Limited data are available on the vitamin D 3 status and bone mineral density (BMD) of patients with psoriasis or with psoriatic arthritis. Our study intended to explore possible correlations between vitamin D status and BMD, as well as among these parameters and the features of the underlying disorder. Seventy-two patients with psoriasis/ or psoriatic arthritis (female : male ratio, 40:32; mean age, 58.5 AE 11.6 years; mean duration of follow up, 142.7 AE 147.7 months) participated in the study. We evaluated the characteristic clinical features of the underlying disease, performed bone densitometry of the lumbar spine and the hip region, measured the serum vitamin 25 (OH)D 3 levels of the patients, and undertook the statistical analysis of the relationships between the clinical and the laboratory parameters. The proportion of patients with a low BMD value did not exceed that seen in the general population. We found an inverse correlation between the serum level of vitamin 25(OH)D 3 and body mass index, as well as between the former and the severity of skin involvement. Furthermore, the activity of psoriatic arthritis was significantly higher in patients with inadequate vitamin D 3 status. In patients with psoriatic arthritis, BMD significantly exceeded the values measured in patients suffering from psoriatic skin lesions only. Our findings suggest the importance of evaluating the vitamin D 3 status and screening for comorbid conditions in patients with psoriasis or psoriatic arthritis. This appears justified, in particular, due to the possible role of hypovitaminosis D 3 in provoking the development of skin lesions and joint symptoms.

Patients with severe psoriasis exhibit signs of subclinical cardiovascular disease compared to control, and prolonged anti-TNF-α therapy has a potentially beneficial effect on these signs.

Abstract

BackgroundThe aim of the present study was to assess whether the efficacy of bisphosphonate treatment is influenced by PTH levels measured in newly diagnosed osteoporotic patients and to identify the threshold value, beyond which PTH level negatively influences therapeutic efficacy.MethodsOne hundred and thirty-eight osteoporotic patients were enrolled into the study. All subjects underwent laboratory screening, bone densitometry with DEXA, and x-ray imaging. The changes in bone density were evaluated after a mean follow-up period of 13.37 ± 1.29 months. Correlation analysis was performed on the clinical data of patients, the percentage changes of BMD values, and the PTH levels measured at the beginning of study, using SPSS software.ResultsThe mean age of the subjects was 64.82 ± 10.51 years, and the female-to-male ratio was 116/22. Baseline BMD value measured with AP DEXA scanning was 0.854 ± 0.108 g/cm2 in the L1-4 vertebrae and 0.768 ± 0.115 g/cm2 in the left femoral neck. By the end of the follow-up period, these values changed to 0.890 ± 0.111 g/cm2 and 0.773 ± 0.111 g/cm2, respectively. We found a statistically significant, negative correlation between PTH levels and the percentage changes of lumbar BMD values measured at the end of the follow-up (correlation coefficient R2 = 0.121, p < 0.0001). The analysis of frequency histograms suggested that negative effects on bone might be expected above a PTH level of 60 pg/mL (7.3 pmol/L).ConclusionOur findings imply that a baseline PTH level over 60 ng/mL can reduce the efficacy of bisphosphonate treatment.

Our findings suggest that adopting tight control as a new therapeutic strategy might be justified in the osteoporosis management. In fact, a greater improvement of BMD can be achieved by treatment according to these principles.