Psoriasis associated with risk for avascular necrosis
Patients with psoriasis had a significant risk for avascular necrosis, which increased with disease severity of psoriasis, according to study results recently published in the Journal of the American Academy of Dermatology.
Researchers identified 28,268 outpatients and inpatients (mean age, 46.12 years) with new-onset psoriasis diagnosed between 2004 and 2006 using data from the Taiwan National Health Insurance Research Database. The patients were matched with 113,072 controls without psoriasis (mean age, 45.96 years) from the Taiwan Longitudinal Health Insurance Database 2000.
Compared with controls, patients with psoriasis had a significantly higher unadjusted risk (hazard ratio = 2.29) and a higher adjusted risk (HR = 1.96; 95% CI, 1.62-2.38) for avascular necrosis (AVN), “a progressively debilitating musculoskeletal disease caused by the death of cellular elements of the bone,” the researchers wrote.
There was a relationship between psoriasis severity and increased risk for AVN. Patients with psoriatic arthritis (adjusted HR = 4.34; 95% CI, 1.80-10.45) had a higher risk for AVN compared with patients without psoriatic arthritis (adjusted HR = 1.88; 95% CI, 1.55-2.29).
There was a higher risk for AVN among men with psoriasis (adjusted HR = 2.2; 95% CI, 1.77-2.72) compared with women with psoriasis (adjusted HR = 1.3; 95% CI, 0.84-1.99).
Patients younger than 30 years also had a higher risk for AVN compared with patients in other age groups (adjusted HR = 2.64; 95% CI, 1.24-5.61).
“The results of this large-scale epidemiological study indicate that psoriasis is associated with increased risk of AVN,” the researchers concluded. “The development of AVN in patients with psoriasis was multifaceted and many factors seem to be at play. Thus, clinicians should maintain a high index of suspicion for patients presenting with localized pain in a weight-bearing joint. To minimize the risk of developing AVN, cautious use of corticosteroids, whether systemic or topical, is recommended.” – by Bruce Thiel
Disclosure: Chiu reports no relevant financial disclosures. Please see the full study for a list of other researchers’ relevant financial disclosures.