Psoriasis and cardiovascular disorders.
ABSTRACT There is considerable evidence to show that patients with moderate-to-severe psoriasis have a significantly increased risk of cardiovascular disease and cardiovascular risk factors such as obesity, diabetes mellitus, the metabolic syndrome and smoking compared to the general population. The mechanistic link between psoriasis and this observed increase in cardiovascular co-morbidities has not been fully defined. It is clear, however, that common inflammatory pathways are at play in the pathophysiology of psoriasis, obesity and coronary artery disease. It had been proposed that the control of systemic inflammation in psoriasis could help reduce cardiovascular morbidity, and retrospective studies of methotrexate and anti-TNF-a agents have suggested a cardio-protective effect with use of these agents. More recently, however, there have been concerns regarding a potential excess of cardiovascular events with the newer generation of anti-interleukin-12p40 antibodies. In this article we review the association of psoriasis with cardiovascular disorders and the effects of current psoriasis therapies on cardiovascular risk.
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ABSTRACT: Psoriasis is an immune-mediated disease that affects 1%-2% of the European and North American population. While topical agents such as corticosteroids and vitamin D derivatives are prescribed for mild disease, they are generally unable to adequately control patients with more severe disease. Over the past decade, research into the immunopathogenesis of psoriasis, including investigations into the role of tumor necrosis factor-alpha and more recently interleukins (IL) 12/23, has led to the advent of targeted biologic therapies based on the central role of a new subset of T cells, Th17. Because of their increased specificity, biologic agents have revolutionized short- to medium-term treatment outcomes and safety profiles for moderate to severe disease over previously gold standard systemic agents. The immunopathogenesis of the disease is still a focus for researchers and novel targets for future agents are being discovered and investigated in clinical trials. In particular, specifically targeting the IL-23/Th17 pathway has given rise to IL-23p19 and IL-17 antagonists, both of which have shown significant promise in clinical trials. IL-22 is involved in keratinocyte proliferation and is being studied as a treatment target for psoriasis. New small molecule oral agents, including Janus kinase and phosphodiesterase inhibitors are currently in phase 2 and 3 clinical trials.Dermatology and therapy. 12/2012; 2(1):16.