Increased Risk of Vertebral Fracture Among Patients with Psoriatic Arthritis: A Systematic Review and Meta-analysis

Patompong Ungprasert¹, Nipith Charoenngam², Ben Ponvilawan³, Jerapas Thongpiya⁴ and Pitchaporn Yingchoncharoen³, ¹Cleveland Clinic, Cleveland Heights, OH, ²Mount Auburn Hospital, Boston, MA, ³Mahidol University, Bangkok, Thailand, ⁴Mahdiol University, Bangkok, Thailand

Meeting: ACR Convergence 2021

Keywords: Clinical Osteoporosis, Epidemiology, Fracture, meta-analysis, Psoriatic arthritis

Session Information

Date: Monday, November 8, 2021

Session Title: Spondyloarthritis Including PsA – Diagnosis, Manifestations, & Outcomes III: Comorbidities, Extra-muskuloskeletal Manifestations, & Related Conditions (1304–1328)

Session Type: Poster Session C

Session Time: 8:30AM-10:30AM

Background/Purpose: Increased risk of vertebral fracture (VF) has been documented in several autoimmune diseases as a result of excessive inflammatory burden and use of corticosteroids. The risk is well-established in several autoimmune diseases with high inflammatory burden such as rheumatoid arthritis and systemic lupus erythematosus. However, the risk among patients with autoimmune diseases of less inflammatory burden, including psoriatic arthritis (PsA), is unclear.

Methods: Potentially eligible studies were identified from MEDLINE and EMBASE database from inception to December 2020 using search strategy that comprised of terms for “Psoriatic Arthritis” and “Vertebral Fracture”. Eligible study must be cohort study that consists of one cohort of patients with PsA and another cohort of comparators without PsA. Then, the study must investigate for the prevalence of VF in both groups. Odds ratio (OR) with 95% confidence intervals (95% CIs) comparing prevalent VF between the groups or sufficient raw data to calculate this OR must be provided. Point estimates with standard errors were retrieved from each study and were combined together using the generic inverse variance method. Funnel plot was used to assess for the presence of publication bias.

Results: A total of 26,090 articles were identified. After two rounds of independent review by three investigators, five cohort studies met the eligibility criteria and were included into the meta-analysis. PsA is significantly associated with VF with the pooled odds ratio of 2.09 (95% CI, 1.11 – 3.96; I² 70%) (Figure 1). The funnel plot was fairly symmetric and was not suggestive of publication bias.

Conclusion: This systematic review and meta-analysis found a significantly increased risk of prevalent VF among patients with PsA.

Figure 1: Forest plot of this meta-analysis

Disclosures: P. Ungprasert, None; N. Charoenngam, None; B. Ponvilawan, None; J. Thongpiya, None; P. Yingchoncharoen, None.

To cite this abstract in AMA style:

Ungprasert P, Charoenngam N, Ponvilawan B, Thongpiya J, Yingchoncharoen P. Increased Risk of Vertebral Fracture Among Patients with Psoriatic Arthritis: A Systematic Review and Meta-analysis [abstract]. Arthritis Rheumatol. 2021; 73 (suppl 9). https://acrabstracts.org/abstract/increased-risk-of-vertebral-fracture-among-patients-with-psoriatic-arthritis-a-systematic-review-and-meta-analysis/. Accessed January 30, 2023.

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