Article
Rheumatoid Factor Status Is a Predictor of Osteoporosis in Patients with Psoriatic Arthritis
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Authors
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Frank Behrens
- CIRI am Klinikum der Johann Wolfgang Goethe-Universität, Rheumatologie, Fraunhofer Institute for Molecular Biology and Applied Ecology IME, Project Group Translational Medicine & Pharmacology TMP, Frankfurt/Main
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Michaela Köhm
- CIRI am Klinikum der Johann Wolfgang Goethe-Universität, Rheumatologie, Fraunhofer Institute for Molecular Biology and Applied Ecology IME, Project Group Translational Medicine & Pharmacology TMP, Frankfurt/Main
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Eva Christina Scharbatke
- Universitätsklinikum Würzburg, Medizinische Klinik und Poliklinik II, Schwerpunkt Rheumatologie und klinische Immunologie, Würzburg
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Marc Schmalzing
- Universitätsklinikum Würzburg, Medizinische Klinik und Poliklinik II, Schwerpunkt Rheumatologie und klinische Immunologie, Würzburg
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Holger Gnann
- Biostatistics GKM Gesellschaft für Therapieforschung mbH, München
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Hanns-Martin Lorenz
- Universitätsklinikum Heidelberg, Medizinische Klinik V, Sektion Rheumatologie, Heidelberg
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Diamant Thaci
- Exzellenzzentrum Entzündungsmedizin der Universität zu Lübeck, Dermatologie, Lübeck
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Harald Louis Burkhardt
- Klinikum der Johann Wolfgang Goethe-Universität, Medizinische Klinik II, Rheumatologie, Fraunhofer Institute for Molecular Biology and Applied Ecology IME, Project Group Translational Medicine & Pharmacology TMP, Frankfurt/Main
| Published: | September 1, 2015 |
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Outline
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Introduction: Osteoporosis is an important comorbidity in patients with rheumatic diseases, but risk factors for osteoporosis in Psoriatic Arthritis (PsA) patients have not been explored.
Methods: We evaluated baseline characteristics of active PsA patients enrolled in a German observational multicenter study with Adalimumab (ADA). Multiple logistic regression analyses were utilized to identify risk factors for osteoporosis. Risk factors were confirmed in a validation cohort.
Results: At baseline, 6.0% (N=88) of patients in the initial PsA cohort (N=1467) had osteoporosis as indicated by medical history. Logistic regression analyses (1194 patients with adequate data for modeling) found that age, systemic glucocorticoid use and rheumatoid factor (RF) seropositivity were significantly associated with osteoporosis. As the association between RF status and osteoporosis has not been previously described in PsA, we evaluated a second cohort of PsA patients (validation cohort; N = 1762) to determine whether this association could be verified. As in the initial cohort, positive RF status was associated with a >2-fold increase in the risk of osteoporosis in patients with PsA in the same range as use of glucocorticoids. The rate of osteoporosis was 5.4% (168/3102) in the total cohort and 12.1% (35/290) in RF-positive patients. Analysis of typical PsA-features like confirmed nail involvement, enthesitis and dactylitis and active psoriasis suggests that it is unlikely that the RF-positive PsA patients were misdiagnosed RA-cases. The full set of predictors of osteoporosis of the full cohort (2956 patients with adequate data) is shown in Table 1. Negative predictors were male gender and higher functional (FFbH) scores.
Conclusion: RF seropositivity is an independent risk factor for osteoporosis in active PsA patients. Other variables that increase the risk of osteoporosis are steroid use, older age, longer disease duration, recent hospitalization, female gender, and worse functional status.
