Studies on osteoporosis in axial spondyloarthritis (axSpA) have focused on the lumbar segment, and few studies have assessed bone mineral density (BMD) in the hip and femoral neck in these patients. The aim of this study was to evaluate the prevalence of low BMD and osteopenia in the total hip or femoral neck and the factors associated with these conditions in axSpA patients. This was a single-centre, observational, cross-sectional study among consecutive patients with axSpA according to the ASAS criteria from the CASTRO registry. All patients underwent total hip and femoral neck DXA BMD measurements. Low BMD was defined as a Z-score less than −1, and osteopenia was defined as a T-score less than −1. Multivariate logistic and generalised linear regressions were used to evaluate factors independently associated with low BMD and osteopenia in the hip or femoral neck and those associated with variability in BMD, respectively. A total of 117 patients were included, among which 30.8% were female and the mean age was 45 years. A total of 36.0% of patients had low BMD (28.1% in the total hip and 27.4% in the femoral neck), and 56.0% of patients had osteopenia (44.7% in the total hip and 53.8% in the femoral neck). A multivariate logistic regression showed that age, radiographic sacroiliitis and ASAS-HI were independently associated with low BMD in the total hip or femoral neck. Factors that were independently associated with osteopenia were Body Mass Index, disease duration, radiographic sacroiliitis and ASAS-HI. In conclusion, 36% of the patients with axSpA had low BMD in the total hip or femoral neck. A younger age and radiographic sacroiliitis were the most important factors associated with decreased BMD.
BackgroundTo date, published studies suggest that a significant proportion of patients with Psoriatic Arthritis (PsA) present asymptomatic sacroiliitis; that is to say, an inflammatory back pain (IBP) absence. This fact could result in the underdiagnosis of axial involvement in these patients (1).ObjectivesTo evaluate the prevalence of radiographic sacroiliitis in patients with PsA and to determine its association with clinical, analytical and demographic factors.MethodsA cross-sectional, observational, and unicentre study in which clinical, analytical and demographic data from 359 patients belonging to a PsA monographic consultation were analyzed. All patients met the CASPAR criteria. The presence of sacroiliitis in the sacroiliac x-ray image was used as a dependent variable, formerly evaluated by a trained Rheumatologist. Likewise, independent variables related to arthropathy, cutaneous involvement and sociodemographic characteristics of the patients were used as well. A descriptive analysis and two logistic regressions (univariate and multivariate), were performed to associate radiographic sacroiliitis to different covariates.ResultsOut of the 359 patients, 214 (59.6%) were men with a mean time of PsA evolution of 10.05±11.6 years. The x-ray image performed showed sacroiliitis in 127 patients (35.4%). Univariate analysis showed that radiographic sacroiliitis is related (p<0.05) to gender (men), psoriasic paternal family history, IBP, positive HLA-B27 antigen and psoriatic cutaneous involvement greater than 25%. The multivariate analysis showed that radiographic sacroiliitis in these patients is predominantly associated to the presence of IBP, the positive HLA-B27 antigen and gender (men). However, sacroiliitis is not not associated to the onset age of PsA (p>0.05).Univariate logistic regressionSacroiliitisNo SacroiliitisOR (CI 95%)p-value n=127 (n%)n=232 (n%) Sex (men)94 (74.0)120 (51.7)2.6 (1.6–4.2)<0.001Psoriasis duration, mean (SD)12.6 (9.2)10.8 (0.2)1.0 (0.9–1.0)0.082PsA duration, mean (SD)5.5 (5.9)4.5 (6.3)1.0 (1.0–1.0)0.041Onset age of PsA ≤45 years76 (59.8)131 (56.6)1.1 (0.7–1.7)0.536– None70 (56.5)150 (65.8)Reference– Paternal29 (23.4)35 (15.4)1.7 (1.0–3.1)0.048– Maternal25 (20.2)43 (18.9)1.2 (0.7–2.2)par 0.449IBP93 (73.2)22 (9.5)26.1 (14.9–47.0)<0.001HLA-B27 +22 (17.5)11 (4.8)4.1 (1.9–9.0)<0.001– <10%177 (76.6)78 (61.9)Reference– 10–25%21 (16.7)21 (16.7)1.5 (0.8–2.8)0.170– >25%23 (10.0)27 (21.4)2.6 (1.4–4.9)0.002ConclusionsThe prevalence of radiographic sacroiliitis in our population is 35.4%, higher than in other series due to the fact that the sacroiliac x-ray images were performed on all patients, regardless of the clinic. The radiographic sacroiliitis in patients with PsA is related to the presence of IBP, HLA-B27 antigen and gender. However, the time of evolution of arthropathy and the onset age of PsA are not related to sacroiliac radiographic involvement.References Jadon DR, Sengupta R, Nightingale A, et al. Axial Disease in Psoriatic Arthritis study: defining the clinical and radiographic phe...
BackgroundIt is well known that the prevalence of Cardiovascular Risk Factors (CVRF) in patients with Psoriatic Arthritis (PsA) is higher than in the general population1. However, there is a lack of studies comparing PsA against Psoriasis without arthritis, and also against peripheral Spondyloarthritis (SpA).Objectivesa) To compare the prevalence of CVRF among patients with PsA, Psoriasis without arthritis and peripheral SpA without Psoriasis; and b) to evaluate the association between CVRF and the presence of arthritis and/or Psoriasis.MethodsA cross-sectional, observational and unicenter study in which clinical, analytical and demographic data from 300 patients were analysed. Patients were divided into four groups: PsA, Psoriasis without arthritis, peripheral SpA without Psoriasis and controls. Patients with PsA and peripheral SpA met CASPAR and peripheral ASAS criteria, respectively. Hypertension, Diabetes (T2DM) and Dyslipidemia were evaluated among the four groups by using the chi-square test. In order to evaluate whether CVRF could be explained by the presence of arthritis or Psoriasis, we divided patients (by excluding control groups) in arthritis/no arthritis and Psoriasis/no Psoriasis. Univariate and multivariate logistic regressions adjusted by sex and age were performed in order to determine variables independently associated with the presence of these three CVRF.ResultsAmong the 300 patients included in the analysis, 89 (29.7%), 35 (11.7%) and 87 (29%) patients reported Hypertension, T2DM and Dyslipidemia, respectively. Regarding classification, 61 (20.3%) patients, 100 (33.3%), 100 (33.3%) and 39 (13.0%) patients were classified as control group, Peripheral SpA without Psoriasis, PsA and Psoriasis without arthritis, respectively. Patients from the control group showed significantly lower prevalence of Hypertension and Dyslipidemia against the other three groups (p<0.05); however, there were no differences between Peripheral SpA group, PsA and Psoriasis without arthritis regarding CVRF.Patients with arthritis showed similar prevalence of CVRF than those without arthritis, as well as patients with Psoriasis vs. no Psoriasis.Univariate analysis showed that Hypertension is significantly associated (p<0.05) to AINEs intake [OR 1.79 (95%CI 1.06–2.99)] as well as with disease duration [OR 1.02 (95%CI 1.01–1.05)]; however, the multivariate analysis adjusted by age and sex did not show significant differences. Regarding T2DM and dyslipidemia, the presence of arthritis or Psoriasis was not associated with the development of these comorbidities.ConclusionsOur data suggest that the prevalence of CVRF among patients with Psoriasis, PsA and peripheral SpA are similar, although it is higher than in the general population. The presence of Hypertension in these patients is associated with the use of NSAIDs; however, greater new studies would be necessary in order to determine specific associations.Reference[1] Kharaishi M, Aslanov R, Rampakakis E, et al. Prevalence of cardiovascular risk factors in patients with psori...
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