Weather and Arthritis
How Psoriatic Arthritis Raises Your Risk for Osteoporosis
Steroid treatment for psoriatic arthritis can put you at risk for osteoporosis, but there are ways to prevent bone loss.
By Elizabeth Connor
Medically Reviewed by Sanjai Sinha, MD
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People with psoriatic arthritis run a higher risk of developing osteoporosis, a disease that causes bones to thin and weaken. Bone loss may be a direct effect of psoriatic arthritis or a side effect of corticosteroid drugs often used in psoriatic arthritis treatment.
Psoriatic arthritis patients tend to have much lower-than-average bone mineral density regardless of gender, menopausal status in females, or age. In one study of people with psoriatic arthritis who had never received steroid treatment, two-thirds of premenopausal women had lost bone density in at least one area. A similar condition was found in all of the postmenopausal women and 80 percent of the men studied. This decreased bone density was not related to the length of time since they were diagnosed with psoriatic arthritis or the severity of their joint inflammation.
How Corticosteroids Are Used
If the symptoms of psoriatic arthritis are not too severe, a physician will usually suggest a nonsteroidal anti-inflammatory drug (NSAID) such as ibuprofen (Motrin, Advil) at first. If that doesn't help or the joint pain and swelling worsens, corticosteroids may be prescribed.
A group of drugs similar to hormones produced naturally by the body (and not to be confused with the anabolic steroids that are sometimes misused by athletes), corticosteroids are very helpful in treating a variety of health conditions, including psoriatic arthritis. Corticosteroids can be given by injection or taken in pill form. For psoriatic arthritis pain relief, an intra-articular injection — meaning directly into the joint — is the most common way to receive the drug.
A study published in the May-June 2013 issue of the Indian Journal of Dermatology found that although the use of corticosteroids in psoriasis has been criticized for exacerbating the condition on withdrawal, the supervision of how the drugs are used, even in low doses, combined with disease-modifying antirheumatic drugs (DMARDs) “may be a good therapeutic option in early stage of the PsA rather than steroid rescue later.” Oral corticosteroid drugs are frequently used for rheumatoid arthritis, which is similar in some ways to psoriatic arthritis, and some doctors may include them in a treatment plan for psoriatic arthritis.
Oral corticosteroids for psoriatic arthritis can be given for varying lengths of time, and with different time intervals between treatments. Corticosteroids injected into a painful joint may need to be repeated multiple times or given in more than one joint.
Generally, the longer a person takes oral treatment or gets corticosteroid injections, the more likely there will be side effects. Corticosteroids slow the growth of bone in the body and interfere with key processes in the development of bone. Anyone using them for more than three months faces the risk of corticosteroid-induced osteoporosis.
“Systemic corticosteroids are the Dr. Jekyll and Mr. Hyde of medicine in that they can be a very effective and efficient means to improve pain, mobility and function in psoriatic arthritis,” says Neha Shah, MD, a rheumatologist and clinical instructor in the department of Immunology and Rheumatology at Stanford Health Care in Palo Alto, California. “However they should be used judiciously to minimize the many potential adverse effects including osteoporosis, an increased risk of infections, weight gain, diabetes, mood and sleep disturbance, elevated blood pressure, high cholesterol, glaucoma, cataracts, thinning of the skin and more.”
The American College of Rheumatology identifies a number of factors that increase your risk for corticosteroid-induced osteoporosis:
- Age, especially if you're over 50
- Caucasian or Asian background
- Slight build
- Not getting enough calcium and vitamin D
- Not getting enough exercise, especially weight-bearing activities
- Having a relative with osteoporosis
- Personal history of bone fracture
- Lower than normal level of sex hormones, such as in post-menopausal women
- Anorexia nervosa
- Excessive alcohol consumption
- Use of other medications, including heparin and certain anti-convulsion drugs
If your psoriatic arthritis treatment includes either oral or intra-articular corticosteroids, there are steps you can take to help avoid corticosteroid-induced osteoporosis:
- At the top of the list, be sure you are getting at least 1,000 to 1,500 milligrams of calcium and 400 to 800 IU of vitamin D daily.
- Although you may be in pain, avoid being completely sedentary — talk with your doctor about ways to work in some weight-bearing exercise every day.
- Ask about getting regular bone-density testing to identify osteoporosis in its early stages (known as osteopenia).
- To prevent or treat corticosteroid-induced osteoporosis, talk to your doctor about taking one of the medications known as bisphosphonates, in particular Fosamax (alendronate) or Actonel (risedronate). A study published in December 2014 in the American Journal of Health-System Pharmacists found that bisphosphonates do not pose a high risk of fetal or neonatal harm. However, it noted that in cases of suspected fetal exposure, newborns should be monitored for hypocalcemia (lower-than-average calcium levels), as well as for neuromuscular and cardiac symptoms. (Women who are pregnant or may become pregnant should discuss taking bisphosphonates with their doctor.)
If corticosteroids are part of your psoriatic arthritis treatment plan, talk to your doctor about the risks and ways to avoid potential complications so you can do your best to keep from developing corticosteroid-induced osteoporosis.
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