Abstract
Both in ankylosing spondylitis (ASP) and psoriatic arthritis (PsA), osteopenia is present in one-third of women and men, whereas osteoporosis mainly affects men, even in their 30 s. Subclinical gut inflammation has been described in patients with AS or PsA. Joint involvement also occurs with other gastrointestinal diseases such as celiac disease. We tested the hypothesis, whether elevated serum levels of human anti-tissue-transglutaminase-IgA (htTG) are associated with changes in disease activity, vitamin D metabolism and bone mineral density (BMD) in patients with ASP and PsA. In a cross-sectional study, we evaluated both biochemical markers of bone turnover, BMD and htTG in 76 patients with ASP and 120 patients with PsA. A reduction of BMD in lumbar spine was determined both in ASP (42.7%) and in PsA (57.3%). Furthermore, a significantly higher prevalence of htTG was detected only in ASP (14/76). ASP patients with negative htTG status have significant higher 25-vitamin D3 levels. ASP patients with positive htTG status are younger. A positive htTG status entails the risk of a bad vitamin D supply, which should be considered in young patients since this constellation favors a reduction in bone density. The coincidence of ASP along with detection of htTG and clinically asymptomatic celiac disease as an accessory source of inflammation with a negative influence on the bone metabolism is also conceivable. Clinicians need to be aware of patients younger than 45 years with ASP, which have important implications for the correct treatment and vitamin D supplementation.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
References
Will R, Palmer R, Bhalla AK, Ring F, Calin A (1989) Osteoporosis in early ankylosing spondylitis: a primary pathological event? Lancet 2(8678–8679):1483–1485
Bhalla AK, Shenstone B (1992) Bone densitometry measurements in early inflammatory disease Baillieres. Clin Rheumatol 6(2):405–414
Reid DM, Kennedy NS, Nicoll J, Smith MA, Tothill P, Nuki G (1986) Total and peripheral bone mass in patients with psoriatic arthritis and rheumatoid arthritis. Clin Rheumatol 5(3):372–378
Harrison BJ, Olver JS, Norman TR, Nathan PJ (2002) Assessing periarticular bone mineral density in patients with early psoriatic arthritis or rheumatoid arthritis. Ann Rheum Dis 61(11):1007–1011
Zonneveld IM, Bakker WK, Dijkstra PF, Bos JD, van Soesbergen RM, Dinant HJ (1996) Methotrexate osteopathy in long-term, low-dose methotrexate treatment for psoriasis and rheumatoid arthritis. Arch Dermatol 132(2):184–187
Walsh NC, Gravallese EM (2004) Bone loss in inflammatory arthritis: mechanisms and treatment strategies. Curr Opin Rheumatol 16(4):419–427
Hahn G, Stuhlmüller B, Hain N, Kalden JR, Pfizenmaier K, Burmester GR (1993) Modulation of monocyte activation in patients with rheumatoid arthritis by leukapheresis therapy. J Clin Invest 91:862–870
Lubrano E, Ciacci C, Ames PR, Mazzacca G, Oriente P, Scarpa R (1996) The arthritis of coeliac disease: prevalence and pattern in 200 adult patients. Br J Rheumatol 35(12):1314–1318
Moll JM, Wright V, New York clinical criteria for ankylosing spondylitis (1973) A statistical evaluation. Ann Rheum Dis 32(4):354–363
Taylor W, Gladman D, Helliwell P, Marchesoni A, Mease P, Mielants H (2006) CASPAR study group. Classification criteria for psoriatic arthritis: development of new criteria from a large international study. Arthritis Rheum 54(8):2665–2673
Bühl A, Zöfel P (1994) SPSS für Windows Version 6. Addison-Wesley, Reading
Marsh MN, Bjarnason I, Shaw J, Ellis A, Baker R, Peters TJ (1990) Studies of intestinal lymphoid tissue. XIV—HLA status, mucosal morphology, permeability and epithelial lymphocyte populations in first degree relatives of patients with coeliac disease. Gut 31(1):32–36
Kallikorm R, Uibo O, Uibo R (2000) Coeliac disease in spondyloarthropathy: usefulness of serological screening. Clin Rheumatol 19(2):118–122
Riente L, Chimenti D, Pratesi F, Delle Sedie A, Tommasi S, Tommasi C, Bombardieri S, Migliorini P (2004) Antibodies to tissue transglutaminase and Saccharomyces cerevisiae in ankylosing spondylitis and psoriatic arthritis. J Rheumatol 31(5):920–924
Francis J, Carty JE, Scott BB (2002) The prevalence of coeliac disease in rheumatoid arthritis. Eur J Gastroenterol Hepatol 14(12):1355–1356
Challa A, Moulas A, Cholevas V, Karastergiou E, Lapatsanis D, Tsianos E (1999) Osteoporosis in adult patients with celiac disease. Bone 24(3):249–255
Lange U, Jung O, Teichmann J, Neeck G (2001) Relationship between disease activity and serum levels of vitamin D metabolites and parathyroid hormone in ankylosing spondylitis. Osteoporos Int 12(12):1031–1035
Armagan O, Uz T, Tascioglu F, Colak O, Oner C, Akgun Y (2005) Serological screening for celiac disease in premenopausal women with idiopathic osteoporosis. Clin Rheumatol 24(3):239–243
Acknowledgments
Special thanks to Jörg Reitze (MORE-Data, 35390 Giessen, Germany) for assistance with the statistical analysis.
Conflict of interest statement
None.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Teichmann, J., Voglau, M.J. & Lange, U. Antibodies to human tissue transglutaminase and alterations of vitamin D metabolism in ankylosing spondylitis and psoriatic arthritis. Rheumatol Int 30, 1559–1563 (2010). https://doi.org/10.1007/s00296-009-1186-y
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00296-009-1186-y