Psoriasis Associated With Increased Risk of Avascular Bone Death Interview with:



Hsien-Yi Chiu, MD/
Tsen-Fang Tsai, MD

Department of Dermatology, National Taiwan University Hospital
Taipei, Taiwan What is the background for this study? What are the main findings?

Response: Psoriasis is a chronic, immune-mediated disorder, characterized by red, itchy and scaly skin patches. Over the past several years, accumulating research had shown the effects of psoriasis go far deeper than the skin and psoriasis is associated with multiple comorbidities.

Psoriasis shares the inflammatory pathways and several contributing factors with avascular necrosis (AVN), a bone disease presented with death of trabecular bone and collapse of the bony structure. However, previous studies mostly focus on evaluation the increased risk of cardiovascular diseases in patients with psoriasis. No large scale studies have previously explored a potential association between psoriasis and AVN.

Our nationwide population-based cohort study investigated this risk in 28268 patients with psoriasis registered in the Taiwan National Health Insurance Research Database. The patients were matched, by age and sex, with 113072 controls without psoriasis. Both the patients and controls were followed to identify those who subsequently diagnosed with an AVN. The results showed that psoriasis was associated with a disease severity–dependent increase in avascular necrosis risk. Moreover, AVN risk was positively associated with male sex, age younger than 30 years, corticosteroid use, severe psoriasis, and concomitant psoriatic arthritis. People with severe psoriasis were 3 times more likely to develop AVN compared with the control group. What should readers take away from your report?

Response: Psoriasis must be considered as a systemic inflammatory disease rather than an isolated skin disease. This study adds significantly to current evidence of psoriasis as a clinically relevant risk factor for AVN. 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. What recommendations do you have for future research as a result of this study?

Response: Further studies are clearly required to elucidate the molecular and cellular mechanism linking between psoriasis and AVN. We may also require more studies to answer questions, such as whether patients with psoriasis should undergo increased bone scan, or radiography screening for AVN and whether anti-psoriatic treatments may reduce the risk of AVN Is there anything else you would like to add?

Response: No disclosures. Thank you for your contribution to the community.


Increased risk of avascular necrosis in patients with psoriatic disease: A nationwide population-based matched cohort study
Chiu, Hsien-Yi et al.
Journal of the American Academy of Dermatology , Volume 0 , Issue 0 ,
Dec 13 2016
Note: Content is Not intended as medical advice. Please consult your health care provider regarding your specific medical condition and questions.

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Last Updated on January 2, 2017 by Marie Benz MD FAAD