Objective To determine the risk of fracture and osteoporosis among patients with psoriatic arthritis (PsA) and psoriasis, compared with the general population and patients with rheumatoid arthritis (RA).
Methods A population-based cohort study was performed in The Health Improvement Network in the UK using data from 1994 to 2014. Patients aged 18–89 years with PsA or psoriasis and up to five unexposed controls matched by practice and start date within that practice were included. Patients with RA and matched controls were included for comparison. Severe psoriasis was defined by a code for psoriasis and either phototherapy or a systemic medication for psoriasis. Incidence and adjusted HRs (aHR) for fracture (all, hip, vertebral) were calculated.
Results Patients with PsA (n=9788), psoriasis (n=158 323) and controls (n=821 834) were identified. Patients with PsA had an elevated risk of all fracture aHR 1.26 (1.06 to 1.27). Patients with mild psoriasis had elevated risk of all fractures, vertebral and hip fracture: aHR 1.07 (1.05 to 1.10), 1.17 (1.03 to 1.33) and 1.13 (1.04 to 1.22). Patients with severe psoriasis had significantly elevated risk of all fracture and vertebral fracture: aHR 1.26 (1.15 to 1.39) and 2.23 (1.54 to 3.22).
Conclusions PsA and psoriasis are associated with an elevated risk for fracture.
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Handling editor Tore K Kvien
AO and LH contributed equally.
Contributors AO and LH designed the study, performed the statistical analysis, wrote the first draft of the paper and integrated feedback. DS assisted in assembling the analytic dataset. All of the coauthors assisted in interpretation of the data and provided feedback on the manuscript draft. All authors have approved the final version of the manuscript.
Funding AO is supported by NIH by K23 AR063764. JT is supported by NIAMS K23AR068433. JFB is supported by a Veterans Affairs Clinical Science Research & Development Career Development Award (IK2 CX000955). JMG is supported by NIH/NIAMS K24 AR064310. Funds to extract the data relevant for this cohort study were provided by the Rheumatology Research Foundation Preceptorship Award.
Competing interests AO has received support from an investigator-initiated research grant from Pfizer and has consulted for Novartis and Pfizer and has received payment for continuing medical education work related to psoriatic arthritis. JT has an investigator-initiated research grant from Pfizer and has received payment for continuing medical education work related to psoriasis. JMG served as a consultant for Abbvie, Astrazeneca, Celgene, Coherus, Eli Lilly, Janssen Biologics (formerly Centocor), Sanofi, Merck, Novartis, Endo, Valeant and Pfizer, receiving honoraria; and received research grants (to the Trustees of the University of Pennsylvania) from Abbvie, Amgen, Eli Lilly, Janssen, Novartis, Regeneron and Pfizer; and received payment for continuing medical education work related to psoriasis.
Ethics approval This study used de-identified patient information, and was therefore eligible for institutional review board exemption. The Cegedim Scientific Review Committee also reviewed and approved the study protocol.
Provenance and peer review Not commissioned; externally peer reviewed.
Transparency AO affirms that the manuscript is an honest, accurate and transparent account of the study being reported; no aspects of the study have been omitted. There were no deviations from the original study plan.
Data sharing statement While we are unable to share the datasets, code lists are available on request.
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