People with psoriasis are at an increased risk of avascular necrosis.
Psoriasis is a chronic, inflammatory skin disease mediated by pro-inflammatory cytokines. Although many chronic inflammatory disorders are associated with increased risk of AVN. there is a paucity of evidence that links psoriasis and AVN. Given the similar mechanisms proposed for pathogenesis and the shared comorbidities between these disorders, the purpose of this study was to assess the risk of AVN in a cohort of patients with psoriasis.
The study retrospectively investigated the incidence of AVN in a population-based cohort of over 28 000 patients with psoriasis and over 110 000 age- and sex-matched controls. At the conclusion of the study, psoriasis was associated with an increased risk of AVN. The results of this study demonstrate that psoriatic patients with localized pain in a weight bearing joint may require further evaluation for AVN, especially with a history of corticosteroid use. This study is strengthened by the use of a large, nationally representative, population-based cohort that was matched with respect to age, sex, and medical history of diabetes mellitus, hip fracture, and alcohol dependence. However, this study was limited by the lack of matching of patients and controls for hyperlipidemia, kidney transplantation, hypertension, cardiovascular disease, obesity, chronic kidney disease, medication use (including bisphosphonates and corticosteroids), as well as other confounders which were not documented in the database. Multi-center prospective trials that control for these AVN risk factors may improve the validity of the study.
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