Relationship between clinical characteristics of psoriasis and psoriatic arthritis and testosterone deficiency in men

Introduction. Sex hormones can contribute to the pathogenesis of psoriatic disease due to the potential impact on the cells of innate and acquired immunity.

Aim. To study the clinical features of psoriasis (PsO) and psoriatic arthritis (PsA) in men depending on the testosterone level.

Materials and methods. We included 54 men with PsA according to the CASPAR criteria. All patients underwent a standard rheumatological examination, PsA activity was determined by DAPSA, body mass index (BMI), and total testosterone (TT) level in the blood were assessed. Hypogonadism was considered TT ≤ 12.0 nmol/l. Subsequently, the subjects were divided into subgroups depending on the presence of hypogonadism, an intergroup comparative analysis was conducted, and a correlation analysis was conducted between the testosterone level and the main quantitative indicators.

Results. Testosterone deficiency was detected in 22 of 54 patients (40.7%). Patients with hypogonadism were characterized by comparable PsO activity according to the PASI index, but had higher PsA activity according to DAPSA (44.0 [28.8; 50.3] vs. 28.3 [24.9; 36.5]; p = 0.027), a higher number of painful joints (NPJ) (14.5 [10.25; 23.25] vs. 9.0 [4.25; 12.75]; p = 0.04) and number of swollen joints (NSJ) (7.0 [4.0; 12.0] vs. 4.0 [2.0; 6.0]; p = 0.029) with comparable axial lesion activity assessed by BASDAI (5.66 ± 1.46 vs. 5.31 ± 1.36; p = 0.4). A trend towards a higher proportion of patients with moderate and severe psoriasis activity according to PASI in hypogonadism was revealed (63.6% versus 40.6%; p = 0.097). Significant negative correlations were found between TT and PASI (r = -0.29; p = 0.032), as well as DAPSA (r = -0.37; p = 0.013), NPJ (r = -0.33; p = 0.022) and NSJ (r = -0.37; p = 0.012). In addition, testosterone levels negatively correlated with C-reactive protein (r = -0.28; p = 0.044) and BMI (r = -0.44; p = 0.001).

Conclusion. Hypogonadism, which is associated with high activity of peripheral arthritis and the presence of metabolic disorders, was detected in one third of men with PsA.

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