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Bone erosions, enthesiophytes enhanced in PsA
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Bone erosions are more dependent on a patient’s age and are enhanced in psoriatic arthritis, whereas enthesiophytes are more dependent on disease duration and are severe in both psoriasis and psoriatic arthritis, according to findings published in Arthritis Research & Therapy.
“A systemic disease with anabolic changes, enthesiophytes starts early in patients with psoriasis, which could be missed by physicians,” Juergen Rech, PD, Dr. med, of the Erlangen University Hospital, Germany, told Healio Rheumatology. “However, these changes are not age dependent, but increase with disease duration. Catabolic changes are strongly age-dependent among PsA patients. Erosive damage also accumulates with longer disease duration.”
To evaluate catabolic and anabolic bone changes in patients with PsA, those with psoriasis and in healthy controls, and to analyze the impact of age and disease duration, the researchers recruited participants from the University of Erlangen-Nuremberg and the Erlangen Imaging Cohort. The cohort, which included patients from the university’s rheumatology department, prospectively studied bone composition in healthy controls and patients with arthritis. Rech and colleagues analyzed 203 patients: 101 with PsA, 55 with psoriasis, and 47 healthy controls.
All participants had their dominant hand scanned using HR-pQCT. The researchers evaluated and analyzed bone erosions and enthesiophytes in terms of various age categories and disease duration. In addition, the researchers collected demographic and disease-specific data from each participant using a health assessment questionnaire.
According to the researchers, patients with PsA had significantly more (P=.002) and larger (P=.003) erosions, as well as enthesiophytes (P<.001), compared with those with psoriasis or the control group. Although bone erosions were similar among participants in both the psoriasis and control groups, enthesiophytes were more frequent in patients with psoriasis. In all three groups, erosions, but not enthesiophytes, demonstrated a strong dependency on age. However, enthesiophytes were mostly influenced by disease duration. In addition, bone erosions were associated with poorer physical function.
“The systemic disease starts really early, although it is maybe not always clinical visible,” Rech said. “We as rheumatologists, but also dermatologists, should think about starting an adequate systemic treatment approach as early as possible to have a chance to avoid structural damage and, with that, the progression of the disease.” – by Jason Laday
Disclosure: Rech reports no relevant financial disclosures. Please see the study for all other authors’ relevant financial disclosures.
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