RT Journal Article
SR Electronic
T1 Systemic evaluation of the relationship between psoriasis, psoriatic arthritis and osteoporosis: observational and Mendelian randomisation study
JF Annals of the Rheumatic Diseases
JO Ann Rheum Dis
FD BMJ Publishing Group Ltd and European League Against Rheumatism
SP 1460
OP 1467
DO 10.1136/annrheumdis-2020-217892
VO 79
IS 11
A1 Jiangwei Xia
A1 Shu-Yang Xie
A1 Ke-Qi Liu
A1 Lin Xu
A1 Pian-Pian Zhao
A1 Si-Rui Gai
A1 Peng-Lin Guan
A1 Jin-Qiu Zhao
A1 Yan-Ping Zhu
A1 Lam C Tsoi
A1 Philip E Stuart
A1 Rajan P Nair
A1 Han-Qi Yang
A1 Yu-Ting Liao
A1 Kaijing Mao
A1 Mo-Chang Qiu
A1 Zhi-Min Ying
A1 Bin Hu
A1 Zhi-Hua Yang
A1 Wei-Yang Bai
A1 Xiao-Wei Zhu
A1 Pei-Kuan Cong
A1 James T Elder
A1 Zhao-Ming Ye
A1 Bin Wang
A1 Hou-Feng Zheng
YR 2020
UL http://ard.bmj.com/content/79/11/1460.abstract
AB Objectives and methods With 432 513 samples from UK Biobank dataset, multivariable linear/logistic regression were used to estimate the relationship between psoriasis/psoriatic arthritis (PsA) and estimated bone mineral density (eBMD)/osteoporosis, controlling for potential confounders. Here, confounders were set in three ways: model0 (including age, height, weight, smoking and drinking), model1 (model0 +regular physical activity) and model2 (model1 +medication treatments). The eBMD was derived from heel ultrasound measurement. And 4904 patients with psoriasis and 847 patients with PsA were included in final analysis. Mendelian randomisation (MR) approach was used to evaluate the causal effect between them.Results Lower eBMD were observed in patients with PsA than in controls in both model0 (β-coefficient=−0.014, p=0.0006) and model1 (β-coefficient=−0.013, p=0.002); however, the association disappeared when conditioning on treatment with methotrexate or ciclosporin (model2) (β-coefficient=−0.005, p=0.28), mediation analysis showed that 63% of the intermediary effect on eBMD was mediated by medication treatment (p<2E-16). Patients with psoriasis without arthritis showed no difference of eBMD compared with controls. Similarly, the significance of higher risk of osteopenia in patients with PsA (OR=1.27, p=0.002 in model0) could be eliminated by conditioning on medication treatment (p=0.244 in model2). Psoriasis without arthritis was not related to osteopenia and osteoporosis. The weighted Genetic Risk Score analysis found that genetically determined psoriasis/PsA were not associated with eBMD (p=0.24 and p=0.88). Finally, MR analysis showed that psoriasis/PsA had no causal effect on eBMD, osteoporosis and fracture.Conclusions The effect of PsA on osteoporosis was secondary (eg, medication) but not causal. Under this hypothesis, psoriasis without arthritis was not a risk factor for osteoporosis.