Osteoporosis in psoriatic arthritis: Risk factors, insufficiency fractures and its association with the disease activity / Osteoporosis en la artritis psoriásica: factores de riesgo, fracturas por insuficiencia y su asociación con la actividad de la enfermedad

Objective: The prevalence of osteoporosis (OP) and insufficiency fractures in psoriatic arthritis (PsA) remains controversial. The aim of this study was to describe the prevalence of OP and insufficiency fractures in a representative cohort of patients with PsA, and to analyse its association with general risk factors and characteristics of the psoriatic disease in our geographical area. Methods: Multi-centric, descriptive study of patients with PsA. We recorded clinical characteristics, as well as protective and risk factors for OP and insufficiency fractures. Hip and lumbar densitometry and lateral X-ray of the spine were evaluated. Descriptive statistics for OP and risk factors were calculated. The patients with OP were compared to those without by univariate analyses, and results were adjusted by age and sex. The association of OP and fractures with clinical characteristics was analysed by logistic regression. Results: 166 patients (50 men; 116 women) were included. OP was present in 26.5%, and it was more frequent in women and patients above 50 years old. Insufficiency fractures occurred in 5.4% of the total sample. In the logistic regression, OP was associated with age over 50 [OR 3.7; 95% CI (1.2–11.6); p=.02]. No association with clinical parameters was found. The most frequent risk factors among patients with OP were vitamin D insufficiency, sedentary behaviour, low calcium intake, and active smoking. In the logistic regression, OP was associated with early menopause [OR 11.7; 95% CI (1.29–106.0); p=.029] and sedentary behaviour [OR 2.3; 95% CI (1.0–5.2); p=.049]. Conclusions: In patients with PsA, OP is more frequent in women and patients over 50 years old. A sedentary lifestyle and early menopause may add extra risk for OP. Type, duration disease, and treatments are not associated with OP or insufficiency fractures.(AU)

Objetivo: El objetivo de este estudio fue describir la prevalencia de osteoporosis (OP) y fracturas por insuficiencia en una cohorte representativa de pacientes con artritis psoriásica (APs) y analizar su asociación con factores de riesgo generales y características de la enfermedad psoriásica en nuestra área geográfica. Métodos: Estudio multicéntrico y descriptivo de pacientes con APs. Se registraron las características clínicas, así como los factores protectores y de riesgo de OP y fracturas por insuficiencia. Se evaluó la densitometría de cadera y lumbar y la radiografía lateral de columna. Se calcularon las estadísticas descriptivas de la OP y los factores de riesgo. Los pacientes con OP se compararon con los que no la tenían mediante análisis univariantes, y los resultados se ajustaron por edad y sexo. La asociación de la OP y las fracturas con las características clínicas se analizó mediante regresión logística. Resultados: Se incluyeron 166 pacientes (50 hombres; 116 mujeres). La OP estaba presente en el 26,5% y era más frecuente en mujeres y pacientes mayores de 50 años. Se produjeron fracturas por insuficiencia en el 5,4% de la muestra total. En la regresión logística la OP se asoció con la edad superior a 50 años (OR: 3,7; IC 95%: 1,2-11,6; p=0,02), con la menopausia precoz (OR: 11,7; IC 95%: 1,29-106,0; p=0,029) y el comportamiento sedentario (OR: 2,3; IC 95%: 1,0-5,2; p=0,049). Conclusiones: En pacientes con APs la OP es más frecuente en mujeres y en aquellos mayores de 50 años. Un estilo de vida sedentario y una menopausia precoz pueden añadir un riesgo adicional de OP. El tipo, la duración de la enfermedad y los tratamientos no se asocian a las fracturas OP ni a las fracturas por insuficiencia.(AU)

The Effect of the Presence of Fibromyalgia on Common Clinical Disease Activity Indices in Patients with Psoriatic Arthritis: A Cross-sectional Study.

OBJECTIVE: To study the effect of the presence of fibromyalgia (FM) on common clinical disease activity indices in patients with psoriatic arthritis (PsA). METHODS: Seventy-three consecutive outpatients with PsA (mean age 51.7 yrs; 42 females, 57.5%) were enrolled in a prospective cross-sectional study. FM was determined according to American College of Rheumatism criteria (2010 and 1990). All patients underwent clinical evaluation of disease activity and completed the Health Assessment Questionnaire (HAQ), the Bath Ankylosing Spondylitis Disease Activity Index (BASDAI), the Dermatology Life Quality Index, and the Leeds Enthesitis Index (LEI). Disease activity was evaluated using the Composite Psoriatic Disease Activity Index (CPDAI), minimal disease activity (MDA), and the Disease Activity Index for Psoriatic Arthritis (DAPSA) scores. RESULTS: The overall prevalence of FM was 17.8% (13 patients), and all but 1 were women (12 patients, 92.3%, p = 0.005). CPDAI and DAPSA scores were significantly higher in patients with coexisting PsA and FM (9.23 ± 1.92 and 27.53 ± 19.23, respectively) than in patients with PsA only (4.25 ± 3.14 and 12.82 ± 12.71, respectively; p < 0.001 and p = 0.003). None of the patients with FM + PsA met the criteria for MDA, whereas 26 PsA-only patients did (43.3%, p = 0.003). HAQ, BASDAI, and LEI scores were significantly worse in patients with PsA and associated FM. CONCLUSION: Coexisting FM is related to worse scores on all tested measures in patients with PsA. Its influence should be taken into consideration in the treatment algorithm to avoid unnecessary upgrading of treatment.