Risk for Endocrine Comorbidities Increased in Psoriatic Arthritis

Patients with psoriatic arthritis (PsA) are more likely to develop endocrine disorders than the general population, according to a study published in the Journal of Rheumatology.¹

Rheumatic diseases are associated with an increased risk for endocrine disorders,² which have an immune component to their pathogenesis. For example, hypothyroidism is more common among patients with rheumatoid arthritis (RA) than among the general population.² However, data on the occurrence of endocrine disorders in patients with PsA are lacking.

Researchers evaluated the prevalence of several endocrine disorders in 3161 patients with PsA and 31,610 control patients in a retrospective study.

Compared with control patients, significantly more patients with PsA had osteoporosis (13.2% vs 9.1%; P <.0001), hypothyroidism (12.7% vs 8.6%; P <.0001), diabetes mellitus (27.9% vs 20.7%; P <.0001), and Cushing disease (0.3% vs 0.1%; P <.0001).

The prevalence of hyperthyroidism, hyperprolactinemia, hyper- and hypoparathyroidism, pituitary adenoma, acromegaly, diabetes insipidus, and Addison disease was similar between both groups.

Patients with PsA who required disease-modifying antirheumatic drug (DMARD) treatment were assumed to have more severe disease than those who did not require DMARDs.

The risk for osteoporosis only was significantly increased among patients treated with DMARDs compared with patients not receiving DMARDs (odds ratio, 1.37).

Summary & Clinical Applicability

Patients with rheumatic diseases are at higher risk of developing endocrine disorders than the general population. In a retrospective study, researchers found an increased prevalence of several endocrine disorders, including osteoporosis, hypothyroidism, diabetes, and Cushing disease, among patients with PsA.

“Physicians should be aware of these comorbidities and screen for [diabetes], hypothyroidism, and osteoporosis to provide optimal medical care to their patients with PsA. Further studies are needed to determine whether more aggressive screening of asymptomatic patients with PsA improves diagnosis and outcomes,” the researchers wrote.

Limitations

• This study was retrospective and may have been underpowered for identifying relationships between PsA and other endocrine disorders
• No data on disease activity were available, so the association between disease burden and the risk for new-onset endocrine disorders could not be evaluated

References

1. Haddad A, Ashkenazi RI, Bitterman H, et al. Endocrine comorbidities in patients with psoriatic arthritis: a population-based case-controlled study [published online April 15, 2017]. J Rheumatol. doi: 10.3899/jrheum.161274
2. Husni ME. Comorbidities in psoriatic arthritis. Rheum Dis Clin North Am 2015;41:677-698.