-020-05724-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2020] [Accepted: 10/29/2020] [Indexed: 10/23/2022]
Abstract
UNLABELLED A total of 25,306 psoriasis participants were matched to 101,224 controls, and the occurrence of osteoporosis was analyzed. Additionally, 79,212 osteoporosis patients were matched to 79,212 controls and a previous history of psoriasis was analyzed. Psoriasis increased the risk of osteoporosis among participants aged ≥ 40 years. INTRODUCTION The aim of the present study was to evaluate the association between psoriasis and osteoporosis using two different studies. METHODS Data from the Korean National Health Insurance Service-Health Screening Cohort of participants aged ≥ 40 years were collected from 2002 to 2013. Psoriasis and osteoporosis were included using International Classification of Diseases (ICD)-10 codes. In study I (a follow-up study), a total of 25,306 psoriasis participants were matched to 101,224 controls with respect to age, sex, income, and region of residence, and the occurrence of osteoporosis was analyzed. Crude (simple) and adjusted hazard ratios (HRs) were analyzed using a stratified Cox proportional hazard model. In study II (a nested case-control study), a total of 79,212 osteoporosis patients were matched to 79,212 controls and a previous history of psoriasis was analyzed. Crude and adjusted odds ratios (ORs) were analyzed using a conditional logistic regression analysis. Subgroup analyses were conducted according to age group and sex. RESULTS The adjusted HR of osteoporosis was 1.09 (95% confidence interval [CI] = 1.05-1.13, P < 0.001) in study I. In the subgroup analysis according to age and sex, the results were consistent except for ≥ 60-year-old women. The adjusted OR of psoriasis was 1.21 (95% CI = 1.16-1.27, P < 0.001) in study II. All subgroups demonstrated high adjusted ORs of osteoporosis for psoriasis. CONCLUSIONS Psoriasis increased the risk of osteoporosis among participants aged ≥ 40 years in Korea.
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Affiliation(s)
- J W Lee
- Department of Orthopaedic Surgery, Yonsei University Wonju College of Medicine, Wonju, Korea
| | - C Min
- Hallym Data Science Laboratory, Hallym University College of Medicine, Anyang, Korea
- Graduate School of Public Health, Seoul National University, Seoul, Korea
| | - C H Bang
- Department of Dermatology, Seoul St Mary's Hospital, The Catholic University of Korea College of Medicine, Seoul, South Korea
| | - B C Kwon
- Department of Orthopedic Surgery, Hallym University College of Medicine, Anyang, Korea
| | - H G Choi
- Hallym Data Science Laboratory, Hallym University College of Medicine, Anyang, Korea.
- Department of Otorhinolaryngology-Head & Neck Surgery, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, 22, Gwanpyeong-ro 170beon-gil, Dongan-gu, Anyang-si, Gyeonggi-do, 14068, Republic of Korea.
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Simon D, Haschka J, Muschitz C, Kocijan A, Baierl A, Kleyer A, Schett G, Kapiotis S, Resch H, Sticherling M, Rech J, Kocijan R. Bone microstructure and volumetric bone mineral density in patients with hyperuricemia with and without psoriasis. Osteoporos Int 2020; 31:931-939. [PMID: 31925472 DOI: 10.1007/s00198-019-05160-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2018] [Accepted: 09/09/2019] [Indexed: 12/15/2022]
Abstract
UNLABELLED We analyzed volumetric bone mineral density (vBMD) and bone microstructure using HR-pQCT in subjects with normouricemia (NU) and subjects with hyperuricemia (HU) with and without psoriasis (PSO). HU was associated with higher cortical vBMD and thickness. Differences in average and trabecular vBMD were found between patients with PSO + HU and NU. INTRODUCTION Hyperuricemia (HU) and gout are co-conditions of psoriasis and psoriatic arthritis. Current data suggest a positive association between HU and areal bone mineral density (BMD) and a negative influence of psoriasis on local bone, even in the absence of arthritis. However, the influence of the combination of HU and psoriasis on bone is still unclear. The aim of this study was to assess the impact of HU with and without psoriasis on bone microstructure and volumetric BMD (vBMD). METHODS Healthy individuals with uric acid levels within the normal range (NU), with hyperuricemia (HU), patients with hyperuricemia and psoriasis (PSO + HU), and patients with uric acid within the normal range and psoriasis (PSO + NU) were included in our study. Psoriasis patients had no current or past symptoms of arthritis. Average, trabecular, and cortical vBMD (mgHA/cm3); trabecular number (Tb.N, 1/mm) and thickness (Tb.Th, mm); inhomogeneity of the network (1/N.SD, mm); and cortical thickness (Ct.Th., mm) were carried out at the ultradistal radius using high-resolution peripheral quantitative computed tomography. In addition, bone turnover markers such as DKK-1, sclerostin, and P1NP were analyzed. RESULTS In total, 130 individuals were included (44 NU participants (34% female), 50 HU (24%), 16 PSO + HU (6%), 20 PSO + NU (60%)). Subjects were aged: NU 54.5 (42.8, 62.1), HU 57.5 (18.6, 65.1), PSO + HU 52.0 (42.3, 57.8), and PSO + NU 42.5 (34.8, 56.8), respectively. After adjusting for age, sex, BMI, and diabetes, patients in the HU group revealed significantly higher values of cortical vBMD (p < 0.001) as well as cortical thickness (p = 0.04) compared to the NU group. PSO + NU showed no differences to NU, but PSO + HU demonstrated both lower average (p = 0.03) and trabecular vBMD (p = 0.02). P1NP was associated with average, cortical, and trabecular vBMD as well as cortical thickness while sclerostin levels were related to trabecular vBMD. CONCLUSION Hyperuricemia in otherwise healthy subjects was associated with a better cortical vBMD and higher cortical thickness. However, patients with both psoriasis and hyperuricemia revealed a lower vBMD.
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Affiliation(s)
- D Simon
- Department of Internal Medicine 3 - Rheumatology and Immunology, Friedrich-Alexander University (FAU) Erlangen-Nürnberg and Universitätsklinikum Erlangen, 91054, Erlangen, Germany
| | - J Haschka
- St. Vincent Hospital Vienna, Medical Department II, Academic Teaching Hospital of the Medical University Vienna, Stumpergasse 13, 1060, Vienna, Austria
- Karl Landsteiner Institute for Rheumatology and Gastroenterology, 1060, Vienna, Austria
| | - C Muschitz
- St. Vincent Hospital Vienna, Medical Department II, Academic Teaching Hospital of the Medical University Vienna, Stumpergasse 13, 1060, Vienna, Austria
| | | | - A Baierl
- Department of Statistics and Operations Research, University of Vienna, Oskar Morgenstern-Platz 1, 1090, Vienna, Austria
| | - A Kleyer
- Department of Internal Medicine 3 - Rheumatology and Immunology, Friedrich-Alexander University (FAU) Erlangen-Nürnberg and Universitätsklinikum Erlangen, 91054, Erlangen, Germany
| | - G Schett
- Department of Internal Medicine 3 - Rheumatology and Immunology, Friedrich-Alexander University (FAU) Erlangen-Nürnberg and Universitätsklinikum Erlangen, 91054, Erlangen, Germany
| | - S Kapiotis
- Central Laboratory, St. Vincent Group, 1060, Vienna, Austria
| | - H Resch
- St. Vincent Hospital Vienna, Medical Department II, Academic Teaching Hospital of the Medical University Vienna, Stumpergasse 13, 1060, Vienna, Austria
- Karl Landsteiner Institute for Rheumatology and Gastroenterology, 1060, Vienna, Austria
- Medical Faculty of Bone Diseases, Sigmund Freud University Vienna, Sigmund Freud Platz 1, Vienna, Austria
| | - M Sticherling
- Department of Dermatology, Friedrich-Alexander University (FAU) Erlangen-Nürnberg and Universitätsklinikum Erlangen, 91054, Erlangen, Germany
| | - J Rech
- Department of Internal Medicine 3 - Rheumatology and Immunology, Friedrich-Alexander University (FAU) Erlangen-Nürnberg and Universitätsklinikum Erlangen, 91054, Erlangen, Germany
| | - R Kocijan
- St. Vincent Hospital Vienna, Medical Department II, Academic Teaching Hospital of the Medical University Vienna, Stumpergasse 13, 1060, Vienna, Austria.
- Karl Landsteiner Institute for Rheumatology and Gastroenterology, 1060, Vienna, Austria.
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Lajevardi V, Abedini R, Moghaddasi M, Nassiri SF, Goodarzi A. Bone mineral density is lower in male than female patients with plaque-type psoriasis in Iran. Int J Womens Dermatol 2017; 3:201-205. [PMID: 29234714 PMCID: PMC5715221 DOI: 10.1016/j.ijwd.2017.07.007] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2015] [Revised: 04/22/2017] [Accepted: 07/30/2017] [Indexed: 02/08/2023] Open
Abstract
Background There are many similarities with regard to contributing cytokines in patients with psoriasis and osteoporosis. A theory of probable relationship between these two entities has been proposed but there is no concordant consensus. The aim of this study was to evaluate bone mineral density (BMD) in patients with psoriasis. Method and materials This cross-sectional study of BMD was conducted with 64 eligible patients with psoriasis who were referred to the dermatology clinic of Razi hospital in Tehran, Iran in between 2011 and 2012. Results The mean T score of femoral neck was –1.17 and –0.49 in men and women, respectively, which was statistically significant (p = .047). The mean T score of the lumbar spine was –0.93 and –0.30 in men and women, respectively, but not statistically significant (p = .058). In total except with the exclusion of the study site (femur or lumbar), men and women did not have a statistically significant difference with regard to osteoporosis or osteopenia in BMD (p = .114). The Pearson correlation coefficient demonstrated a moderate inverse relationship between age and T score of the femoral neck and lumbar spine (r = –0.419 and –.406, respectively), which was statistically significant (p = .001). Although there was no statistically significant relationship between the Psoriasis Area and Severity Index (PASI) and T scores of the femoral neck (p = .596), a positive and weak correlation was observed between the PASI and T scores for the lumbar spine, which was statistically significant (r = 0.269; p = .03). Conclusion Patients with psoriasis had decreased bone density, which was more significant in men. Prevalence of osteoporosis showed no statistically significant difference when compared with the healthy population in Iran.
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Affiliation(s)
- V Lajevardi
- Department of Dermatology, Tehran University of Medical Sciences, Razi Hospital, Tehran, Iran
| | - R Abedini
- Department of Dermatology, Tehran University of Medical Sciences, Razi Hospital, Tehran, Iran
| | - M Moghaddasi
- Department of Rheumatology, Tehran University of Medical Sciences, Sina Hospital, Tehran, Iran
| | - S F Nassiri
- Department of Dermatology, Tehran University of Medical Sciences, Razi Hospital, Tehran, Iran
| | - A Goodarzi
- Department of Dermatology, Iran University of Medical Sciences, Rasool Akram Hospital, Tehran, Iran
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Kathuria P, Gordon KB, Silverberg JI. Association of psoriasis and psoriatic arthritis with osteoporosis and pathological fractures. J Am Acad Dermatol 2017; 76:1045-1053.e3. [DOI: 10.1016/j.jaad.2016.11.046] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2016] [Revised: 11/09/2016] [Accepted: 11/14/2016] [Indexed: 12/21/2022]
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Modalsli EH, Åsvold BO, Romundstad PR, Langhammer A, Hoff M, Forsmo S, Naldi L, Saunes M. Psoriasis, fracture risk and bone mineral density: the HUNT Study, Norway. Br J Dermatol 2017; 176:1162-1169. [PMID: 27718508 DOI: 10.1111/bjd.15123] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/04/2016] [Indexed: 12/25/2022]
Abstract
BACKGROUND An association between psoriasis and osteoporosis has been reported. OBJECTIVES To investigate, in a large prospective population-based Norwegian study, whether psoriasis is associated with increased risk of forearm or hip fracture; to investigate the cross-sectional association between psoriasis and bone mineral density (BMD) T-score in a subpopulation. METHODS Hospital-derived fracture data from Nord-Trøndelag County (1995-2013) were linked to psoriasis information, BMD measurements and lifestyle factors from the third survey of the Nord-Trøndelag Health Study 2006-08 (HUNT3); socioeconomic data from the National Education Database; and use of medication from the Norwegian Prescription Database. RESULTS Among 48 194 participants in HUNT3, we found no increased risk of forearm or hip fracture in 2804 patients with self-reported psoriasis [overall age- and sex-adjusted hazard ratio 1·03, 95% confidence interval (CI) 0·82-1·31]. No clear association was found between psoriasis and mean BMD T-score; overall age- and sex-adjusted differences in total hip, femoral neck and lumbar spine BMD T-scores were 0·02 (95% CI -0·11 to 0·14), 0·05 (95% CI -0·06 to 0·17) and 0·07 (95% CI -0·09 to 0·24), respectively. No clear association was found between psoriasis and prevalent osteoporosis in either total hip, femoral neck or lumbar spine; overall age- and sex-adjusted odds ratio was 0·77 (95% CI 0·54-1·10). Associations did not change substantially after adjustment for education, smoking, systemic steroid use and body mass index. CONCLUSIONS We found no association between psoriasis and risk of fracture. The study did not indicate reduced BMD T-score or higher prevalence of osteoporosis among patients with psoriasis.
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Affiliation(s)
- E H Modalsli
- Department of Public Health and General Practice, Faculty of Medicine, NTNU, Norwegian University of Science and Technology, Trondheim, Norway.,Department of Dermatology, St. Olavs Hospital, Trondheim University Hospital, Norway
| | - B O Åsvold
- Department of Public Health and General Practice, Faculty of Medicine, NTNU, Norwegian University of Science and Technology, Trondheim, Norway.,Department of Endocrinology, St. Olavs Hospital, Trondheim University Hospital, Norway
| | - P R Romundstad
- Department of Public Health and General Practice, Faculty of Medicine, NTNU, Norwegian University of Science and Technology, Trondheim, Norway
| | - A Langhammer
- Department of Public Health and General Practice, Faculty of Medicine, NTNU, Norwegian University of Science and Technology, Trondheim, Norway
| | - M Hoff
- Department of Public Health and General Practice, Faculty of Medicine, NTNU, Norwegian University of Science and Technology, Trondheim, Norway.,Department of Rheumatology, St. Olavs Hospital, Trondheim University Hospital, Norway.,Nord-Trøndelag Hospital Trust, Levanger, Norway
| | - S Forsmo
- Department of Public Health and General Practice, Faculty of Medicine, NTNU, Norwegian University of Science and Technology, Trondheim, Norway
| | - L Naldi
- Centro Studi Gruppo Italiano Studi Epidemiologici in Dermatologia (GISED), Bergamo, Italy.,Azienda Ospedaliera Papa Giovanni XXIII, Bergamo, Italy
| | - M Saunes
- Department of Dermatology, St. Olavs Hospital, Trondheim University Hospital, Norway.,Department of Cancer Research and Molecular Medicine, Faculty of Medicine, NTNU, Norwegian University of Science and Technology, Trondheim, Norway
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11
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Chandran S, Aldei A, Johnson SR, Cheung AM, Salonen D, Gladman DD. Prevalence and risk factors of low bone mineral density in psoriatic arthritis: A systematic review. Semin Arthritis Rheum 2016; 46:174-182. [DOI: 10.1016/j.semarthrit.2016.05.005] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2016] [Revised: 04/25/2016] [Accepted: 05/20/2016] [Indexed: 11/26/2022]
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12
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Solak B, Dikicier BS, Celik HD, Erdem T. Bone Mineral Density, 25-OH Vitamin D and Inflammation in Patients with Psoriasis. PHOTODERMATOLOGY PHOTOIMMUNOLOGY & PHOTOMEDICINE 2016; 32:153-60. [DOI: 10.1111/phpp.12239] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 02/09/2016] [Indexed: 01/01/2023]
Affiliation(s)
- Berna Solak
- Department of Dermatology; School of Medicine; Sakarya University; Sakarya Turkey
| | - Bahar Sevimli Dikicier
- Department of Dermatology; Sakarya University Training and Research Hospital; Sakarya Turkey
| | - Hanife Duzgun Celik
- Department of Physical Medicine and Rehabilitation; Sakarya University Training and Research Hospital; Sakarya Turkey
| | - Teoman Erdem
- Department of Dermatology; School of Medicine; Sakarya University; Sakarya Turkey
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13
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Abstract
Psoriasis is a chronic inflammatory disease associated with several comorbidities. A few decades ago, it was considered an exclusive skin disease but today it is considered a multisystem disease. It is believed that 73% of psoriasis patients have at least one comorbidity. Studies have demonstrated the association of psoriasis with inflammatory bowel disease, uveitis, psychiatric disorders, metabolic syndrome and its components and cardiovascular diseases. The systemic inflammatory state seems to be the common denominator for all these comorbidities. This work aims at presenting a review of the current literature on some new comorbidities that are associated with psoriasis as osteoporosis, obstructive sleep apnea and chronic obstructive pulmonary disease. While there is still controversy, many studies already point to a possible bone involvement in patients with psoriasis, especially in the male group, generally less affected by osteoporosis. Psoriasis and chronic obstructive pulmonary disease present some risk factors in common as obesity, smoking and physical inactivity. Besides, both diseases are associated with the metabolic syndrome. These factors could be potential confounders in the association of the two diseases. Further prospective studies with control of those potential confounders should be developed in an attempt to establish causality. Existing data in the literature suggest that there is an association between obstructive sleep apnea and psoriasis, but studies performed until now have involved few patients and had a short follow-up period. It is, therefore, premature to assert that there is indeed a correlation between these two diseases.
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Affiliation(s)
- Jackson Machado-Pinto
- Santa Casa de Belo Horizonte - Belo Horizonte (MG),
Brazil
- Faculdade de Ciências Medica de Minas Gerais
(FCMMG) - Belo Horizonte (MG), Brazil
| | - Michelle dos Santos Diniz
- Santa Casa de Belo Horizonte - Belo Horizonte (MG),
Brazil
- Universidade Federal de Minas Gerais (UFMG) - Belo
Horizonte (MG), Brazil
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14
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Kocijan R, Englbrecht M, Haschka J, Simon D, Kleyer A, Finzel S, Kraus S, Resch H, Muschitz C, Engelke K, Sticherling M, Rech J, Schett G. Quantitative and Qualitative Changes of Bone in Psoriasis and Psoriatic Arthritis Patients. J Bone Miner Res 2015; 30:1775-83. [PMID: 25827104 DOI: 10.1002/jbmr.2521] [Citation(s) in RCA: 49] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2014] [Revised: 03/11/2015] [Accepted: 03/26/2015] [Indexed: 12/15/2022]
Abstract
Psoriatic arthritis (PsA) is a chronic inflammatory disease characterized by periarticular bone loss and new bone formation. Current data regarding systemic bone loss and bone mineral density (BMD) in PsA are conflicting. The aim of this study was to evaluate bone microstructure and volumetric BMD (vBMD) in patients with PsA and psoriasis. We performed HR-pQCT scans at the ultradistal and periarticular radius in 50 PsA patients, 30 psoriasis patients, and 70 healthy, age- and sex-related controls assessing trabecular bone volume (BV/TV), trabecular number (Tb.N), inhomogeneity of the trabecular network, cortical thickness (Ct.Th), and cortical porosity (Ct.Po), as well as vBMD. Trabecular BMD (Tb.BMD, p = 0.021, 12.0%), BV/TV (p = 0.020, -11.9%), and Tb.N (p = 0.035, 7.1%) were significantly decreased at the ultradistal radius and the periarticular radius in PsA patients compared to controls. In contrast, bone architecture of the ultradistal radius and periarticular radius was similar in patients with psoriasis and healthy controls. Duration of skin disease was associated with low BV/TV and Tb.N in patients with PsA. These data suggest that trabecular BMD and bone microstructure are decreased in PsA patients. The observation that duration of skin disease determines bone loss in PsA supports the concept of subclinical musculoskeletal disease in psoriasis patients.
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Affiliation(s)
- Roland Kocijan
- Department of Internal Medicine 3 and Institute of Clinical Immunology, University of Erlangen-Nuremberg, Erlangen, Germany.,St. Vincent Hospital, Medical Department II, The VINFORCE Study Group, Academic Teaching Hospital of Medical University of Vienna, Vienna, Austria
| | - Matthias Englbrecht
- Department of Internal Medicine 3 and Institute of Clinical Immunology, University of Erlangen-Nuremberg, Erlangen, Germany
| | - Judith Haschka
- Department of Internal Medicine 3 and Institute of Clinical Immunology, University of Erlangen-Nuremberg, Erlangen, Germany.,St. Vincent Hospital, Medical Department II, The VINFORCE Study Group, Academic Teaching Hospital of Medical University of Vienna, Vienna, Austria
| | - David Simon
- Department of Internal Medicine 3 and Institute of Clinical Immunology, University of Erlangen-Nuremberg, Erlangen, Germany
| | - Arnd Kleyer
- Department of Internal Medicine 3 and Institute of Clinical Immunology, University of Erlangen-Nuremberg, Erlangen, Germany
| | - Stephanie Finzel
- Department of Internal Medicine 3 and Institute of Clinical Immunology, University of Erlangen-Nuremberg, Erlangen, Germany
| | - Sebastian Kraus
- Department of Internal Medicine 3 and Institute of Clinical Immunology, University of Erlangen-Nuremberg, Erlangen, Germany
| | - Heinrich Resch
- St. Vincent Hospital, Medical Department II, The VINFORCE Study Group, Academic Teaching Hospital of Medical University of Vienna, Vienna, Austria
| | - Christian Muschitz
- St. Vincent Hospital, Medical Department II, The VINFORCE Study Group, Academic Teaching Hospital of Medical University of Vienna, Vienna, Austria
| | - Klaus Engelke
- Institute of Medical Physics, Erlangen-Nuremberg, Erlangen, Germany
| | - Michael Sticherling
- Department of Dermatology, University of Erlangen-Nuremberg, Erlangen, Germany
| | - Jürgen Rech
- Department of Internal Medicine 3 and Institute of Clinical Immunology, University of Erlangen-Nuremberg, Erlangen, Germany
| | - Georg Schett
- Department of Internal Medicine 3 and Institute of Clinical Immunology, University of Erlangen-Nuremberg, Erlangen, Germany
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15
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Sahana PK, Sarma N, Sengupta N, Somani PS. A Florid Case of Iatrogenic Cushing's Syndrome Induced by Topical Steroid with Osteoporosis and Hypogonadism. Indian J Dermatol 2015; 60:420. [PMID: 26288430 PMCID: PMC4533560 DOI: 10.4103/0019-5154.160514] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Here we report a case of a young male who developed full blown iatrogenic Cushing's syndrome after use of superpotent clobetasol propionate cream 0.05% for long duration to suppress psoriatic skin lesions. He also developed osteoporosis and hypogonadism. This case demonstrates that injudicious use of topical steroids can have disastrous consequences.
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Affiliation(s)
- Pranab Kumar Sahana
- Department of Endocrinology, Nilratan Sircar Medical College, Kolkata, West Bengal, India
| | - Nilendu Sarma
- Department of Dermatology, Nilratan Sircar Medical College, Kolkata, West Bengal, India
| | - Nilanjan Sengupta
- Department of Endocrinology, Nilratan Sircar Medical College, Kolkata, West Bengal, India
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16
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Oliveira MDFSPD, Rocha BDO, Duarte GV. Psoriasis: classical and emerging comorbidities. An Bras Dermatol 2015; 90:9-20. [PMID: 25672294 PMCID: PMC4323693 DOI: 10.1590/abd1806-4841.20153038] [Citation(s) in RCA: 197] [Impact Index Per Article: 21.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2013] [Accepted: 08/28/2013] [Indexed: 02/08/2023] Open
Abstract
Psoriasis is a chronic inflammatory systemic disease. Evidence shows an association
of psoriasis with arthritis, depression, inflammatory bowel disease and
cardiovascular diseases. Recently, several other comorbid conditions have been
proposed as related to the chronic inflammatory status of psoriasis. The
understanding of these conditions and their treatments will certainly lead to better
management of the disease. The present article aims to synthesize the knowledge in
the literature about the classical and emerging comorbidities related to
psoriasis.
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17
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Abstract
With the introduction of topical corticosteroids, a milestone has been achieved in dermatologic therapy; owing to its potent anti-inflammatory and ant proliferative effects, it became possible to treat some hitherto resistant dermatoses. But this magic drug can cause enough mischief if used inappropriately. Children are more susceptible to the systemic adverse effects because of enhanced percutaneous absorption through their tender skin. So, systemic side effects should be kept in mind while prescribing this therapeutically valuable topical medicament.
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Affiliation(s)
- Sandipan Dhar
- From the Department of Pediatric Dermatology, Institute of Child Health, Kolkata, India
| | - Joly Seth
- Department of Dermatology, Burdwan Medical College, Burdwan, West Bengal, India
| | - Deepak Parikh
- Department of Pediatric Dermatology, BJ Wadia Hospital for Children, Mumbai, Maharashtra, India
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18
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Gönül M, Gönül E. A case of multiple bone fractures due to the use of topical corticosteroid therapy for psoriasis. J DERMATOL TREAT 2014; 26:215-6. [DOI: 10.3109/09546634.2014.933164] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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19
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20
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Keller JJ, Kang JH, Lin HC. Association between osteoporosis and psoriasis: results from the Longitudinal Health Insurance Database in Taiwan. Osteoporos Int 2013; 24:1835-41. [PMID: 23052942 DOI: 10.1007/s00198-012-2185-5] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2012] [Accepted: 10/01/2012] [Indexed: 01/06/2023]
Abstract
UNLABELLED This population-based analysis explored the association between osteoporosis and a previous diagnosis of psoriasis. We found that the adjusted odds ratio (OR) of having been previously diagnosed with psoriasis for subjects with osteoporosis was 1.65 (95 % confidence interval [CI], 1.42-1.94) when compared to controls. INTRODUCTION Although previous studies have investigated this association between psoriasis and osteoporosis, significant controversy remains regarding its presence. Therefore, this study set out to explore the association between osteoporosis and a previous diagnosis of psoriasis through a population-based case-control study in Taiwan. METHODS We identified 17,507 cases with a diagnosis of osteoporosis and randomly extracted 52,521 controls without a history of osteoporosis. We used conditional logistic regression analyses to calculate the OR for having been previously diagnosed with psoriasis. RESULTS Subjects with osteoporosis had a significantly higher prevalence of previously diagnosed psoriasis (1.50 % vs. 0.87 %, p < 0.001) compared to controls. Conditional logistic regression analysis revealed that the OR of having been previously diagnosed with psoriasis for subjects with osteoporosis was 1.65 (95 % CI, 1.42-1.94) when compared to controls after adjusting for monthly income, hypertension, diabetes, coronary heart disease, hyperlipidemia, rheumatoid arthritis, stroke, renal disease, Parkinson's disease, hyperthyroidism, chronic hepatopathy, Cushing's syndrome, malabsorption, tobacco use disorder, obesity, alcohol abuse/alcohol dependence syndrome, the use of SSRIs, and the use of systemic glucocorticoids. Furthermore, osteoporosis was significantly associated with a previous diagnosis of psoriasis in both sexes; the adjusted OR of prior psoriasis for cases when compared to controls was 1.52 (95 % CI, 1.16-1.99) and 1.73 (95 % CI, 1.44-2.13) for males and females, respectively. We also found that the adjusted OR of prior severe psoriasis for cases was 1.96 (95 % CI, 1.37-2.81) that of controls. CONCLUSIONS This investigation succeeded in detecting an association between osteoporosis and prior psoriasis among both men and women.
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Affiliation(s)
- J J Keller
- School of Public Health, Taipei Medical University, Taipei, Taiwan
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21
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Balato N, Balato A, Gallo L, Napolitano M, Patruno C, Ayala F. Psoriasis and osteoporosis: data from a Southern Italian population. Arch Osteoporos 2012. [PMID: 23203734 DOI: 10.1007/s11657-012-0112-1] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
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22
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Osteoporosis in psoriatic arthritis: is there any? Wien Klin Wochenschr 2011; 123:743-50. [PMID: 22127468 DOI: 10.1007/s00508-011-0095-8] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2011] [Accepted: 10/10/2011] [Indexed: 02/08/2023]
Abstract
AIMS Although considered as a feature of inflammatory rheumatic diseases, there is a lot of controversy around low bone mass in patients with psoriatic arthritis. The aim of this cross-sectional study was to analyze bone mineral density in patients with psoriatic arthritis, as well as to investigate its possible association with some measures of disease activity and functional capacity. SUBJECTS AND METHODS Sixty-nine patients with established psoriatic arthritis (mean age 56.20 ± 12.23 years) and who have not been treated with specific antiosteoporotic drugs were recruited from the out-patient clinic database. Bone mineral density was measured by dual-energy X-ray absorptiometry at the lumbar spine and at the left hip. Disease activity measures included: duration of morning stiffness, tender and swollen joint count, patient's and physician's global assessment, presence of dactylitis and enthesitis, ESR, CRP and Disease Activity Score 28. Health Assessment Questionnaire was used to assess functional status. RESULTS According to WHO definition, spinal osteoporosis was found in 7.2% of patients, total hip osteoporosis in 1.4% of patients and femoral neck osteoporosis in 2.9% of patients. There was no significant association of any of the measures of disease activity with BMD at any site. Higher HAQ scores were associated with lower total hip BMD. CONCLUSIONS In our sample of patients with psoriatic arthritis we did not find increased prevalence of osteoporosis. There was no association of BMD with indices of disease activity, while negative correlation was found between HAQ and total hip BMD.
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23
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Attia EAS, Khafagy A, Abdel-Raheem S, Fathi S, Saad AA. Assessment of osteoporosis in psoriasis with and without arthritis: correlation with disease severity. Int J Dermatol 2011; 50:30-5. [PMID: 21182499 DOI: 10.1111/j.1365-4632.2010.04600.x] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
BACKGROUND The most frequent extracutaneous association with psoriasis is arthritis. Because proinflammatory cytokines are increased in psoriasis, patients with this disease may be more prone to osteoporosis than the healthy individuals. METHODS We evaluated 50 patients with psoriasis, with or without psoriatic arthritis (PsA), for the presence and degree of osteoporosis by performing dual energy x-ray absorptiometry (DEXA) and obtaining serum osteoprotegrin (OPG) levels. In addition, we correlated these results with the extent of skin and joint disease. Psoriasis area and severity index (PASI) was determined in all 50 patients with psoriasis, and total joint score (TJS) was recorded in the 16 patients who also had PsA. Results of DEXA and serum OPG were also obtained for 20 healthy individuals who served as controls. RESULTS Osteoprotegrin level was significantly increased in psoriasis patients (with or without PsA) vs. controls. However, DEXA revealed that PsA patients had a higher degree of osteoporosis in the femur neck and wrist. In PsA patients, TJS correlated positively with both disease duration and PASI but correlated negatively with Z score of the femur. CONCLUSION Psoriasis patients with or without arthritis may suffer from osteoporosis as evidenced by significantly increased serum OPG. Prolonged and extensive cutaneous disease is an important risk factor for the development and severity of PsA. Patients with a greater number of affected joints are at higher risk of osteoporosis.
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Affiliation(s)
- Enas A S Attia
- Departments of Dermatology, Venereology, and Andrology, Faculty of Medicine, Ain Shams University, Cairo, Egypt.
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24
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Pedreira PG, Pinheiro MM, Szejnfeld VL. Bone mineral density and body composition in postmenopausal women with psoriasis and psoriatic arthritis. Arthritis Res Ther 2011; 13:R16. [PMID: 21299865 PMCID: PMC3241360 DOI: 10.1186/ar3240] [Citation(s) in RCA: 66] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2010] [Revised: 01/06/2011] [Accepted: 02/07/2011] [Indexed: 01/15/2023] Open
Abstract
Introduction The aim of the present study was to compare bone mineral density (BMD) and body composition (BC) measurements as well as identify risk factors for low BMD and osteoporotic fractures in postmenopausal women with psoriasis (Ps) and psoriatic arthritis (PsA). Methods A cross-sectional study was carried out in 45 PsA women, 52 Ps women and 98 healthy female controls (HC). Clinical risk factors for low bone density and osteoporotic fracture were evaluated by a specific questionnaire. An X-ray absorptiometry (DXA) at the lumbar spine, total femur and total body was performed on all patients. Skin and joint outcomes were measured by specific tools (PASI, HAQ and DAS28). Morphometric vertebral fractures were evaluated by lumbar and thoracic spine X-ray, according to Genant's method. Results There were no significant differences in age, body mass index (BMI), total lean mass and bone mineral density among the groups. However, the PsA group had a significantly higher body fat percentage (BF%) than the Ps and HC groups. Osteoporotic fractures were more frequently observed in PsA and Ps groups than in the HC group (P = 0.01). Recurrent falls and a longer duration of disease increased the risk of fracture (odds ratio (OR) = 18.3 and 1.08, respectively) in the PsA group (P = 0.02). Disability was the main factor related to osteoporotic fracture in the Ps group (odds ratio (OR) = 11.1) (P = 0.02). Conclusions Ps and PsA patients did not present lower BMD. However, they had a higher prevalence of osteoporotic fractures and higher risk of metabolic syndrome. Patients with a longer duration of disease, disability and recurrent falls need preventive measures.
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Affiliation(s)
- Paulo G Pedreira
- Rheumatology Division, Federal University of São Paulo, UNIFESP/Paulista School of Medicine, EPM, 740, Botucatu Street, 04023-900 São Paulo-SP, Brazil.
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25
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Mahmoud Ghaniema E, Fathi Ahmed S, Raouf Amin I, Soliman Ayoub M. Evaluation of osteoporosis in hemophilic arthropathy patients: correlation with disease severity and serum trace minerals. J Osteoporos 2011; 2011:106380. [PMID: 22007335 PMCID: PMC3189571 DOI: 10.4061/2011/106380] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2010] [Revised: 04/08/2011] [Accepted: 08/10/2011] [Indexed: 11/20/2022] Open
Abstract
Objective. To find out the presence of osteoporosis in hemophilic arthropathy patients and its correlation with clinical severity and serum levels of magnesium, copper, and zinc. Methods. Joint score, functional assessment score, bone densitometry, and serum magnesium, copper and zinc were done in twenty male hemophilic arthropathy patients and twenty controls. Results. There was highly significant lower Z scores of lumbar spine and neck of femur in patients versus controls (P < 0.011). Z score of neck of femur correlated negatively with total joint score (P = 0.013) and functional assessment score (P = 0.011). Serum levels of copper and zinc correlated positively with Z score of neck of femur (P = 0.004, P = 0.001, resp.). Conclusion. Osteoporosis represents a frequent concomitant observation in hemophiliacs. Screening of young hemophiliacs for osteoporosis is recommended with measuring serum levels of magnesium, copper, and zinc for better management of the disease.
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Affiliation(s)
| | - Sahar Fathi Ahmed
- Rheumatology and Rehabilitation Department, Ain Shams University, Cairo 11566, Egypt,*Sahar Fathi Ahmed:
| | - Irene Raouf Amin
- Rheumatology and Rehabilitation Department, Ain Shams University, Cairo 11566, Egypt
| | - Maryse Soliman Ayoub
- Internal Medicine Department (Hematology Unit), Ain Shams University, Cairo 11566, Egypt
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26
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Reddy SM, Anandarajah AP, Fisher MC, Mease PJ, Greenberg JD, Kremer JM, Reed G, Chen R, Messing S, Kaukeinen K, Ritchlin CT. Comparative analysis of disease activity measures, use of biologic agents, body mass index, radiographic features, and bone density in psoriatic arthritis and rheumatoid arthritis patients followed in a large U.S. disease registry. J Rheumatol 2010; 37:2566-72. [PMID: 20843908 DOI: 10.3899/jrheum.100483] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
OBJECTIVE To compare disease activity, radiographic features, and bone density in psoriatic arthritis (PsA) and rheumatoid arthritis (RA) matched cohorts. METHODS Disease activity and radiographic data in the Consortium of Rheumatology Researchers of North America database from 2001 to 2008 were compared for 2481 patients with PsA and 17,107 patients with RA subsequently matched for age, gender, and disease duration. Radiographic outcomes included presence of erosions, and joint deformity. In addition, bone mineral density (BMD) scores for lumbar spine (L-spine) and femoral neck were compared using the same matching criteria plus weight and smoking status. RESULTS Tender (4.5 vs 3.4, p < 0.001) and swollen (4.4 vs 2.9, p < 0.012) joint counts, and modified Health Assessment Questionnaire scores were significantly higher (0.4 vs 0.3, p < 0.001) in patients with RA compared with patients with PsA. Patient general health and pain scores were also higher in patients with RA vs patients with PsA. Joint erosions (47.4% vs 37.6%, p = 0.020) and deformity (25.2% vs 21.6%, p = 0.021) were more prevalent in RA than PsA. In multivariate analysis, a reduced prevalence of erosions in PsA vs RA was noted (OR 0.609, p < 0.001). After matching, T-scores for L-spine (-0.54 vs -0.36, p = 0.077) and femoral neck (-0.88 vs -0.93, p = 0.643) were similar in patients with RA and patients with PsA, although body weight was a major confounder. CONCLUSION The level of disease activity and radiographic damage was significantly higher for RA vs PsA subjects, although the magnitude of differences was relatively small. BMD levels were comparable between cohorts. Outcomes in patients with PsA and patients with RA may be more similar than previously reported.
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Affiliation(s)
- Soumya M Reddy
- New York University School of Medicine-Hospital for Joint Diseases, New York, USA.
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27
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Haeck IM, Hamdy NAT, Timmer-de Mik L, Lentjes EGWM, Verhaar HJJ, Knol MJ, de Bruin-Weller MS, Bruijnzeel-Koomen CAFM. Low bone mineral density in adult patients with moderate to severe atopic dermatitis. Br J Dermatol 2009; 161:1248-54. [PMID: 19673879 DOI: 10.1111/j.1365-2133.2009.09327.x] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
BACKGROUND Atopic dermatitis (AD) is a chronic inflammatory skin disease commonly treated with topical corticosteroids. The inflammatory nature of this disorder and the use of topical corticosteroids represent potential risk factors for bone loss. OBJECTIVES The aim was to assess the prevalence of osteoporosis and osteopenia in adult patients with moderate to severe AD. In addition, the associations between topical/oral corticosteroid use and bone mineral density (BMD) and between disease activity and BMD were studied. PATIENTS AND METHODS We studied 125 adult patients with moderate to severe AD. Using dual-energy X-ray absorptiometry, BMD was measured at lumbar spine and hips. The cumulative dose of topical and oral corticosteroids was calculated from pharmacy prescription records. Lifestyle parameters were collected by a questionnaire. Biochemical parameters of bone metabolism and disease activity [serum concentration of thymus and activation-regulated chemokine (TARC) levels] were also measured. RESULTS Osteoporosis was documented in six patients (4.8%) and osteopenia in 41 patients (32.8%); 30.4% of the patients had a Z-score <or= -1 (low BMD), with more men (43.8%) than women (16.4%) affected. There was no significant association between low BMD and biochemical parameters of bone metabolism, serum TARC levels and cumulative dose of topical and oral corticosteroids during the 5 years prior to inclusion. CONCLUSIONS We document a Z-score <or= -1 in about one-third of predominantly male patients with moderate to severe AD, being independent of the cumulative dose of topical and corticosteroids used within 5 years prior to study. Whether the relatively high prevalence of low BMD is due to the cumulative dose of topical corticosteroids beyond 5 years prior to the study or the chronicity of the underlying inflammatory process or a combination of these, remains to be established.
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Affiliation(s)
- I M Haeck
- Department of Dermatology and Allergology, University Medical Center Utrecht, Inhouse postnumber G02.124, Utrecht, the Netherlands.
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Abstract
Previous reports showed associations between psoriasis and chronic diseases. Little is known about the association between osteoporosis and psoriasis. The goal of the study was to assess the association between psoriasis and osteoporosis in a population-based case-control study, utilizing the database of a large health-care provider organization in Israel, Clalit Health Services. Patients (aged 51-90 years) diagnosed with psoriasis were compared with a sample of age- and sex-matched enrollees without psoriasis regarding the prevalence of osteoporosis. Data on health-related lifestyles and other comorbidities were collected. The study included 7,936 psoriasis cases and 14,835 controls. The prevalence of osteoporosis was significantly greater in males with psoriasis compared with the control group (3.1 vs 1.7%, P<0.001, odds ratio (OR)=1.86, 95% confidence interval (CI): 1.44-2.39) and slightly greater in females with psoriasis (22.3 vs 20.2%, P=0.008, OR=1.13, 95% CI: 1.03-1.25). A multivariate logistic regression model demonstrated that after controlling for confounders, psoriasis was significantly associated with osteoporosis in males (adjusted OR=1.70, 95% CI: 1.31-2.19, P<0.001). The weak association between psoriasis and osteoporosis in females lost statistical significance in a multivariate model (adjusted OR=1.09, 95% CI: 0.98-1.21, P=0.100). Psoriasis was found to be associated with osteoporosis among males, but not among females.
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Borman P, Babaoğlu S, Gur G, Bingol S, Bodur H. Bone mineral density and bone turnover in patients with psoriatic arthritis. Clin Rheumatol 2007; 27:443-7. [PMID: 17876648 DOI: 10.1007/s10067-007-0725-8] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2007] [Revised: 08/06/2007] [Accepted: 08/28/2007] [Indexed: 01/01/2023]
Abstract
Psoriasis is a common inflammatory skin disease, and conflicting data have been published about osteoporosis and bone turnover markers in patients with psoriatic arthritis. The aim of this study was to assess bone mineral density (BMD) and bone turnover markers in psoriatic patients with and without peripheral arthritis and to investigate the relationship between clinical parameters and markers of bone turnover. Forty-seven patients (24 women, 23 men) with psoriasis were included to the study. Demographic data and clinical characteristics were recorded. Erythrocyte sedimentation rate and C-reactive protein were assessed as disease activity parameters. BMD was determined for lumbar spine and total hip by dual X-ray absorptiometry (DXA). Serum Ca, P, alkalen phosphatase (ALP), and serum type I collagen cross-linked C telopeptide (CTX) were measured as bone turnover markers in all patients. The patients were divided into two groups according to their peripheral arthritis status. The clinical and laboratory variables, as well as bone mass status of the groups, were compared with each other. Eighteen patients had peripheral arthritis. All the female patients were premenopausal. None of the patients had radiologically assessed axial involvement. There was no significant difference between the BMD levels of psoriatic patients with and without arthropathy. One patient (5%) had osteoporosis, and nine (50%) patients had osteopenia in arthritic group, while eight (27.5%) patients had osteopenia in patients without arthritis. Serum CTX, ALP, Ca, and P levels were not significantly different in arthritic than in non-arthritic patients (p > 0.05). In patients with psoriatic arthritis, the duration of arthritis was negatively correlated with BMD values of lumbar spine and total femur and serum CTX levels, suggesting an association of increased demineralization with the duration of joint disease. In conclusion, psoriatic patients with peripheral arthritis with longer duration of joint disease may be at a risk for osteoporosis, which can require preventative treatment efforts.
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Affiliation(s)
- Pinar Borman
- Clinic of Physical Medicine and Rehabilitation II, Numune Training and Research Hospital, Samanpazari, Ankara, Turkey.
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Kastelan D, Kastelan M, Massari LP, Korsic M. Possible association of psoriasis and reduced bone mineral density due to increased TNF-alpha and IL-6 concentrations. Med Hypotheses 2006; 67:1403-5. [PMID: 16844318 DOI: 10.1016/j.mehy.2006.04.069] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2006] [Accepted: 04/28/2006] [Indexed: 10/24/2022]
Abstract
Psoriasis is a chronic erythematosquamous disease affecting about 2-3% of the population. It is generally considered to be a T cell-mediated disorder. Psoriasis is characterized by Th1-type cytokine pattern with the predominant secretion of IL-2, IL-6, IFN-gamma and TNF-alpha. Such cytokine pattern is sufficient in inducing keratinocyte hyperproliferation, a hallmark of psoriasis. It seems that development of psoriatic lesions is mediated by TNF-alpha and proliferation of local T cells is dependent on local TNF-alpha production. IL-6 enhances activation, proliferation and chemotaxis of T cells into psoriatic lesions. It is also a direct keratinocyte mitogen that could directly stimulate keratinocyte proliferation. Data of possible association between psoriasis and reduced bone mineral density (BMD) are limited and therefore, not fully conclusive. The major limitation of two studies reported so far was small sample size. Based on increased concentrations of TNF-alpha and IL-6 in psoriasis we hypothesized that these patients are more prone to osteoporosis than healthy subjects. TNF-alpha enhances bone resorption via stimulating osteoclast development and activity as well as bone formation. On the other hand, IL-6 is also a potent stimulator of bone resorption. Moreover, increased production of TNF-alpha and IL-6 has been found in postmenopausal women with osteoporosis. Several lines of evidence support our hypothesis; higher value of IL-6 was recorded in children with idiopathic osteoporosis than in healthy controls; TNF-alpha knock-out mice do not lose bone after ovariectomy; polymorphism of TNFRSF1B gene which encodes 75 Kd TNF receptor is associated with BMD; treatment with anti-TNF-alpha antibody exert beneficial effect on bone metabolism in patients with rheumatoid arthritis and finally, raloxifene inhibit osteoclast activity by reducing TNF-alpha and IL-6 synthesis. However, our hypothesis raised number of questions. Are increased serum concentrations of TNF-alpha and IL-6 mirrored by increased concentrations of these cytokines on the local level? Furthermore, could other cytokines relevant in the pathogenesis of the psoriasis, first of all IFN-gamma, modulate the risk of osteoporosis? Thus, a large prospective, case-control study with the data on BMD, biochemical parameters of bone turnover and fractures have to be done to test our hypothesis.
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Affiliation(s)
- Darko Kastelan
- Division of Endocrinology, Department of Internal Medicine, University Hospital Zagreb, Kispaticeva 12, 10000 Zagreb, Croatia.
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Sánchez Regaña M, Ojeda Cuchillero R, Umbert Millet P. Elevated serum parathyroid hormone levels in a patient with annular pustular psoriasis. J Eur Acad Dermatol Venereol 2005; 19:767-8. [PMID: 16268893 DOI: 10.1111/j.1468-3083.2005.01256.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Regaña MS, Ezquerra GM, Millet PU. Serum Levels of Parathyroid Hormone and Parathyroid‐related Peptide in Psoriasis. Acta Derm Venereol 2005; 85:420-3. [PMID: 16159734 DOI: 10.1080/00015550510033705] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
Abstract
Psoriasis is a common skin disorder that may be triggered by hormonal disturbances, among other factors. Some studies have demonstrated an elevation of serum parathyroid hormone (PTH) levels in psoriasis and several other diseases of keratinization of unknown aetiology. PTH-related peptide (PTH-rp), on the other hand, is a potent inhibitor of epidermal cell growth factor and is not expressed in psoriatic skin. Serum levels of this peptide have not been reported in psoriasis. Immunoassay was used to measure serum PTH and PTH-rp in 22 patients with plaque-type psoriasis before and after treatment with mometasone furoate. Results were compared with a group of 20 healthy, non-psoriatic volunteers. Serum PTH levels were significantly elevated in the psoriatic group compared with the control group (p=0.001) and were significantly reduced after treatment (p=0.01). A correlation was found between pretreatment serum PTH levels and psoriasis area and severity scores (PASI) (r=0.42; p=0.01). In contrast, serum PTH-rp levels were not different between psoriatics and controls and were not affected by treatment. These findings indicate that serum PTH concentrations reflect disease activity in patients with psoriasis.
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Affiliation(s)
- Manuel Sánchez Regaña
- Psoriasis and Phototherapy Center, Department of Dermatology, Hospital Universitari Sagrat Cor, Teaching Unit of University of Barcelona, Barcelona, Spain.
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Abstract
This review summarizes articles written about psoriatic arthritis in the past year. It concentrates on clinical and epidemiologic issues, pathogenesis and treatment, and updates the reader regarding new concepts in psoriatic arthritis.
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