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Xia J, Xie SY, Liu KQ, Xu L, Zhao PP, Gai SR, Guan PL, Zhao JQ, Zhu YP, Tsoi LC, Stuart PE, Nair RP, Yang HQ, Liao YT, Mao K, Qiu MC, Ying ZM, Hu B, Yang ZH, Bai WY, Zhu XW, Cong PK, Elder JT, Ye ZM, Wang B, Zheng HF. Systemic evaluation of the relationship between psoriasis, psoriatic arthritis and osteoporosis: observational and Mendelian randomisation study. Ann Rheum Dis 2020; 79:1460-1467. [PMID: 32737104 PMCID: PMC7970448 DOI: 10.1136/annrheumdis-2020-217892] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2020] [Revised: 06/28/2020] [Accepted: 06/29/2020] [Indexed: 02/03/2023]
Abstract
OBJECTIVES AND METHODS With 432 513 samples from UK Biobank dataset, multivariable linear/logistic regression were used to estimate the relationship between psoriasis/psoriatic arthritis (PsA) and estimated bone mineral density (eBMD)/osteoporosis, controlling for potential confounders. Here, confounders were set in three ways: model0 (including age, height, weight, smoking and drinking), model1 (model0 +regular physical activity) and model2 (model1 +medication treatments). The eBMD was derived from heel ultrasound measurement. And 4904 patients with psoriasis and 847 patients with PsA were included in final analysis. Mendelian randomisation (MR) approach was used to evaluate the causal effect between them. RESULTS Lower eBMD were observed in patients with PsA than in controls in both model0 (β-coefficient=-0.014, p=0.0006) and model1 (β-coefficient=-0.013, p=0.002); however, the association disappeared when conditioning on treatment with methotrexate or ciclosporin (model2) (β-coefficient=-0.005, p=0.28), mediation analysis showed that 63% of the intermediary effect on eBMD was mediated by medication treatment (p<2E-16). Patients with psoriasis without arthritis showed no difference of eBMD compared with controls. Similarly, the significance of higher risk of osteopenia in patients with PsA (OR=1.27, p=0.002 in model0) could be eliminated by conditioning on medication treatment (p=0.244 in model2). Psoriasis without arthritis was not related to osteopenia and osteoporosis. The weighted Genetic Risk Score analysis found that genetically determined psoriasis/PsA were not associated with eBMD (p=0.24 and p=0.88). Finally, MR analysis showed that psoriasis/PsA had no causal effect on eBMD, osteoporosis and fracture. CONCLUSIONS The effect of PsA on osteoporosis was secondary (eg, medication) but not causal. Under this hypothesis, psoriasis without arthritis was not a risk factor for osteoporosis.
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Affiliation(s)
- Jiangwei Xia
- Diseases & Population (DaP) Geninfo Lab, School of Life Sciences, Westlake University, 18 Shilongshan Road, Hangzhou, Zhejiang, 310024, China,Instituteof Basic Medical Sciences, Westlake Institute for Advanced Study, 18 Shilongshan Road, Hangzhou, Zhejiang, 310024, China
| | - Shu-Yang Xie
- Binzhou Medical University, Yantai, Shandong, 264003, China
| | - Ke-Qi Liu
- Jiangxi Medical College, Shangrao, Jiangxi, China
| | - Lin Xu
- Binzhou Medical University, Yantai, Shandong, 264003, China
| | - Pian-Pian Zhao
- Diseases & Population (DaP) Geninfo Lab, School of Life Sciences, Westlake University, 18 Shilongshan Road, Hangzhou, Zhejiang, 310024, China,Instituteof Basic Medical Sciences, Westlake Institute for Advanced Study, 18 Shilongshan Road, Hangzhou, Zhejiang, 310024, China
| | - Si-Rui Gai
- Diseases & Population (DaP) Geninfo Lab, School of Life Sciences, Westlake University, 18 Shilongshan Road, Hangzhou, Zhejiang, 310024, China,Instituteof Basic Medical Sciences, Westlake Institute for Advanced Study, 18 Shilongshan Road, Hangzhou, Zhejiang, 310024, China
| | - Peng-Lin Guan
- Diseases & Population (DaP) Geninfo Lab, School of Life Sciences, Westlake University, 18 Shilongshan Road, Hangzhou, Zhejiang, 310024, China,Instituteof Basic Medical Sciences, Westlake Institute for Advanced Study, 18 Shilongshan Road, Hangzhou, Zhejiang, 310024, China
| | - Jin-Qiu Zhao
- The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Yan-Ping Zhu
- Binzhou Medical University, Yantai, Shandong, 264003, China
| | - Lam C. Tsoi
- Department of Dermatology, University of Michigan, Ann Arbor, Michigan, United States,Department of Biostatistics, Center for Statistical Genetics, University of Michigan, Ann Arbor, Michigan, United States
| | - Philip E. Stuart
- Department of Dermatology, University of Michigan, Ann Arbor, Michigan, United States,Department of Biostatistics, Center for Statistical Genetics, University of Michigan, Ann Arbor, Michigan, United States
| | - Rajan P. Nair
- Department of Dermatology, University of Michigan, Ann Arbor, Michigan, United States,Department of Biostatistics, Center for Statistical Genetics, University of Michigan, Ann Arbor, Michigan, United States
| | - Han-Qi Yang
- School of Public Health, Boston University, Boston, Massachusetts, 02118, United States
| | - Yu-Ting Liao
- School of Public Health and Management, Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Kaijing Mao
- School of Cellular and Molecular Medicine, University of Bristol, Bristol, United Kingdom
| | - Mo-Chang Qiu
- Jiangxi Medical College, Shangrao, Jiangxi, China
| | - Zhi-Min Ying
- Department of Orthopedic Surgery, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, 310009, China
| | - Bin Hu
- Department of Orthopedic Surgery, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, 310009, China
| | - Zhi-Hua Yang
- Department of Orthopedic Surgery, Zhejiang Xiaoshan hospital, Hangzhou, Zhejiang, China
| | - Wei-Yang Bai
- Diseases & Population (DaP) Geninfo Lab, School of Life Sciences, Westlake University, 18 Shilongshan Road, Hangzhou, Zhejiang, 310024, China,Instituteof Basic Medical Sciences, Westlake Institute for Advanced Study, 18 Shilongshan Road, Hangzhou, Zhejiang, 310024, China
| | - Xiao-Wei Zhu
- Diseases & Population (DaP) Geninfo Lab, School of Life Sciences, Westlake University, 18 Shilongshan Road, Hangzhou, Zhejiang, 310024, China,Instituteof Basic Medical Sciences, Westlake Institute for Advanced Study, 18 Shilongshan Road, Hangzhou, Zhejiang, 310024, China
| | - Pei-Kuan Cong
- Diseases & Population (DaP) Geninfo Lab, School of Life Sciences, Westlake University, 18 Shilongshan Road, Hangzhou, Zhejiang, 310024, China,Instituteof Basic Medical Sciences, Westlake Institute for Advanced Study, 18 Shilongshan Road, Hangzhou, Zhejiang, 310024, China
| | - James T. Elder
- Department of Dermatology, University of Michigan, Ann Arbor, Michigan, United States,Ann Arbor Veterans Affairs Hospital, Ann Arbor, Michigan, United States
| | - Zhao-Ming Ye
- Department of Orthopedic Surgery, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, 310009, China
| | - Bin Wang
- Binzhou Medical University, Yantai, Shandong, 264003, China
| | - Hou-Feng Zheng
- Diseases & Population (DaP) Geninfo Lab, School of Life Sciences, Westlake University, 18 Shilongshan Road, Hangzhou, Zhejiang, 310024, China,Instituteof Basic Medical Sciences, Westlake Institute for Advanced Study, 18 Shilongshan Road, Hangzhou, Zhejiang, 310024, China
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