D'Epiro Sara, Marocco Chiara, Salvi Monica, Mattozzi Carlo, Luci Cecilia, Macaluso Laura, Giancristoforo Simona, Campoli Marco, Scarnò Marco, Migliaccio Silvia, Calvieri Stefano, Richetta Antonio
Dermatology and Venereology Policlinico Umberto I of Rome, University of Rome "Sapienza"
J Dermatol. 2014 Sep;41(9):783-7. doi: 10.1111/1346-8138.12546. Epub 2014 Jul 3.
Psoriasis is a chronic inflammatory disease associated with several comorbidities. Osteoporosis is defined as a reduction in bone mineral density with impaired bone microarchitecture. Several mechanisms may be implicated as a possible cause for the association between psoriasis and osteoporosis, such as systemic inflammation, anti-psoriatic drug intake and joint dysfunction for psoriatic arthritis (PsA). The aim of the present study was to assess bone mineral density (BMD) in patients with psoriasis, correlating the prevalence of osteopenia/osteoporosis with Psoriasis Area and Severity Index (PASI) score, mean duration of psoriatic disease, PsA and previous treatments for psoriasis. Forty-three consecutive patients with psoriasis, 19 of whom were affected by the arthropathic form, were enrolled. We evaluated the severity of psoriasis as measured by PASI score, the CASPAR criteria and ultrasounds of the joints to verify the diagnosis of PsA and the age of psoriasis onset to estimate mean disease duration. Patients underwent a bone density scan of the lumbar spine and femoral neck by dual-energy X-ray absorptiometry to measure BMD. Patients with osteopenia/osteoporosis showed a statistically significant longer average duration of psoriatic disease (17 years), compared to patients affected by psoriasis with normal T-score (8.8 years) (P = 0.04). The linear logistic regression confirms a significant relation between mean psoriatic disease duration and BMD alterations (P = 0.04). Our results suggest the necessity of an early diagnostic evaluation of bone metabolism in patients with psoriasis, especially if characterized by longer disease duration.
银屑病是一种与多种合并症相关的慢性炎症性疾病。骨质疏松症的定义是骨矿物质密度降低且骨微结构受损。银屑病与骨质疏松症之间的关联可能涉及多种机制，如全身炎症、抗银屑病药物的摄入以及银屑病关节炎（PsA）的关节功能障碍。本研究的目的是评估银屑病患者的骨矿物质密度（BMD），将骨质减少/骨质疏松症的患病率与银屑病面积和严重程度指数（PASI）评分、银屑病病程的平均时长、PsA以及既往银屑病治疗情况相关联。连续纳入了43例银屑病患者，其中19例患有关节病型银屑病。我们通过PASI评分、CASPAR标准和关节超声评估银屑病的严重程度，以核实PsA的诊断，并通过银屑病发病年龄来估算平均病程。患者接受双能X线吸收法进行腰椎和股骨颈的骨密度扫描以测量BMD。与T值正常的银屑病患者（8.8年）相比，骨质减少/骨质疏松症患者的银屑病平均病程在统计学上显著更长（17年）（P = 0.04）。线性逻辑回归证实银屑病平均病程与BMD改变之间存在显著关联（P = 0.04）。我们的结果表明，对银屑病患者进行骨代谢的早期诊断评估很有必要，尤其是病程较长的患者。
