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Gastrointestinal comorbidities in patients with psoriatic arthritis

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Abstract

Comorbidities associated with psoriatic arthritis (PsA) include cardiovascular diseases, diabetes mellitus, and obesity. This study evaluated the association between PsA and common gastrointestinal (GI) diseases. A retrospective study was performed in Israel’s largest health care provider database between 2002 and 2013. 3161 PsA patients were matched for age and sex with 31610 randomly selected patients. We searched these patients’ records for the presence of peptic ulcer disease (PUD), reflux esophagitis, Crohn’s disease, ulcerative colitis, irritable bowel syndrome (IBS) and celiac disease. T-test was used to compare continuous variables and a Chi-square test was used for categorical variables. Multivariate logistic regression models were used to assess the association between PsA and GI comorbidities. PsA was associated with Crohn’s disease (OR 2.4, 95 %CI: 1.75–3.32, p < 0.0001), ulcerative colitis (OR 2.1, 95 %CI: 1.33–3.26, p = 0.001), reflux esophagitis (OR 1.6, 95 %CI: 1.44–1.78, p < 0.0001), PUD (OR 1.5, 95 %CI: 1.31–1.63, p < 0.0001) and IBS (OR 1.4, 95 %CI: 1.01–1.86, p = 0.045). After controlling for known risk factors, the association remained significant between PsA and Crohn’s disease (OR 2.2, 95 %CI: 1.59–3.03, p < 0.0001), ulcerative colitis (OR 1.9, 95 %CI: 1.21–3.00, p = 0.005), reflux esophagitis (OR 1.5, 95 %CI: 1.31–1.63, p < 0.0001), and PUD (OR 1.3, 95 %CI: 1.12–1.47, p < 0.0001). No significant association was found between PsA and celiac disease. In the current study PsA was associated with gastrointestinal morbidities including Crohn’s disease, ulcerative colitis, PUD and IBS. Physicians treating patients with PsA should be aware of these associations.

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References

  1. Armstrong EJ, Harskamp CT, Armstrong AW (2013) Psoriasis and major adverse cardiovascular events: a systematic review and meta-analysis of observational studies. J Am Heart Assoc 2:e000062. doi:10.1161/JAHA.113.000062

    Article  PubMed  PubMed Central  Google Scholar 

  2. Oliveira M de FSP de, Rocha B de O, Duarte GV (2015) Psoriasis: classical and emerging comorbidities. Ann Bras Dermatol 90:9–20. doi: 10.1590/abd1806–4841.20153038

  3. Shapiro J, Cohen AD, David M, et al. (2007) The association between psoriasis, diabetes mellitus, and atherosclerosis in Israel: a case-control study. J Am Acad Dermatol 56:629–634. doi:10.1016/j.jaad.2006.09.017

    Article  PubMed  Google Scholar 

  4. Armstrong AW, Harskamp CT, Armstrong EJ (2013) Psoriasis and the risk of diabetes mellitus: a systematic review and meta-analysis. JAMA Dermatol 149:84–91. doi:10.1001/2013.jamadermatol.406

    Article  PubMed  Google Scholar 

  5. Ogdie A, Schwartzman S, Eder L, et al. (2014) Comprehensive treatment of psoriatic arthritis: managing comorbidities and extraarticular manifestations. J Rheumatol 41:2315–2322. doi:10.3899/jrheum.140882

    Article  CAS  PubMed  Google Scholar 

  6. Helliwell PS (2004) Relationship of psoriatic arthritis with the other spondyloarthropathies. Curr Opin Rheumatol 16:344–349

    Article  PubMed  Google Scholar 

  7. Rudwaleit M, Baeten D (2006) Ankylosing spondylitis and bowel disease. Best Practice & Research Clinical Rheumatology 20:451–471. doi:10.1016/j.berh.2006.03.010

    Article  Google Scholar 

  8. Levine JS, Burakoff R (2011) Extraintestinal manifestations of inflammatory bowel disease. Gastroenterol Hepatol (N Y) 7:235–241

    Google Scholar 

  9. Binus AM, Han J, Qamar AA, et al. (2012) Associated comorbidities in psoriasis and inflammatory bowel disease. J Eur Acad Dermatol Venereol 26:644–650. doi:10.1111/j.1468-3083.2011.04153.x

    Article  CAS  PubMed  Google Scholar 

  10. Barnas JL, Ritchlin CT (2015) Etiology and pathogenesis of psoriatic arthritis. Rheum Dis Clin N Am 41:643–663. doi:10.1016/j.rdc.2015.07.006

    Article  Google Scholar 

  11. Ciccia F, Guggino G, Ferrante A, et al. (2016) Interleukin-9 overexpression and Th9 polarization characterize the inflamed gut, the synovial tissue, and the peripheral blood of patients with psoriatic arthritis. Arthritis & Rheumatology (Hoboken, NJ) 68:1922–1931. doi:10.1002/art.39649

    Article  CAS  Google Scholar 

  12. Wohl Y, Dreiher J, Cohen AD (2010) Pemphigus and osteoporosis: a case-control study. Arch Dermatol 146:1126–1131. doi:10.1001/archdermatol.2010.257

    Article  PubMed  Google Scholar 

  13. Cohen AD, Weitzman D, Birkenfeld S, Dreiher J (2010) Psoriasis associated with hepatitis C but not with hepatitis B. Dermatology (Basel) 220:218–222. doi:10.1159/000286131

    Article  Google Scholar 

  14. Dreiher J, Kresch FS, Comaneshter D, Cohen AD (2012) Risk of herpes zoster in patients with psoriasis treated with biologic drugs. J Eur Acad Dermatol Venereol 26:1127–1132. doi:10.1111/j.1468-3083.2011.04230.x

    Article  CAS  PubMed  Google Scholar 

  15. Zisman D, Bitterman H, Shalom G, et al. (2014) Psoriatic arthritis treatment and the risk of herpes zoster. Ann Rheum Dis. doi:10.1136/annrheumdis-2013-205148

    PubMed  Google Scholar 

  16. Liu J-T, Yeh H-M, Liu S-Y, Chen K-T (2014) Psoriatic arthritis: epidemiology, diagnosis, and treatment. World J Orthop 5:537–543. doi:10.5312/wjo.v5.i4.537

    Article  PubMed  PubMed Central  Google Scholar 

  17. Russolillo A, Iervolino S, Peluso R, et al. (2013) Obesity and psoriatic arthritis: from pathogenesis to clinical outcome and management. Rheumatology (Oxford) 52:62–67. doi:10.1093/rheumatology/kes242

    Article  CAS  Google Scholar 

  18. Cañete JD, Mease P (2012) The link between obesity and psoriatic arthritis. Ann Rheum Dis 71:1265–1266. doi:10.1136/annrheumdis-2012-201632

    Article  PubMed  Google Scholar 

  19. Makredes M, Robinson D, Bala M, Kimball AB (2009) The burden of autoimmune disease: a comparison of prevalence ratios in patients with psoriatic arthritis and psoriasis. J Am Acad Dermatol 61:405–410. doi:10.1016/j.jaad.2009.02.015

    Article  PubMed  Google Scholar 

  20. Perez-Alamino R, Maldonado-Ficco H, Maldonado-Cocco JA (2015) Rheumatic manifestations in inflammatory bowel diseases: a link between GI and rheumatology. Clin Rheumatol. doi:10.1007/s10067-015-3116-6

    PubMed  Google Scholar 

  21. Scher JU, Ubeda C, Artacho A, et al. (2015) Decreased bacterial diversity characterizes the altered gut microbiota in patients with psoriatic arthritis, resembling dysbiosis in inflammatory bowel disease. Arthritis & Rheumatology (Hoboken, NJ) 67:128–139. doi:10.1002/art.38892

    Article  CAS  Google Scholar 

  22. Tamboli CP, Neut C, Desreumaux P, Colombel JF (2004) Dysbiosis in inflammatory bowel disease. Gut 53:1–4

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  23. Mielants H, De Vos M, Cuvelier C, Veys EM (1996) The role of gut inflammation in the pathogenesis of spondyloarthropathies. Acta Clin Belg 51:340–349

    Article  CAS  PubMed  Google Scholar 

  24. Mielants H, Veys EM, De Vos M, et al. (1995) The evolution of spondyloarthropathies in relation to gut histology. I. Clinical aspects. J Rheumatol 22:2266–2272

    CAS  PubMed  Google Scholar 

  25. Mielants H, Veys EM, Cuvelier C, et al. (1995) The evolution of spondyloarthropathies in relation to gut histology. II. Histological aspects. J Rheumatol 22:2273–2278

    CAS  PubMed  Google Scholar 

  26. Mielants H, Veys EM, Cuvelier C, et al. (1995) The evolution of spondyloarthropathies in relation to gut histology. III. Relation between gut and joint. J Rheumatol 22:2279–2284

    CAS  PubMed  Google Scholar 

  27. Schatteman L, Mielants H, Veys EM, et al. (1995) Gut inflammation in psoriatic arthritis: a prospective ileocolonoscopic study. J Rheumatol 22:680–683

    CAS  PubMed  Google Scholar 

  28. Bandinelli F, Manetti M, Ibba-Manneschi L (2016) Occult spondyloarthritis in inflammatory bowel disease. Clin Rheumatol 35:281–289. doi:10.1007/s10067-015-3074-z

    Article  PubMed  Google Scholar 

  29. Teahon K, Smethurst P, Levi AJ, et al. (1992) Intestinal permeability in patients with Crohn’s disease and their first degree relatives. Gut 33:320–323

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  30. Vaile JH, Meddings JB, Yacyshyn BR, et al. (1999) Bowel permeability and CD45RO expression on circulating CD20+ B cells in patients with ankylosing spondylitis and their relatives. J Rheumatol 26:128–135

    CAS  PubMed  Google Scholar 

  31. Li W-Q, Han J-L, Chan AT, Qureshi AA (2013) Psoriasis, psoriatic arthritis and increased risk of incident Crohn’s disease in US women. Ann Rheum Dis 72:1200–1205. doi:10.1136/annrheumdis-2012-202143

    Article  PubMed  Google Scholar 

  32. Cojocaru M, Cojocaru IM, Silosi I, Vrabie CD (2011) Gastrointestinal manifestations in systemic autoimmune diseases. Maedica (Buchar) 6:45–51

    CAS  Google Scholar 

  33. Pellicano R (2014) Gastrointestinal damage by non-steroidal anti-inflammatory drugs: updated clinical considerations. Minerva Gastroenterol Dietol 60:255–261

    CAS  PubMed  Google Scholar 

  34. Mertz HR, Walsh JH (1991) Peptic ulcer pathophysiology. Med Clin North Am 75:799–814

    Article  CAS  PubMed  Google Scholar 

  35. Szodoray P, Alex P, Chappell-Woodward CM, et al. (2007) Circulating cytokines in Norwegian patients with psoriatic arthritis determined by a multiplex cytokine array system. Rheumatology (Oxford) 46:417–425. doi:10.1093/rheumatology/kel306

    Article  CAS  Google Scholar 

  36. Iqbal T, Zaidi MA, Wells GA, Karsh J (2013) Celiac disease arthropathy and autoimmunity study. J Gastroenterol Hepatol 28:99–105. doi:10.1111/j.1440-1746.2012.07272.x

    Article  PubMed  Google Scholar 

  37. Lauret E, Rodrigo L (2013) Celiac disease and autoimmune-associated conditions. Biomed Res Int. doi:10.1155/2013/127589

    PubMed  PubMed Central  Google Scholar 

  38. Ludvigsson JF, Lindelöf B, Zingone F, Ciacci C (2011) Psoriasis in a nationwide cohort study of patients with celiac disease. J Invest Dermatol 131:2010–2016. doi:10.1038/jid.2011.162

    Article  CAS  PubMed  Google Scholar 

  39. Ojetti V, Aguilar Sanchez J, Guerriero C, et al. (2003) High prevalence of celiac disease in psoriasis. Am J Gastroenterol 98:2574–2575. doi:10.1111/j.1572-0241.2003.08684.x

    Article  CAS  PubMed  Google Scholar 

  40. Lubrano E, Iovino P, Tremolaterra F, et al. (2001) Fibromyalgia in patients with irritable bowel syndrome. An association with the severity of the intestinal disorder. Int J Color Dis 16:211–215

    Article  CAS  Google Scholar 

  41. Salaffi F, De Angelis R, Carotti M, et al. (2014) Fibromyalgia in patients with axial spondyloarthritis: epidemiological profile and effect on measures of disease activity. Rheumatol Int 34:1103–1110. doi:10.1007/s00296-014-2955-9

    PubMed  Google Scholar 

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Author information

Authors and Affiliations

  1. The Ruth and Bruce Rappaport Faculty of Medicine, Technion, Haifa, Israel

    Ariel Zohar, Haim Bitterman & Devy Zisman

  2. Central Headquarters, Clalit Health Services, Tel Aviv, Israel

    Arnon Dov Cohen, Haim Bitterman, Ilan Feldhamer, Sari Greenberg-Dotan, Doron Comanesther & Erez Batat

  3. Siaal Research Center for Family Medicine and Primary Care, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheba, Israel

    Arnon Dov Cohen

  4. Department of Community Medicine and Epidemiology, Carmel Medical Center, Haifa, Israel

    Idit Lavi

  5. Department of Rheumatology, Carmel Medical Center, 7 Michal Street, 34362, Haifa, Israel

    Devy Zisman

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  1. Ariel Zohar
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  2. Arnon Dov Cohen
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Correspondence to Devy Zisman.

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The authors declared no conflict of interest.

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Ariel Zohar and Arnon Dov Cohen contributed equally to the manuscript.

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Zohar, A., Cohen, A.D., Bitterman, H. et al. Gastrointestinal comorbidities in patients with psoriatic arthritis. Clin Rheumatol 35, 2679–2684 (2016). https://doi.org/10.1007/s10067-016-3374-y

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  • DOI: https://doi.org/10.1007/s10067-016-3374-y

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