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Endocrine Comorbidities in Patients with Psoriatic Arthritis: A Population-based Case-controlled Study
Amir Haddad1,2, Ron Ilan Ashkenazi1,2, Haim Bitterman1,2
1From the Department of Rheumatology, and the Department of Internal Medicine, and the Department of Community Medicine and Epidemiology, Carmel Medical Center; Bruce and Ruth Rappaport Faculty of Medicine Technion, Haifa; Chief Physician's Office, Central Headquarters, Clalit Health Services, Tel Aviv; Siaal Research Center for Family Medicine and Primary Care, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheba, Israel.
Objective:
To investigate endocrine comorbidities in patients with psoriatic arthritis (PsA).
Methods:
A retrospective, cross-sectional study was performed with the database of Clalit Health Services, the largest healthcare provider in Israel, between 2002 and 2014. Patients with PsA were identified and matched by age and sex to healthy controls. The following morbidities were analyzed: hypo/hyperthyroidism, hypo/hyperparathyroidism, hyperprolactinemia, Cushing disease, Addison disease, diabetes insipidus, diabetes mellitus (DM), pituitary adenoma, acromegaly, and osteoporosis. Descriptive statistics were applied. The associations between PsA and endocrine comorbidities were analyzed by univariable and multivariable analysis.
Results:
The study included 3161 patients with PsA, 53.4% women, mean age 58.4 ± 15.4 years, and 31,610 controls. Comparative analyses yielded higher proportion of hypothyroidism (12.7% vs 8.6%, p < 0.0001), Cushing disease (0.3% vs 0.1%, p < 0.0001), osteoporosis (13.2% vs 9.1%, p < 0.0001), and DM (27.9% vs 20.7%, p < 0.0001) in the PsA group compared with the control group. In the multivariable regression analysis, the following diseases were more frequent in the PsA group: hypothyroidism (OR 1.61, 95% CI 1.47-1.81), DM (OR 1.35, 95% CI 1.18-1.42), Cushing disease (OR 3.96, 95% CI 1.67-9.43), and osteoporosis (OR 1.56, 95% CI 1.37-1.78).
Conclusion:
PsA is associated with a high frequency of hypothyroidism, osteoporosis, DM, and Cushing disease. Awareness of these comorbidities may help physicians provide the optimal medical care to patients with PsA.