engleski

Osteoporosis in psoriatic arthritis: is there any?

Introduction Psoriatic arthritis (PsA) is a chronic inflammatory arthritis associated with psoriasis affects approximately 2 percent of the world’ s population. Although considered as a feature of inflammatory rheumatic diseases, there is a lot of controversy around low bone mass in patients with PsA. Aim of the study The aim of this cross-sectional study was to add the evidence regarding bone mineral density (BMD) in PsA, as well as to investigate its association with some measures of activity and severity of the disease. Subjects and methods Sixty-nine ambulatory, community-dwelling patients (31 men and 38 women) with established PsA, recruited from the database of the University Hospital, were asked to participate in the study. The diagnosis of PsA was reconfirmed by one rheumatologist experienced in PsA (SG). No patients previously diagnosed to have PsA were excluded due to having different rheumatic condition at the time of the study. BMD was measured by dual-energy X-ray absorptiometry at the lumbar spine and at the left hip in standard manner. The patients were categorized according to WHO definition (expressed as T- scores) as normal, osteopoenic or osteoporotic. Disease activity and severity measures possibly associated with bone mineral status included: morning stiffness duration (in minutes), 68/66 tender and swollen joint count (the hip is not assessed for swelling), patient global assessment (on 100 mm visual analogue scale - VAS), physician global assessment (on 0-100 mm VAS), Health Assessment Questionnaire (HAQ) (range 0-3), Bath Ankylosing Spondylitis Functional Index (BASFI) (range 0-100), ESR (mm/h), CRP (mg/L) and Disease Activity Score (DAS) 28 (range 0-10). Statistical analysis included Student T-test, Oneway ANOVA, Pearson correlation and Spearman’ s Rho correlation. Statistical significance was set up at P 0.01. Results Patients’ mean age was 56.20± ; 12.23 years, the duration of psoriasis (Ps) was 225.39± ; 138.34 months and the duration of PsA was 159.84± ; 110.84 months. The BMD values for lumbar spine, total hip and for femoral neck were 1.006± ; 0.161 g/cm2, 0, 984± ; 0.156 g/cm2 and 0.784± ; 0.195 g/cm2, respectively. Sex distribution of BMD values is presented in table 1 and patients’ distribution according to WHO classification of osteoporosis in table 2. There was no significant association of any of the measures of disease activity and severity with BMD at any site, except for the correlation between higher HAQ score with lower BMD value in hip region (p 0.01). Conclusions In our sample of middle aged patients with PsA we did not find increased prevalence of osteoporosis. With the exception of HAQ score and BMD in the hip region there was, also, no association of BMD with indices of severity and activity of disease. Further research in a larger sample and longitudinal studies might elucidate this topic.

osteoporosis; psoriatic arthritis

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