Fragility Fractures in Psoriatic Arthritis Patients: A Matched-Control Study

Luciano Fernando Lo Giudice¹, Marina Scolnik², Florencia Pierini³, Nicolas Martin Marin Zucaro¹, John Fredy Jaramillo Gallego¹ and Enrique R Soriano², ¹Rheumatology Unit, Internal Medicine Service, Hospital Italiano de Buenos Aires, Capital Federal, Argentina, ²Rheumatology Unit, Internal Medicine Service. Hospital Italiano Buenos Aires. Argentina, Buenos Aires, Argentina, ³Rheumatology Unit, Internal Medicine Service, Hospital Italiano de Buenos Aires, CABA, Argentina

Meeting: 2018 ACR/ARHP Annual Meeting

Keywords: Fracture risk, glucocorticoids, osteoporosis, Psoriatic arthritis and spondylarthritis

Session Information

Date: Monday, October 22, 2018

Title: Spondyloarthritis Including Psoriatic Arthritis – Clinical Poster II: Clinical/Epidemiology Studies

Session Type: ACR Poster Session B

Session Time: 9:00AM-11:00AM

Background/Purpose: patients with Psoriatic Arthritis (PsA) in spite of having bone production as one of their characteristic features, very often have osteoporosis, but scarce data is available on fracture risk. Our objective was to compare incidence of osteoporotic fractures in PsA patients diagnosed after year 2000 with matched controls from a university hospital-based health management organization (HMO).

Methods: Consecutive PsA patients diagnosed after year 2000, from the HMO, were matched (age and sex) with controls (1:2). The follow-up period began at the first medical claim at the HMO. Subjects were then followed until they voluntarily left the HMO, a fracture occurred, the end of study (May 1st 2018), or death. Electronic medical records were reviewed and demographic, clinical and treatment data were collected. Incidence rates per 1000 persons-years (PY) of distinct types of fractures after index dates were calculated and compared between groups. A multivariate cox regression analysis was performed to investigate determinants of fractures.

Results: 92 PsA patients were included. Patients characteristics are shown in table 1. 92 PsA patients contributed with 788.2 PY of follow up, and 184 controls contributed 1718.4 PY. Media age at psoriasis and PsA diagnosis was 34.5 years (SD 19.3) and 49.1 years (SD 17.7) respectively. 8.7 % (95% CI 4.4-16.5) of PsA patients had axial involvement. 84.6 % (95% CI 75.5-90.8) of PsA patients were treated with conventional DMARDs and 29.7% (95% CI 21.1-40.0) received biologic treatment. Topical corticosteroids were used by 60.9% (95% CI 50.5-70.4) of PsA patients and 22.8% (95% CI 15.3-32.6) received oral corticosteroids. No difference was found in the overall fracture incidence rate per 1000 PY between PsA and controls (10.2, 95% CI 5.1-19.3, vs 8.7, 95% CI 5.2-13.9, p 0.36). Vertebral fractures were more frequent in PsA patients with an incidence rate of 10.2 per 1000 persons-years (95% CI 5.1-19.3) versus 4.6 per 1000 persons-years in the control group (95% CI 2.4-9.2), but it did not reach statistical significance (p=0.06). In the Cox regression analysis, after adjusting for biphosphonate use, only age (HR 1.10, 1.05-1.16, p < 0.001) and a female sex (HR 3.94, 1.11-13.91, p =0.03) were associated with fractures while PsA diagnosis and use of corticosteroids were not.

Conclusion: in this cohort of PsA patients diagnosed after year 2000, no overall increased risk of fractures was found in comparison with matched controls. This may be due to a rational use of corticosteroids.

	PsA patients (n=92)	Controls (n=184)	p
Mean Age at first HMO claim, years , (SD)	50.2 (16.2)	48.5 (16.0)	0.41
Female, n (%)	44 (47.8)	88 (47.8)	1
Median Follow up , years, (IQR)	8.8 (5.6-11.9)	10.1 (4.8-13.8)	0.19
BMI <20, n (%, 95% CI)	1 (1.1, 0.2-7.7)	4 (2.3, 0.9-6.1)	0.49
Ever Smoker, n (%, 95% CI)	42 (50.0, 39.3-60.6)	75 (43.1, 35.9-50.6)	0.29
BMD ever, n (%, CI)	22 (23.9, 16.2-33.8)	46 (25.0, 19.2-31.8)	0.84
Topical steroids > 3 months, n (%,95% CI)	56 (60.9, 50.5-70.4)	7 (3.8, 1.8-7.8)	<0.001
Oral Corticosteroid use, ever, n (%, 95% CI)	21 (22.8, 15.3-32.6)	6 (3.3, 1.5-7.1)	<0.001
Biphosphonate use, n (%, 95% CI)	6 (6.5, 2.9-13.9)	13 (7.1, 4.1-11.8)	0.87
Prior fracture, n (%, 95% CI)	0	7 (3.8, 1.8-7.8)	0.06
Any fracture, n (%, 95% CI)	8 (8.7, 4.4-16.5)	15 (8.2, 4.9-13.1)	0.88
Any fracture, incidence rate per 1000 persons-years (95% CI)	10.2 (5.1-19.3)	8.7 (5.2-13.9)	0.36
Vertebral fracture, n (%, 95% CI)	8 (8.7, 4.4-16.5)	8 (4.3, 2.2-8.5)	0.14
Vertebral fracture, incidence rate per 1000 persons-years (95% CI)	10.2 (5.1-19.3)	4.6 (2.4-9.2)	0.06
Radius fracture, n (%, 95% CI)	1 (1.1, 0.1-7.4)	7 (3.8, 1.8-7.8)	0.21
Radius fracture, incidence rate per 1000 persons-years (95% CI)	1.27 (0.1-8.5)	4.1 (1.9-8.4)	0.14
Rib fracture, n (%, 95% CI)	0	3 (1.6, 0.5-4.9)	0.22
Rib fracture, incidence rate per 1000 persons-years (95% CI)	0	1.7 (0.5-5.3)	0.16
Hip fracture, n (%, 95% CI)	1 (1.1, 0.1-7.4)	1 (0.5, 0.1-3.8)	0.62
Hip fracture, incidence rate per 1000 persons-years (95% CI)	1.27 (0.1-8.5)	0.6 (0.1-4.4)	0.31
Pelvis fracture, n (%, 95% CI)	0	2 (1.1	0.32
Pelvis fracture, incidence rate per 1000 persons-years, (95% CI)	0	1.2 (0.3-4.5)	0.24

Disclosure: L. F. Lo Giudice, None; M. Scolnik, None; F. Pierini, None; N. M. Marin Zucaro, None; J. F. Jaramillo Gallego, None; E. R. Soriano, AbbVie, Bristol-Myers Squibb, GSK, Janssen, Novartis, Pfizer Inc, Roche, UCB, 2,AbbVie, Bristol-Myers Squibb, Eli Lilly, GSK, Janssen, Novartis, Pfizer Inc, Roche, Sanofi, UCB, 5,AbbVie, Bristol-Myers Squibb, Eli Lilly, Janssen, Novartis, Pfizer Inc, Roche, Sandoz, UCB, 8.

To cite this abstract in AMA style:

Lo Giudice LF, Scolnik M, Pierini F, Marin Zucaro NM, Jaramillo Gallego JF, Soriano ER. Fragility Fractures in Psoriatic Arthritis Patients: A Matched-Control Study [abstract]. Arthritis Rheumatol. 2018; 70 (suppl 9). https://acrabstracts.org/abstract/fragility-fractures-in-psoriatic-arthritis-patients-a-matched-control-study/. Accessed .

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