Quantitative and Qualitative Changes of Bone in Psoriasis and Psoriatic Arthritis Patients

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.

Prevalence and risk factors of low bone mineral density in psoriatic arthritis: A systematic review

“…Some studies show normal BMD levels in PsA patients but increased fractures with longer duration of disease [17]. Studies on bone microarchitecture and bone quality in PsA are sparse, and there is no conclusive evidence to support compromised bone quality in these patients [18]. A preliminary review of studies evaluating BMD in PsA provides inconsistent and conflicting results [19][20][21][22][23][24].…”

Inflammatory osteolysis: a conspiracy against bone

“…Inflammatory diseases that affect joints, skin and the gutincluding rheumatoid arthritis (RA), psoriatic arthritis (PsA), and Crohn's disease -also promote bone loss that is often severe (1)(2)(3). Inflammation-driven bone degradation affects the axial and appendicular skeleton early in life and enhances the risk of fracture.…”

New Interleukins in Psoriasis and Psoriatic Arthritis Patients: The Possible Roles of Interleukin-33 to Interleukin-38 in Disease Activities and Bone Erosions

“…From bench to bedside, treatment methods of Ps and PsA have changed dramatically due to the development and introduction of biologic agents, particularly inhibitors of the pro-inflammatory cytokines [1] . The successes achieved by TNF-α inhibitors (TNFi) and IL-12/IL-23p40 inhibitors have also been instrumental in carrying out additional re- A range of bone pathologies was observed in patients with PsA including aberrant bone loss and new bone formation [6,7] . Approximately one-fifth of patients with PsA develop a destructive, disabling form of arthritis over time.…”