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Here is an interesting large cohort study that looked at the use non-steroidal anti-inflammatory drugs (NSAIDs) and the increased risk of psoriatic arthritis, it suggests that long term use may increase the risk of psoriatic arthritis.
Source: medicaljournals.se
Quote:
Study population:
The NHS II was established in 1989 when 116,430 registered female nurses aged 25–42 years were enrolled using a mailed baseline questionnaire which inquired about medical history and lifestyle practices. Biennially, cohort members receive a questionnaire enquiring about diseases and health-related factors. The follow-up rate exceeds 90% for each cycle. The institutional review board of Partners Health Care System approved this study. The completion and return of the self-administered questionnaire was considered as informed consent.
Ascertainment of psoriasis and psoriatric arthritis cases:
In 2005, women in the NHS II were asked if they had personal history of clinician-diagnosed psoriasis and the date of diagnosis (before 1991, 1991–1994, 1995–1998, 1999–2002, or 2003–2005) on the biannual questionnaire. During 2008–2011, we confirmed self-reported psoriasis using Psoriasis Screening Tool (PST) questionnaire, which inquired about the type of clinicians making the diagnosis and phenotypes (23). A pilot study using the PST showed 99% sensitivity and 94% specificity for psoriasis screening (23). Diagnosis of psoriasis with concomitant PsA was confirmed using psoriatic arthritis screening and evaluation (PASE) questionnaire, which includes a symptom scale with 7 items and a function scale with 8 items (24). Women chose one of 5 categories relating to agreement (strongly agree to strongly disagree) for each item. A total score of 47 or greater has been shown to identify PsA with a high sensitivity and specificity in our pilot study (24, 25). PASE has good test–retest reliability (25), and has been shown to be an effective tool in identifying PsA cases with 77% sensitivity and 79% specificity in the present cohort (26).
Assessment of medication use:
Cohort participants were asked about regular use (defined as ≥ 2 times/week) of aspirin, other NSAIDs, and acetaminophen (paracetamol) on baseline questionnaire in 1989. Since 1993, regular use of these medications during the past two years was assessed biennially. Information on average weekly dose (0, 1–2 tablets/week, 3–5 tablets/week, 6–14 tablets/week, and ≥ 15 tablets/week) of these medications during the past two years was first collected in 1999, and updated biennially thereafter. In 2001 and 2003, we also asked women about weekly dose of low-dose (baby) aspirin. Intake of 4 baby aspirin was converted to 1 adult standard-dose tablet (325 mg) as previously documented (27). We estimated duration of use by using the starting duration in 1989 and updating this variable according to the duration of use on each subsequent biennial questionnaire (18). We categorized medication use according to regular use status, duration, and weekly dose (27–29).
Results:
During 1,321,280 person-years of follow-up from 1991 to 2005, we documented a total of 646 incident psoriasis cases and 165 concomitant PsA cases. Regular acetaminophen users were at a higher risk of developing psoriasis (age-adjusted HR 1.29, 95% CI: 1.08–1.54) or psoriasis with concomitant PsA (age-adjusted HR 2.23, 95% CI: 1.63–3.07) when compared to non-regular users. Regular NSAIDs users were also more likely to develop psoriasis (age-adjusted HR 1.26, 95% CI: 1.06–1.49) or PsA (age-adjusted HR 1.74, 95% CI: 1.26–2.40) when compared to non-regular users.
Conclusion:
In this large, prospective cohort study, we found that regular acetaminophen (paracetamol) use may be associated with an increased risk of psoriasis with concomitant PsA in women, and women who used this medication more than 10 years were at a substantially increased risk of developing PsA. Although the association between regular NSAIDs use and risk of PsA was of marginal significance, analysis by duration suggested that women who used NSAIDs for long durations were also more likely to develop PsA. The efficacy of NSAIDs in treating PsA may need to be assessed more thoroughly, and special attention on psoriasis and PsA screening may be needed for those who are prescribed for acetaminophen and NSAIDs for long-term periods.
We are deeply indebted to the participants and staff of the Nurses’ Health Study II for their valuable contributions. This work was supported by the Department of Dermatology, Brigham and Women’s Hospital, Boston, Massachusetts and NIH grant R01 CA50385. The funding sources did not involve in the data collection, data analysis, manuscript writing and publication.
Competing interests: AAQ serves as a consultant for Abbott, Centocor, Novartis and the Centres for Disease Control and Prevention. The other authors declare no conflict of interest.
Source: medicaljournals.se
