Assessment of osteoporosis in psoriasis with and without arthritis: correlation with disease severity

• Published in: International Journal of Dermatology 2011-01, Vol.50 (1), p.30-35
• Main Authors: Attia, Enas A. S., Khafagy, Ayman, Abdel-Raheem, Sameh, Fathi, Sahar, Saad, Abeer A.
• Format: Article
• Language: English
• Subjects: Absorptiometry, Photon; Adult; Arthritis, Psoriatic - blood; Arthritis, Psoriatic - complications; Arthritis, Psoriatic - diagnostic imaging; Biological and medical sciences; Dermatology; Diseases of the osteoarticular system; Female; Femur - diagnostic imaging; Humans; Male; Medical sciences; Middle Aged; Miscellaneous. Osteoarticular involvement in other diseases; Neck - diagnostic imaging; Osteoporosis - blood; Osteoporosis - complications; Osteoporosis - diagnostic imaging; Osteoporosis. Osteomalacia. Paget disease; Osteoprotegerin - blood; Psoriasis - blood; Psoriasis - complications; Psoriasis - diagnostic imaging; Psoriasis. Parapsoriasis. Lichen; Severity of Illness Index; Wrist - diagnostic imaging; Young Adult
• ISSN: 0011-9059; 1365-4632
• DOI: 10.1111/j.1365-4632.2010.04600.x

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.