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Psoriasis: Comorbidities and associations
Abstract
Psoriasis is a chronic, genetic, inflammatory skin disease affecting approximately 2% of the population worldwide. Over the past decade, multiple studies have shown that not only is there an association between psoriasis and psoriatic arthritis, depression, and substance abuse, but psoriasis patients also have a higher incidence of obesity, diabetes, heart disease and stroke. In addition, and more concerning, young psoriatic patients particularly those with more severe disease are at an increased mortality risk even when controlling for these factors. The systemic inflammation in psoriasis generates elevation of C-reactive protein, homocysteine, and inflammatory cytokines such as TNF-a, IL-6, IL-17, IL-20, IL-22, and IL-23, which may contribute to the overall morbidity and mortality in these patients. Within this article we will discuss the associations between psoriasis and multiple systemic health problems.
... Psoriasis is a common, chronic, stigmatizing and still incurable skin disease, affecting 2% to 4% of the world's population [1,2]. In the past, it was considered an exclusively dermatological and rheumatic disease, affecting the skin, nails and joints. ...
... Since 2000, research into the still-unknown pathogenesis of psoriasis has exploded, which has led to the perception of psoriasis etiopathogenesis in a new light. Numerous studies have demonstrated a distinct relationship between psoriasis and the immune system as well as cardiometabolic diseases (CMDs), leading to the characterization of psoriasis as a systemic disease with an immunometabolic foundation [1,2]. Patients with psoriasis have an increased risk of developing metabolic syndrome (MS), including abdominal obesity, diabetes mellitus (DM), lipid disorders and non-alcoholic fatty liver disease (NAFLD) [3]. ...
... So far, many factors have been identified that affect the occurrence of psoriasis and its course, such as genetic predisposition, viral and bacterial infections, environmental factors or drugs used in cardiology and immunology [1,8]. Despite that, the complex pathogenesis of psoriasis is still an enigma. ...
Angiopoietin-like protein 8 (ANGPTL8) exerts pleiotropic effects, taking part in lipid and carbohydrate metabolism, inflammation, hematopoiesis and oncogenesis. So far, the exact molecular targets of ANGPTL8 remain poorly defined. We aimed to evaluate the serum concentration of ANGPTL8 in individuals with psoriasis and examine how systemic therapy affects the concentration of ANGPTL8. The study enrolled 35 patients with plaque-type psoriasis that were followed for 3 months of treatment with methotrexate or acitretin, and 18 healthy volunteers without psoriasis as controls. Serum ANGPTL8 concentrations were analyzed by ELISA and differences between groups were determined using Student’s t-test or the Mann–Whitney test, while correlations were assessed using Spearman’s rank test. The average concentration of ANGPTL8 differed significantly between the psoriasis group (before and after therapy) and the control group (p < 0.05). Significant negative correlations between ANGPTL8 and total cholesterol and LDL levels were noted (both p < 0.05). A significant increase in ANGPTL8 concentration was observed after acitretin (p < 0.05), whereas in patients treated with methotrexate the ANGPTL8 did not change significantly (p > 0.05). Additionally, a negative, statistically significant correlation with PASI was found after treatment (p < 0.05). Based on our study, it appears that elevated levels of ANGPTL8 may reduce the likelihood of atherogenic dyslipidemia in individuals with psoriasis, and treatment for psoriasis may impact the protective effects of ANGPTL8.
... [1] It is a complex immune-mediated disease, in which T lymphocytes and dendritic cells play a central role. [2] The chronic inflammation associated with psoriasis is considered a key element linking the disease with various comorbidities such as arthritis, [3] metabolic syndromes, cardiovascular disease, malignancy, and renal disease. [3][4][5][6][7] Chronic kidney disease (CKD) is usually diagnosed in patients with a glomerular filtration rate < 60 mL/min/1.73 ...
... [2] The chronic inflammation associated with psoriasis is considered a key element linking the disease with various comorbidities such as arthritis, [3] metabolic syndromes, cardiovascular disease, malignancy, and renal disease. [3][4][5][6][7] Chronic kidney disease (CKD) is usually diagnosed in patients with a glomerular filtration rate < 60 mL/min/1.73 m², with or without albuminuria, for more than 3 months. ...
... [2] Increasing evidence supports an association between psoriasis and multiple comorbidities including CKD and glomerular disorders. [3] The pathogenesis of psoriasis-related renal disease may be related to an increased immunoactivity burden. [20] Hyperuricemia is commonly seen in patients with psoriasis, [21] and treatment toxicity is well-known risk factors for renal disease. ...
Background: Previous studies showed a higher risk of renal disease among patients with psoriasis; however, this association has been inconsistent. Objectives: This study aimed to carry out a comparison in the probability from suffering renal diseases—including chronic kidney disease (CKD), end-stage renal disease (ESRD), IgA nephropathy (IgAN), glomerular disease (GD), and those resulting in death caused by other renal diseases—in patients with psoriasis. Methods: The systematic review and meta-analysis was conducted to identify cohort studies with reported hazard ratios (HRs) and a 95% confidence intervals (CIs) for the renal outcomes among patients with psoriasis. The meta-analysis was analyzed with the random-effects modeling and was further stratified by psoriasis severity. Results: Three studies were included. Compared to controls without psoriasis, patients with psoriasis had increased risks of CKD (HR: 1.53; 95% CI: 1.20–1.96) and ESRD (HR: 1.24, 95% CI: 1.06–1.46). The risks of CKD (HR: 1.91, 95% CI: 1.78–2.05) and ESRD (HR: 2.72, 95% CI: 1.71–4.34) were increased in servere psoriasis patients. Due to substantial heterogeneity across enrolled studies (I2 = 95%), the risk of CKD in mild psoriasis was insignificant (HR: 1.14, 95% CI 0.87–1.48). Two studies identified severe psoriasis were related to higher risks of IgAN and GD, whereas one study found that mild psoriasis was associated with an increased risk of death from renal disease. Conclusion: Patients with severe psoriasis have a higher risk of incident CKD, ESRD, and GD. However, we only identified two cohort studies that compared the risk of IgAN and GD in psoriasis patients to general populations. It is difficult to conclude that severe psoriasis was associated with higher risks of IgAN and GD. For mild psoriasis, the association with renal disease was less consistent.
... In recent years the viewpoint on the pathogenesis of psoriasis has evolved significantly at the same time due to continuous enriched research in this field. Thus, currently psoriasis is definitely more than skin deep and closely related to numerous cardiometabolic disorders (CMDs), including obesity, diabetes mellitus (DM), dyslipidemia, and hypertension, which make up the metabolic syndrome (MS), as well as non-alcoholic fatty liver disease (NAFLD) and cardiovascular diseases (CVD) [2][3][4]. It has been widely proven that the higher rate of comorbidities is related to psoriasis severity [5,6]. ...
... Psoriatics with severe form present a higher rate of ischemic heart diseases but also have additional absolute risk of 6.2% of a major adverse cardiovascular event (MACE) within 10 years of psoriasis history compared to the healthy population [2,8]. The multidirectional relationship of psoriasis with numerous comorbidities is translated by common genetic or immunological pathways, oxidative stress, as well as systemic metabolically driven inflammation which is important in psoriasis pathogenesis and consequently leads to the development of atherosclerosis, insulin resistance, and CMDs [3][4][5]. For years, researchers have been constantly looking for novel modulators of metaflammation in psoriasis to reduce the risk of internal disorders or use as potential targets for therapeutic intervention. ...
Galectin-3 (gal-3) is a multifunctional regulator of various biological processes and diseases,
which are common comorbidities in psoriasis. Data regarding potential diagnostic role of gal-3 in psoriasis are insufficient. Serum gal-3 levels were evaluated before and after twelve weeks of treatment with acitretin or methotrexate in 31 patients with plaque-type psoriasis and compared to 11 healthy control group. The mean serum galectin-3 level in patients with psoriasis was significantly higher compared to the control group (p < 0.01). In patients with obesity and long-lasting psoriasis (>20 years) positive relations of gal-3 and PASI were noted. In psoriatics with low gal-3 levels, positive correlations between the gal-3 and BMI, glucose level, and with the latter in short-lasting psoriasis (<20 years) were noted. In the long history of psoriasis, gal-3 was negatively correlated with lipids levels. The Gal-3 level might be a multifaceted modulator of the course of psoriasis and predictive factor of cardiometabolic comorbidities’ development, especially in patients with a long history of
the disease or obesity. Patients with low serum gal-3 and short history of psoriasis are presumably at greater risk of diabetes. In patients with long-lasting psoriasis and concomitant obesity, gal-3 may exert a protective role against dyslipidemia or perhaps further CMD development.
... Psoriasis may seem like a simple skin condition at first glance. However, in reality, this nosology hides one of the most common pathologies that can be found in all parts of the world, with a complex, unexplored process of pathogenesis, which affects mostly able-bodied people and has huge consequences for the psychological sphere of human life [2,14,17,23]. W hen focusing on the pathogenesis of this disease, scientists ultimately agree that a key element in the development of psoriasis is the inflammatory component. ...
... Systemic inflammation that occurs in psoriasis causes an increase in a number of inflammatory cytokines, including IL-6, IL-17, IL-20, IL-22 and IL-23. In addition, there is ample evidence of the association of psoriasis with other systemic inflammatory diseases of the human body [14]. ...
Using a constitutional approach to predict the onset of a disease can be key not only to solving the problem of late-stage lifestyle modification therapy but also to understanding the deep, seemingly incomprehensible links between organs and body structure. The aim of the study was to establish and analyze the differences in total, longitudinal and transverse body sizes between healthy and/or psoriatic men of different somatotypes depending on the severity of the disease. Anthropo-somatotypological examination was performed on Ukrainian men (aged 22 to 35 years) with psoriasis (n=100, including 32 with mild and 68 with severe). A clinical assessment of the severity and area of psoriatic lesions was performed using the PASI index. Anthropometric data of 82 practically healthy men of the same age group was taken from the data bank of the research center of National Pirogov Memorial Medical University, Vinnytsya. Statistical processing of the obtained results was performed in the license package “Statistica 5.5” using non-parametric evaluation methods. In patients with mild and severe psoriasis, men of mesomorphic and endo-mesomorphic somatotypes in comparison with healthy men of the corresponding somatotypes, higher values of almost all total (in the endo-mesomorphs with severe disease), transverse (except for shoulder width) and lateral body size (except endo-mesomorphs with severe disease) was found. In patients with psoriasis, men of endo-mesomorphic somatotype with a mild course of the disease found greater than in patients with a similar course men of mesomorphic somatotype, body weight, length and surface area, height of acromial and finger anthropometric points, and transverse middle thoracic diameters and anteroposterior middle thoracic diameter; and in patients with psoriasis men of endo-mesomorphic somatotype with a severe course of the disease – only greater values than in patients with a similar course of the disease men of mesomorphic somatotype, interspinous distance. When comparing the total, longitudinal and transverse dimensions of the body between men with psoriasis of the corresponding somatotypes, in representatives of the mesomorphic somatotype with a mild course of the disease found greater than with severe course, body length values and lower – posterior middle thoracic diameter. The revealed differences in total, longitudinal and transverse body sizes between healthy and/or patients with mild or severe psoriasis Ukrainian men of mesomorphic and endo-mesomorphic somatotypes provide an opportunity to increase the effectiveness of the use of body structure and size to identify risk groups psoriasis.
... It increases incidence with age and frequency among Caucasians compared to other ethnic groups and no clear inclination towards gender [1,2]. Although initially, psoriasis was thought to be a disease of the skin, it has become increasingly recognized as a systemic inflammatory disease resulting in multiple comorbidities, especially with longer duration and severity of the disease [3,4]. Psoriasis has been found to significantly reduce life quality, affecting physical and mental health with an increased risk of poor self-esteem, anxiety, depression, and substance use [5]. ...
... Severe psoriasis, by itself, was found to be an independent risk factor of cardiovascular disease [8]. Apart from cardiovascular diseases, psoriasis is also associated with malignancy, serious infections, other autoimmune disorders, nonalcoholic fatty liver disease, chronic obstructive pulmonary disease, and chronic kidney disease [4,9,10]. The association of psoriasis with multiple comorbidities is thought to be due to shared genetics, pathophysiology of systemic inflammation, and the increased prevalence of risk factors like smoking, obesity, and alcohol use in psoriasis patients [11]. ...
Background We used a large United States population-based database to analyze the reasons for hospitalization of psoriasis patients. Methods International Classification of Diseases, 10th revision (ICD-10) code was used to identify hospitalizations in National Inpatient Sample (NIS) 2017 with a principal or secondary diagnosis of psoriasis. The reasons for hospitalization were divided into 19 categories based on their principal discharge ICD-10 diagnosis code. We also ranked the five most common specific reasons for hospitalization of psoriasis patients. Results There were over 35 million discharges included in the 2017 NIS database. A total of 165215 hospitalizations had either a principal or secondary ICD 10 code for psoriasis. Based on ICD-10 code categories, the top five reasons for hospitalization in patients with history of psoriasis were: Cardiovascular (CV) (26605, 16.10%), rheumatologic (19555, 11.84%), digestive (18465, 11.18%), infection (16395, 9.92%), and respiratory (14865, 9.00%). Sepsis was the most common principal diagnosis of psoriasis hospitalizations. Conclusion CV diseases were the most common ICD category, and sepsis was the most common principal diagnosis for psoriasis hospitalization. Management of medical co-morbidities is important in reducing rates of hospitalization of psoriasis patients.
... Psoriasis is a systemic, immunometabolic, and still untreatable disease affecting 2%-4% of the general population worldwide. This disease was considered as a solely dermatological condition, while recent studies have linked psoriasis to many comorbidities namely obesity, cardiometabolic events, diabetes mellitus type 2 (DM type 2), lipid disturbances, and liver dysfunctions [1][2][3]. Further investigations have highlighted a higher risk of hypertension, metabolic syndrome (MS), or DM in association with the severity of psoriasis [1][2][3][4][5][6]. ...
... This disease was considered as a solely dermatological condition, while recent studies have linked psoriasis to many comorbidities namely obesity, cardiometabolic events, diabetes mellitus type 2 (DM type 2), lipid disturbances, and liver dysfunctions [1][2][3]. Further investigations have highlighted a higher risk of hypertension, metabolic syndrome (MS), or DM in association with the severity of psoriasis [1][2][3][4][5][6]. The morbidity of psoriatic patients is significantly higher compared with the population, which is due to the increased risk of cardiovascular events, mainly myocardial infarction (MI) and thromboembolic disorders [4][5][6][7]. ...
Background:
Proprotein convertase subtilisin/kexin type 9 (PCSK9) exerts an important role in inflammatory processes, lipids homeostasis, and cardiometabolic disorders that are closely associated with psoriasis. The aim of the study was to analyze the clinical and diagnostic value of serum PCSK9 concentrations and their connections with disease severity, inflammation, metabolic syndrome, and impact of systemic therapies in psoriatic patients. The study enrolled thirty-five patients with active plaque-type psoriasis and eighteen healthy volunteers served as controls. Blood samples were obtained before and after 12 weeks of treatment with methotrexate or acitretin. Serum PCSK9 concentrations were measured by the ELISA (Enzyme-Linked Immunosorbent Assay) commercial kits. Morphological and biochemical parameters were assayed using routine laboratory techniques. Psoriatic patients showed significantly elevated levels of PCSK9 compared to controls (p < 0.01), mostly in patients with a mild and moderate course of psoriasis. PCSK9 concentrations correlated positively with BMI and triglyceride levels (p < 0.05). Interestingly, PCSK9 had a strong negative correlation with low-density lipoprotein levels and total cholesterol (p < 0.05). Three months of monotherapy with methotrexate significantly reduced PCSK9 level (p < 0.05), on the contrary, the acitretin group showed a further increase of PCSK9 levels (p < 0.05). PCSK9 seems to be a novel marker of psoriasis and a putative explanation of lipid disturbances, which are common in patients with psoriasis and are vital for the further developing of metabolic syndrome. Methotrexate should be considered as a treatment of choice in patients with an elevated PCSK9 concentration.
... Psoriasis is a systemic chronic inflammatory disease affecting 2-4% of the world population. It involves primarly the skin, however significant associations with numerous comorbidities including obesity, cardiometabolic diseases (CMDs), metabolic syndrome (MS), diabetes mellitus (DM) or nonalcoholic fatty liver disease (NAFLD) have been demonstrated [11,12]. A number of studies have shown higher rate of hypertension, MS or DM within the severity of psoriasis [1,11,12,17]. ...
... It involves primarly the skin, however significant associations with numerous comorbidities including obesity, cardiometabolic diseases (CMDs), metabolic syndrome (MS), diabetes mellitus (DM) or nonalcoholic fatty liver disease (NAFLD) have been demonstrated [11,12]. A number of studies have shown higher rate of hypertension, MS or DM within the severity of psoriasis [1,11,12,17]. The mortality rate of psoriatics is increased compared with the general population due to increased risk of cardiovascular disorders, mainly myocardial infarction (MI) and thromboembolic events [1,17,18]. ...
Fatty acid-binding proteins play an inconclusive role in lipid metabolism and cardiometabolic diseases (CMDs) which are closely related with psoriasis. Aim of the study was to investigate the diagnostic value of serum liver fatty acid-binding protein (FABP1) level and associations with disease severity, inflammation or metabolic parameters and influence of systemic treatment in psoriatic patients. The study included thirty-three patients with active plaque-type psoriasis and eleven healthy volunteers. Blood samples were obtained before and after 12 weeks of therapy with methotrexate and acitretin. Serum FABP1 concentrations were analyzed by the enzyme-linked immunosorbent assay. Statistical analysis was performed for correlation of FABP1 with anthropometric, metabolic or inflammatory indices and treatment used. Serum liver-type FABP levels were significantly increased in psoriatic patients compared to the controls (p < 0.001). No statistical correlations between FABP1 and PASI (p = 0.25) was noted, however patients with severe psoriasis had the highest level of FABP1. No significance with metabolic parameters was obtained, beside a positive significant relation with BMI after therapy (p = 0.03). Liver-type FABP significantly correlated with CRP (p = 0.01) and morphotic blood elements. Systemic treatment combined resulted in significant decrease of FABP1 (p = 0.04), regardless of the drug: p = 0.1 in acitretin group, p = 0.3 in methotrexate group. Liver-type FABP might be a novel marker of psoriasis and predictor of clinical response to systemic therapy. FABP1 could be involved in CMDs risk assessment and perhaps link psoriasis with hematological disorders.
... PsA-induced joint damaging complications not only lead to lower articular function and higher mortality but also affect patients' ability to work and affect their social 34 .In patient with severely affected psoriasis, a 5-year shorter life expectancy tends to happen among them, mostly due to cardiovascular disease 34 .What's more, psoriasis has strong connection with metabolic syndrome, making it a marker for increased risk for the morbidity and mortality associated with these diseases 35 . ...
... Psoriasis causes detrimental effects on the quality of life of both adults and children. Elevated rates of various psychopathologies, including poor self-esteem, sexual dysfunction, anxiety, depression, and suicidal ideation, have been reported in patients with psoriasis [31][32][33][34][35] . ...
... Chronic in ammation is one of the main features of psoriasis, psoriatic in ammation is a complicated pathophysiologic process maintained by different skin cells 10,11 . As the most abundant type of skin cells, keratinocytes interact with immune cells and involve in the induction and ampli cation of psoriatic in ammation, which can be regulated by epigenetic factors 9,12,13 . ...
Psoriatic inflammation can be regulated by epigenetic factors, but little is known about their role. This work aims to reveal the effects of lncRNA UCA1 in keratinocyte inflammation. UCA1 was a psoriasis-related lncRNA in eight GEO transcriptome datasets and psoriatic skin. When we over-expressed or knocked down UCA1 in the keratinocyte cell line (HaCaT), the transcriptome and proteomic data showed that UCA1 could positively regulate inflammatory functions, such as response to cytokine. Experimental findings confirmed that UCA1 could increase inflammatory cytokine secretion, innate immunity gene expression, and ability of vascular endothelial cells. Besides, UCA1 could activate the NF-κB signaling pathway, which might be the target of UCA1-incuded HIF-1α and STAT3. We then uncovered the direct interactions between UCA1 and N6-methyladenosine (m ⁶ A) methyltransferase METTL14. METTL14 proved to be a functional suppressor of inflammation, it could antagonize the functions of UCA1. Subsequently, we found the m ⁶ A levels of HIF-1α were decreased in psoriatic lesions, thus HIF-1α could be the target of METTL14. In general, this work indicates that UCA1 can positively regulate keratinocytes inflammation and psoriasis development, it binds METTL14 and then activates HIF-1α and NF-κB signaling pathway. Our work presents a new understanding of UCA1 and METTL14 in psoriatic inflammation.
... Numerous studies on psoriasis show a higher incidence, as compared with the general population, of associated diseases, lipid disorders, obesity, arterial hypertension, type 2 diabetes or liver function impairment [28][29][30]. An increased risk of cardiovascular events is especially dangerous. ...
Inflammation and atherogenic dyslipidaemia are often observed in skin diseases and represent an increased risk of cardiovascular disorders. Proprotein convertase subtilisin/kexin type 9 plays an important role in the regulation of serum low-density lipoprotein cholesterol levels. Its biological role, however, seems to go much beyond the regulation of cholesterol metabolism. The article presents potential pathophysiological links between inflammatory process and lipid disorders based on the example of psoriasis and systemic lupus erythematosus.
... A wide variety of conditions such as metabolic syndrome, obesity, diabetes mellitus (DM), cardiovascular disease (CVS), malignancy, and psychiatric disorders have been associated with psoriasis. [1] The long-term, waxing and waning course of psoriasis causes a negative impact on the quality of life in patients. Impaired quality of life is generally associated with an increased risk of depression and anxiety. ...
... Psoriasis is a common chronic inflammatory skin disorder with a variable worldwide prevalence of up to 11.4% in adults and 1.4% in children [1]. Although classically associated with the development of multiple inflammatory skin plaques in an extensor distribution, a growing body of evidence now substantiates an appreciation of psoriasis as a systemic disease with associated extracutaneous comorbidities [2]. In particular, patients with psoriasis are more likely to exhibit comorbid atherosclerotic vascular disease-cardiovascular, cerebrovascular, and peripheral vascular-and its risk factors such as obesity, metabolic syndrome, hypertension, diabetes, and smoking [3,4]. ...
The role of platelet function indices—platelet count (PLT), mean platelet volume (MPV), platelet distribution width (PDW), plateletcrit (PCT), immature platelet fraction (IPF), and platelet mass index (PMI)—in psoriasis is uncertain. This systematic review and meta-analysis aimed to evaluate the association of these platelet biomarkers with both presence and severity of psoriasis. We searched MEDLINE (Ovid), Embase (Ovid), and the Cochrane Library from inception to November 2021. To evaluate the association of platelet function indices and psoriasis, we recorded mean differences (MD) and 95% confidence intervals (CI) as well as correlation coefficients (r) for each included study, and generated summary estimates using random-effects inverse-variance modelling. We screened 1,079 unique studies, and included 33 studies with 6724 patients in the quantitative analyses. Compared with controls, patients with psoriasis had higher PLT (MD 12.86 × 10 ⁹ /L, 95% CI 6.34–19.39, p < 0.001), MPV (MD 0.61fL, 95% CI 0.31–0.92, p < 0.001), and PCT (MD 0.05%, 95% CI 0.01–0.09, p = 0.010), but similar PDW (MD 0.16%, 95% CI -0.46–0.79, p = 0.610). Psoriasis Area and Severity Index (PASI) was weakly correlated with PLT (r 0.17, 95% CI 0.06–0.28, p = 0.003), MPV ( r 0.36, 95% CI 0.22–0.49, p < 0.001), and PDW ( r 0.17, 95% CI 0.08–0.26, p < 0.001). Study numbers were insufficient to judge the relationship of IPF and PMI with psoriasis presence, or PCT, IPF, and PMI with psoriasis severity. In summary, PLT, MPV, and PCT are significantly elevated in patients with psoriasis, and PLT, MPV, and PDW are weakly correlated with PASI. Future studies are needed to evaluate the independent diagnostic and prognostic potentials of these biomarkers in patients with psoriasis.
... Взаимосвязь НЖБП и псориаза сложна и в настоящее время активно изучается. В патогенезе заболеваний предполагают общность воспалительных механизмов, что может объяснять частое сочетание НЖБП и псориаза [12,17,18,19]. Цитокины вырабатываются иммунной системой для регуляции комплекса межклеточных взаимодействий при иммунном ответе, обладают плейотропизмом и, как следствие, воздействуют на различные типы клеток макроорганизма. ...
Non-alcoholic fatty liver disease (NAFLD), being a marker of significant changes in the hepatobiliary system against the background of metabolic syndrome and other endocrine pathologies, has a significant impact on the course of psoriatic disease. The presence of common mechanisms in the pathogenesis of these diseases suggests a very close relationship between them. This requires a multidisciplinary approach to studying the mechanisms of the pathogenesis of psoriasis and NAFLD, which will improve the methods of diagnosis and treatment of both diseases.
... Concerning the diseases associated with psoriasis [26], traditional Persian scholars believe that internal organ malfunctions [27,28] disorders [30] are the main cause of psoriasis. ...
Psoriasis is an inflammatory and autoimmune disease with unknown etiology. This is a chronic, recurrent, distressing and costly disease, which has a great impact on the quality of life of individuals. Its treatment varies from topical to systemic medication and sometimes with a great deal of side effects. Probably, changing nutritional habits, life style modification and applying preventive measures may reduce the high amount use of chemical drugs and the costs of the disease. This study investigates etiology, clinical manifestation and natural treatments of psoriasis from the perspective of Persian Medicine by which prevention and nutritional recommendations and some treatments can be introduced. Searching selected sources of Persian Medicine including the Canon of Medicine, Zakhirah -E- Kharazm Shahi, Kamel alsanaat, Sharh al-asbab va al-alamat, Tebbe-Akbari, Moalejate Aghili, Exir-e-Azam, three diseases named “Ghooba”, “Barase Asvad” and “Saafe-Yabes” were found to be similar to psoriasis in their manifestations. Therefore, study of their specific treatments in the levels of lifestyle management more importantly nutrition and herbal therapy could be noteworthy for the future studies.
... Biological treatments such as tumor necrosis factor (TNF) and interleukin (IL) 12/23 and IL-17 inhibitors have revolutionized the therapeutic management of moderate-to-severe psoriasis, permitting a significant number of patients to attain clear skin [3][4][5][6][7][8][9][10]. However, many patients still remain untreated or do not respond to or experience treatmentrelated toxicities [11]. ...
Background
Information is limited from real-life studies evaluating the efficacy and safety of brodalumab.
Research design and methods
In this real-life study, we retrospectively examined a database of 90 patients with moderate-to-severe psoriasis treated with brodalumab (210 mg, s.c.) and followed for 1 year. Disease severity and treatment response were assessed by the Psoriasis Area and Severity Index (PASI) at baseline and after 4, 12, 24, 36, and 48 weeks. Predictors of a PASI response were evaluated by logistic regression.
Results
After 48 weeks, 92.2% of patients (mean age 50.2±15 years) treated with brodalumab achieved a PASI score of <3. Furthermore, PASI score decreased from 17.4±10.3 at baseline to 1.7±3.9 and 1.4±3.7 at 12 and 24 weeks, and PASI 75, 90, and 100 response was achieved in 87.3%, 81.8%, and 72.7% of patients respectively at 48 weeks.
Univariate regression analysis revealed that previous exposure to anti-IL17A treatment was associated with poorer PASI response between 36–48 weeks. In a range of specific difficult-to-treat cases previously having failed with other biologics, brodalumab significantly improved outcome, leading to complete remission.
Conclusion
Brodalumab was observed to be effective and safe in patients with moderate-severe chronic psoriasis in a real world-setting.
... However, genetic and environmental factors play a role. The immunopathology of psoriasis has been accepted as T cell activation, causing systemic inflammation and increased cytokine activity [2,3]. Vascular endothelial growth factor (VEGF), hypoxia-inducible factors, and tumor necrosis factor-α (TNF-α) may be associated with disease development [4]. ...
Background
This study aims to evaluate choroidal thickness (CT), retinal thickness, ganglion cell-inner plexiform layer (GCIPL), and retinal nerve fiber layer (RNFL) structures in psoriasis patients using optical coherence tomography (OCT).
Methods
This study included 33 psoriasis patients and 33 healthy individuals. Moreover, psoriasis patients who did not use any systemic anti-inflammatory treatment were evaluated. Retinal and choroidal images of the participants were obtained with spectral-domain OCT. Furthermore, CT was measured in the subfoveal, temporal, and nasal positions at 500-µm intervals to a distance of 1,500 μm from the foveal center.
Results
The mean psoriasis area and severity index (PASI) score was 5.70 (range, 2.40–9.00). No significant differences were found in subfoveal ( p = 0.659), temporal, and nasal CT values in psoriasis patients compared with the control group ( p > 0.05). Similarly, no statistically significant differences were found between the groups in terms of central retinal thickness, macular GCIPL, and RNFL ( p > 0.05). Moreover, no significant correlation exists between the duration of psoriasis disease and PASI scores and OCT parameters ( p > 0.05).
Conclusions
No significant changes in CT, ganglion cell layer, RNFL, and retinal thickness values were noted in psoriasis patients with mild to moderate mean PASI score.
... [3][4][5] A number of diseases have been associated with psoriasis including, among others, nonalcoholic fatty liver disease (NAFLD). 6 NAFLD is a spectrum of hepatic disorders ranging from a relatively benign fatty liver (nonalcoholic fatty liver) to an inflammatory fatty liver (nonalcoholic steatohepatitis; NASH) that can progress into fibrosis, cirrhosis, or even hepatocellular carcinoma. NAFLD is linked to metabolic syndrome and thought to be a hepatic manifestation of metabolic syndrome. ...
Background:
A growing body of evidence links psoriasis to several metabolic disorders, but the causal relationship between psoriasis and nonalcoholic fatty liver disease (NAFLD) remains understudied.
Purpose:
To measure the correlation between the severity of psoriasis and the degree of NAFLD.
Patients and methods:
A cross-sectional study was conducted on adult patients with psoriasis in the Dermatovenereology Outpatient Clinic of Cipto Mangunkusumo Hospital from December 2017 through February 2018. Psoriasis severity (psoriasis area and severity index [PASI] and body surface area [BSA]) was recorded and compared with NAFLD degree measured by controlled attenuation parameter (CAP).
Results:
A total of 36 subjects were enrolled with an average age of 49.08 years (±15.52 years). The proportions of mild, moderate, and severe psoriasis were 50%, 27.8%, and 22.2%, respectively. Median of PASI was 6.1 (2-38.4) and BSA was 7.5 (2-93). The proportion of NAFLD was 77.8%. The mean of the CAP score was 250.03±45.64. There was no statistically significant correlation between psoriasis severity based on PASI and CAP score (r = 0.258; p = 0.128). However, if the degree of psoriasis was based on BSA, a significant correlation was found (r = 0.382; p = 0.021). The body mass index (BMI) and abdominal circumference were significantly correlated with CAP score (r = 0.448, p = 0.006 and r = 0.485, p = 0.003, respectively).
Conclusion:
Psoriasis extension correlates with NAFLD severity; further studies should assess in detail the effect of therapies on this pathophysiological link.
... Psoriasis is a chronic inflammatory immune skin disease affecting 2-3% of the world's population [1]. Biological therapies such as tumor necrosis factor (TNF), interleukin (IL) 12/23, and IL-17 inhibitors have revolutionized the management of moderate-to-severe psoriasis, allowing a high proportion of patients to attain clear skin [2][3][4][5][6][7][8][9]. Despite this, many patients still remain untreated, do not respond, or experience treatment-related toxicities [10]. ...
Little information is available from real-life studies evaluating the efficacy of guselkumab in moderate-to-severe psoriasis. In this real-life study, we retrospectively examined a database of 52 patients with moderate-to-severe psoriasis treated with guselkumab (100 mg, s.c.) and followed for 1 year. Disease severity and treatment response was assessed by the Psoriasis Area and Severity Index (PASI) at baseline and after 4, 12, 20, 28, 36, 44, and 52 weeks. Predictors of a PASI response were evaluated by univariate and multivariate regression. After 12 months, 84.2% of patients (mean age 51.3 ± 14.1 years) treated with guselkumab achieved a PASI score of <3. Furthermore, PASI score decreased from 20 ± 13.3 at baseline to 4.4 ± 4.7 and 2.7 ± 3.9 at 12 and 20 weeks, and PASI 75, 90, and 100 response was achieved in 84.2%, 78.9%, and 63.2% of patients respectively at 12 months. Stepwise multivariate regression analysis revealed that previous biological treatment and the presence of comorbidities were associated with poorer response between 28–44 weeks, however the presence of obesity per se was not associated with poorer response. Difficult-to-treat areas were also improved as early as 12 weeks following guselkumab. Guselkumab was observed to be effective and safe in patients with moderate-severe chronic psoriasis in a real world-setting.
... Psoriasis is an immune-related disease characterized by a gradual long-term development and frequent recurrence of symptoms; it has been shown to negatively affect the quality of the life in adults and children due to social isolation, occupational stress and stigmatization [29][30][31][32][33][34][35][36]. On the basis of an in-depth survey of the recent clinical trials and research on the underlying mechanisms, we found that psoriasis is a chronic multisystem inflammatory disease associated with a variety of related complications, including hypertension, cardiovascular disease, metabolic syndrome, malignant tumors and inflammatory bowel disease [37,38]. ...
Background:
Plaque psoriasis is a refractory inflammatory skin disease. The common therapies used to treat plaque psoriasis in traditional Chinese medicine (TCM) and western medicine (WM) have distinct characteristics and advantages. Although a combination of TCM and WM therapies, adjusted to the clinical situation, is widely used, there are no systematic studies on the hierarchical selection of this treatment combination based on the severity of skin lesions. We therefore designed a randomized clinical trial to focus on the sequence of internal and external treatments of TCM in patients with mild-to-moderate plaque psoriasis and to optimize the integration of Chinese and western medicine for the treatment of patients with severe plaque psoriasis, thereby achieving high-level clinical evidence and establish treatment norms for the integrated use of Chinese and western medicines.
Methods:
In this proposed multicenter, single-blinded, randomized controlled trial, 108 patients with mild-to-moderate plaque psoriasis will be randomly assigned to two groups in a 1:1 ratio to receive either internal or external TCM treatment, and 270 patients with severe plaque psoriasis will be randomly assigned to three groups in a 1:1:1 ratio to receive treatment with TCM or WM, or TCM + WM. All enrolled patients will receive 8 weeks of treatment. Follow-up assessments will be done 8 weeks after the treatment. The primary outcome of this study is the evaluation of efficacy and relapse rate, based on the Psoriasis Area and Severity Index, and the secondary outcome measures include determination of the affected body surface area, physician's global assessment, pruritus scores (determined using a visual analog scale), TCM symptom score, Dermatology Life Quality Index, patient-reported quality of life score and incidence of serious adverse events.
Discussion:
This study will provide high-level clinical evidence for internal and external TCM treatment optimization and will contribute to establishing norms for the integration of Chinese and western Medicines.
Trial registration:
ClinicalTrials.gov, NCT03941431. Registered on 8 May 2019.
... Psoriasis is an immune-related disease characterized by a gradual long-term development and frequent recurrence of symptoms, and has been shown to negatively affect the quality of the life in adults and children due to social isolation, occupational stress, and stigmatization [30][31][32][33][34][35][36][37]. On the basis of an in-depth survey of the recent clinical trials and research on the underlying mechanisms, we found that psoriasis is a chronic multi-system inflammatory disease, associated with a variety of related complications, including hypertension, cardiovascular disease, metabolic syndrome, malignant tumors, and inflammatory bowel disease [38,39]. ...
Background: Plaque psoriasis is a refractory inflammatory skin disease. The common therapies used to treat plaque psoriasis in traditional Chinese medicine (TCM) and Western medicine (WM) therapies have distinct characteristics and advantages. Although a combination of TCM and WM therapies, adjusted to the clinical situation, is widely used; there are no systematic studies on the hierarchical selection of this treatment combination, based on the severity of skin lesions. We therefore designed a randomized clinical trial to focus on the sequence of internal and external treatments of TCM in patients with mild to moderate plaque psoriasis and to optimize the integration of Chinese and Western medicine for the treatment of patients with severe plaque psoriasis, thereby achieving high-level clinical evidence and establish treatment norms for the integrated use of Chinese and Western medicines.
Methods: In this proposed multi-center, single-blinded, randomized, controlled trial, 108 patients, with mild-to-moderate plaque psoriasis, will be randomly assigned to two groups in a 1:1 ratio to receive either internal or external TCM treatment and 270 patients, with severe plaque psoriasis, will be randomly assigned to three groups in a 1:1:1 ratio to receive treatment with TCM or WM, or TCM+WM. All enrolled patients will receive 8 weeks of treatment. Follow-up assessments will be done 8 weeks after the treatment. The primary outcome of this study is the evaluation of efficacy and relapse rate, based on the psoriasis area and severity index, and the secondary outcome measures include determination of the affected body surface area, physician’s global assessment, pruritus scores (determined using a visual analogue scale), TCM symptom score, dermatology life quality index, patient-reported quality of life score, and incidence of serious adverse events.
Discussion: This study will provide a high-level clinical evidence for internal and external TCM treatment optimization and will contribute to establishing norms for the integration of Chinese and Western Medicines.
... 4 Psoriasis is characterized by joint involvement in addition to skin, although the presence of accompanying comorbidities such as metabolic syndrome, cardiovascular disease, psychological/psychiatric disorders, inflammatory bowel disease and insulin resistance suggests that the chronic inflammation also affects other organs. 5,6 Sensorineural hearing loss (SNHL) occurs as a complication of autoimmune disorders, and was first described by McCabe. 7 In literature, hearing loss has been associated with various diseases, including rheumatoid arthritis, vitiligo, inflammatory bowel disease, systemic lupus erythematosus and Behcet's disease in the etiopathogenesis, of which autoimmunity and chronic inflammation play a role. ...
... Psoriasis is a chronic inflammatory autoimmune skin disease with a prevalence worldwide of 2-3% [1]. The availability of biological therapies such as tumor necrosis factor (TNF), interleukin (IL) 12/23 and IL-17 inhibitors has revolutionized the management of moderate-to-severe psoriasis [2][3][4]. However, despite this, many patients still remain untreated, do not respond, or experience treatment-related toxicities [5]. ...
Background: Limited information is available from real-life studies evaluating the long-term efficacy and drug retention of ustekinumab.
Research design and methods: Data from 378 patients with moderate-severe psoriasis were retrospectively analysed. Over 8 years, disease severity and treatment response were evaluated using the PASI score. Predictors of PASI response were evaluated by logistic regression. Ustekinumab retention rate was calculated by the Kaplan-Meier method.
Results: Over the 8 years, >80% of patients achieved a PASI score of <3 and PASI 75, 90 and 100 response was achieved in 76.2%, 61.9% and 57.1% of patients respectively. Predictor variables for improved PASI response (after 2 years) were HLA-C*06-POS patients, female gender and BMI <30 Kg/M². The 2-year retention rate was 81% and 59% after 8 years with mean retention rate of 5.4 years. Improved retention rate was observed in patients positive for the HLA-C*06 allele (3.7 vs. 2.5 years, p=0.005) and female gender (3.7 vs. 3.3 years, p=0.06), with no significant difference observed in other patient groups. Ustekinumab was generally well tolerated without evidence of cumulative toxicity or organ toxicity.
Conclusion: The long-term use of ustekinumab was observed to be effective and safe in patients with moderate-severe chronic psoriasis in a real world-setting.
... A strong association has been found between smoking and both diseases. In addition, many diseases, including diabetes (42,43) and COPD (9,44), cardiovascular diseases (CVD) (45,46), obesity (47), may interact with both diseases at the same time, but the related mechanisms are still not completely clear, and comorbidities often tend to be more frequently seen in severe disease (47). Therefore, in psoriasis patients, the existence of risk factors and comorbidities could not only affect the occurrence and development of psoriasis but also accelerate the destruction of periodontal tissue. ...
Background and Objective: Patients with psoriasis have a significantly elevated risk of periodontitis compared with the nonpsoriasis controls. However, the data regarding the difference in the periodontal health status of the psoriasis patients and the nonpsoriasis controls are limited and inconsistent; hence, a specialized meta-analysis that quantitatively compared the periodontal status between the psoriasis and nonpsoriasis subjects by evaluating the related clinical periodontal indexes was needed. The aim of this meta-analysis was to quantitatively evaluate whether the periodontal status of psoriasis patients is worse than that of nonpsoriasis subjects. Methods: We searched PubMed and EMBASE for all eligible studies that compared the periodontal status between psoriasis patients and nonpsoriasis subjects. The studies were screened based on pre-established inclusion criteria. After extracting the available periodontal indexes from the included studies, the weighted mean difference (WMD) with 95% confidence intervals (CIs) was calculated by pooling the mean and standard deviations (SD) of each index. Results: In total, 8 studies, including 812 psoriasis patients and 772 nonpsoriasis subjects, were included in our meta-analysis, and the publication dates ranged from 2013 to 2019; eight periodontal indexes were analyzed. The WMD (95% CIs) for each index were: bleeding on probing (%), 9.188 (4.046–14.330, P < 0.001); probing depth (mm), 0.524 (0.183–0.865, P = 0.003); clinical attachment loss (mm), 0.408 (0.051–0.765, P = 0.025); plaque index, 0.186 (−0.170 to 0.543, P = 0.306); gingival index, 0.458 (−0.413 to 1.328, P = 0.303), remaining teeth, −1.709 (−2.106 to −1.312, P < 0.001); missing teeth, 1.130 (0.275–1.985, P = 0.010); the level of alveolar bone loss (mm), 0.400 (0.102–0.698, P = 0.008). Conclusion: In summary, our meta-analysis revealed that psoriasis patients suffer from worse periodontal health than do nonpsoriasis subjects, mainly characterized by worse gingival inflammation, more alveolar bone loss, fewer remaining teeth and more missing teeth. Considering the limitations of this meta-analysis, more high-quality and well-designed studies are needed to validate our conclusions in the future.
... [1][2][3] Psoriatic arthritis (PsA) is an inflammatory joint pathology that occurs in association with psoriasis, present in 10 to 30% of those with cutaneous manifestations. 4,5 The course of PsA ranges from mild manifestations to a debilitating picture. Skin injuries usually precede arthropathy and severity of cutaneous disease is unrelated to joint disease activity. ...
Background:
Psoriatic Arthritis is the spondyloarthritis associated with psoriasis, which is often related to high mortality due to cardiovascular causes.
Objectives:
To quantify cardiovascular risk factors (hypertension, diabetes, dyslipidemia, obesity and smoking) and to measure risk by the Global Cardiovascular Risk Score in patients with psoriatic arthritis.
Methods:
Patients with psoriatic arthritis according to the Classification Criteria for Psoriatic Arthritis, aged between 30 and 74 years and without any other clinically manifest chronic inflammatory disease, atherosclerotic disease or heart failure were included. After an interview, clinical examination and data extraction from medical records, risk stratification was performed using a calculator available on the online platform of the Framingham Heart Study. We considered p < 0.05 as significant. Chi-square test and Fisher’s exact test were used to compare frequencies, as well as correlation measurements.
Results:
45 patients were included, 68,9% of which were women and the mean age was 53,94 years. Dyslipidemia was confirmed in approximately 93%, hypertension in 46%, obesity in 40%, 33.3% were diabetics and, 13.3%, smokers; 95% had increased abdominal circumference. It was observed that 53% had high cardiovascular risk, 29% had intermediate risk and 18% had low risk. Individuals with altered C-reactive protein and erythrocyte sedimentation rate presented, respectively, higher levels of LDL-C and total cholesterol.
Conclusions:
There was a high occurrence of risk factors and the majority of the sample was stratified into high or intermediate cardiovascular risk.
... The cutaneous lesions show elevated levels of pro-inflammatory cytokines, and a low-grade systemic inflammatory response is believed to occur. 1 The pro-inflammatory molecules released during chronic inflammation can favor the pre-sence of one or more comorbidities, including diabetes mellitus, dyslipidemia, acute myocardial infarction and obesity. [2][3][4][5] There is an increasing number of epidemiological studies on the association between psoriasis and obesity. The mechanism responsible for this association is not yet understood, though it is probably multifactorial, involving genetic and environmental fac- tors and inflammatory mediators. ...
Background
Psoriasis and obesity are somewhat related to a low-grade systemic inflammatory response.
Objectives
To determine leptin and adiponectin levels in psoriasis patients compared to control patients matched for weight.
Methods
A case-control study was performed, evaluating 113 psoriasis patients and 41 controls with other dermatologic diseases.
Results
The prevalence of obesity was 33% in cases and 21.9% in controls. All evaluated comorbidities were more prevalent among cases. When stratified by weight, the comorbidities were more frequent in overweight patients. We found no correlation between being overweight (p=0.25), leptin (p=0.18) or adiponectin (p=0.762) levels and psoriasis severity. When overweight cases and controls were compared, we found differences in the adiponectin values (p= 0.04). The overweight cases had lower adiponectin levels than the overweight controls. We found no differences in the leptin dosage between cases and controls. The overweight cases had higher leptin values than the normal weight cases (p<0.001).
Study limitations
Several patients used systemic anti-inflammatory medication.
Conclusions
The prevalence of obesity among psoriasis cases (33%) was higher than in the general population (17.4%). We did not find any correlation between severity of psoriasis and inflammatory cytokines and the condition of being overweight. The overweight cases had lower values of adiponectin than the overweight controls. It seems, therefore, that there is a relationship between adiponectin and psoriasis, but this relationship depends on the presence of obesity.
... Psoriasis is a multisystem inflammatory disorder with multiple associated comorbidities, such as psoriatic arthritis, obesity, metabolic syndrome, cardiovascular, and cerebrovascular diseases [2,6,[11][12][13]. Several studies showed that circulating 25 hydroxyvitamin D (25(OH)D) levels were significantly lower among patients with psoriasis than healthy controls [14][15][16]. ...
Background:
There are limited randomized controlled trials of oral vitamin D supplementation in psoriasis, especially in Asia, and the results are inconclusive.
Objective:
To investigate the clinical effect of oral vitamin D supplementation on psoriasis.
Methods:
Patients with psoriasis were randomized to receive vitamin D2 60,000 IU or similar-looking placebo pills once every 2 weeks for 6 months. The primary outcome was improvement of the Psoriasis Area and Severity Index (PASI) score at 3 and 6 months after treatment. Serum levels of 25(OH)D, calcium, phosphate, parathyroid hormone, and C-reactive protein and adverse events were monitored. The chi-square test, Fisher's exact test, Student's t-test, and Spearman's correlation analysis were used in statistical analysis.
Results:
Of 50 subjects screened, 45 were eligible and randomized to the oral vitamin D2 group (n=23) or placebo group (n=22). At enrollment, the mean PASI score was 4.45, and 26.7% of patients had vitamin D deficiency. At 3 months, the oral vitamin D2 group had significantly higher PASI improvement than the placebo group (mean PASI improvement: 1.43 versus [vs.] -0.33, p-value=0.034; mean %PASI improvement: 34.21% vs. -1.85%, p-value=0.039). The mean serum 25(OH)D level was significantly higher in the oral vitamin D group than in the placebo group (27.4 vs. 22.4 ng/mL, p-value=0.029). Serum 25(OH)D concentrations were significantly inversely correlated with PASI scores at the 6-month follow-up. No major adverse event was observed overall.
Conclusion:
Oral vitamin D2 supplementation in patients with psoriasis increased the serum vitamin D level and significantly improved the treatment outcome without increasing adverse events.
Trial registration:
This trial is registered with Thai Clinical Trials Registry TCTR20180613001.
... Up to 30% of psoriatic patients may also suffer from seronegative spondyloarthritis (Parisi, Symmons, Griffiths, & Ashcroft, 2013). Several studies demonstrated the association between psoriasis and a number of disease-related comorbidities including blood hypertension and cardiovascular diseases, obesity, type II diabetes, dyslipidemia-singularly or combined in order to configure the metabolic syndromenonalcoholic fatty liver disease, psychiatric disease, and inflammatory bowel disease (Farley & Menter, 2011). Despite new molecules discovered in the last two decades many patients remain untreated, do not respond or lose response, or suffer from treatment-related side effects; in particular psoriasis affecting the nails, scalp, and palms can often be difficult to treat (Gisondi et al., 2017). ...
Nail involvement can place a significant burden on patients as a result of functional damage and psychosocial problems, leading to major repercussions on the quality of life. There is strong evidence that nail psoriasis can often be difficult to treat. We report a a 69 year‐old‐man with severe onychodystrophy, onycholysis, and pain in the hands; he had been previously treated with topical and systemic traditional therapies without satisfactory response. The patient showed multiple severe psoriatic crumbly nails (NAPSI score of 69) and started ustekinumab treatment at standard dosage of 45 mg fl s.c.. After 24 weeks, both nail matrix and nail bed disease showed marked improvement and the patient continued therapy with ustekinumab (NAPSI 0 at week 104). At week 136 (September 2015) the patient had been complaining of hands pain (Pain‐VAS 80) and ultrasonographic evaluations found a synovial proliferation with effusion on metacarpophalangeal joints. The patient continued therapy with ustekinumab, adding methotrexate 10 mg fl.s.c /week. In November 2016, the patient showed a remission of symptoms; clinical and ultrasonografic evaluations did not find signs of synovitis. Methotrexate treatment was suspended and currently the patient reached more than four years of ustekinumab treatment without sign and symptoms of synovitis.
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... Psoriasis has long been considered the "disease of the healthy", but many evidences are increasingly contradicting this traditional concept. Today, it is identified as a pathology with systemic involvement and frequent associations with other concomitant non-dermatological morbid conditions [4,5]. ...
Psoriasis is a multifactorial disease that can be related to genetic, environmental and immunological causes. Therefore, not only a single factor but different aspects contribute to the onset of the disease, varying from individual to individual. It would be characterized by an abnormal proliferation and differentiation of keratinocytes, mediated by a dysregulation in the auto-immune T cell response in which several cytokines participate, including Interleukin (IL)-17, IL-17A, IL-12, IL-22, IL-23. These cells and cytokines are responsible for the aggression on skin cells, inflammation and accelerated reproduction of the cells of the epidermis. Due to the chronic inflammation, psoriasis is frequently associated with other concomitant non-dermatological morbid conditions such as arthropathy which can be complicated by a disabling evolution. Psoriasis is also frequently associated with comorbidities such as Cardiovascular Diseases (CVD), hyperlipidemia, diabetes and obesity.
The knowledge of common inflammatory pathways and of the potential links between psoriasis and other diseases should encourage dermatologists to a multidisciplinary approach to psoriasis and to an optimal management also in the light of new therapeutic possibilities.
... Psoriasis, for example, has major systemic health implications, including erosive inflammatory arthritis and increased risk of cardiovascular disease, metabolic syndrome, diabetes, and obesity. [29][30][31][32][33][34] While commercial tanning beds and in-office phototherapy units have a similar appearance, they utilize different equipment and emit a vastly different spectrum of UV radiation. For example, narrowband UVB phototherapy devices emit a concentrated dose of 311 to 313nm UVB, while tanning beds emit an average of five-percent broad spectrum UVB (290-320nm) with the remaining 95 percent composed of UVA light (320-400nm). ...
BACKGROUND: The commercial tanning industry has opposed efforts to educate the public on the risks of tanning as well as attempts to restrict minors' access to tanning services. Despite a paucity of supporting literature, statements from the tanning industry claiming that dermatologists routinely use in-office phototherapy for cosmetic treatments and refer patients to tanning salons have successfully derailed and defeated legislation in many states. OBJECTIVE: This study aims to evaluate dermatologist referrals for ultraviolet radiation for cosmetic and medical purposes via tanning beds or phototherapy, as well as their opinions on tanning, legislation, and ultraviolet radiation counseling practices. DESIGN: The study was conducted using a 10-question anonymous survey. SETTING: The participants were surveyed during meetings of three regional dermatologic societies. PARTICIPANTS: One hundred and fifty-two dermatologists attending society meetings participated in the study. MEASURES: The authors measured physician referrals, opinions, and recommendations regarding ultraviolet exposure. RESULTS: Zero physicians (0/152) recommended tanning salons for cosmetic reasons. These 152 dermatologists referred 458 (417 adult, 41 pediatric) out of an estimated 809,369 patients (0.057%) to tanning salons for medical treatment. Of these physicians, 76 out of 152 and 15 out of 152 reported referring at least one adult or one pediatric patient, respectively, within the last year. All respondents supported ultraviolet tanning legislation and discouraged cosmetic tanning. CONCLUSION: These findings directly contradict the assertion that dermatologists use ultraviolet radiation for cosmetic purposes or routinely refer patients to tanning salons. This study underscores the complex nature of ultraviolet radiation, as dermatologists infrequently utilize ultraviolet radiation for medical purposes and unanimously support restrictive legislation. In addition, these dermatologists counsel against cosmetic tanning and list tanning bed use among their highest concerns with regard to the health of pediatric patients.
... Elevated rates of various psychopathologies, including poor self-esteem, sexual dysfunction, anxiety, depression and suicidal ideation, have been reported in patients with psoriasis. [31][32][33][34][35] Psoriasis is not a disease that only affects the skin. Increasing evidence supports the recognition of psoriasis as a chronic multisystem inflammation disorder with multiple associated comorbid conditions. ...
Introduction:
Psoriasis vulgaris is a common skin disease that is characterised by persistent localised erythematous scaly plaques. Yinxieling is a Chinese herbal formula for psoriasis that has been used for more than 20 years in China. To facilitate application, PSORI-CM01 was developed based on the optimisation and simplification of Yinxieling tablets performed in a previous study and in clinical practice. However, the scientific evidence regarding whether PSORI-CM01 is more effective for psoriasis than the original Yinxieling remains insufficient. Therefore, we designed a randomised clinical trial to investigate the effect, safety and cost-effectiveness of PSORI-CM01 granules compared with those of Yinxieling tablets for the treatment of patients with psoriasis.
Methods and analysis:
This ongoing study is a two-arm parallel, randomised, double-blind, double-dummy clinical trial. Five hundred and fifty-six participants with psoriasis will be recruited and then randomly allocated into two groups in a 1:1 ratio. Participants in PSORI-CM01 group will receive a 5.5 g granule of PSORI-CM01 two times daily and five placebo tablets three times daily for 12 weeks. The participants in the Yinxieling group will receive five Yinxieling tablets three times daily and a placebo granule two times daily for 12 weeks. The primary outcome is the reduction of the Psoriasis Area and Severity Index. The secondary outcomes include relapse rate, Visual Analogue Scale scores, body surface area and the Dermatology Life Quality Index. Cost-effectiveness analysis will be performed from a health and community care provider perspective.
Ethics and dissemination:
This research protocol had been reviewed and approved by the institutional review boards of three trial centres (Guangdong Provincial Hospital of Chinese Medicine (B2014-026-01), Affiliated Hospital of Tianjin Chinese Medicine Academy (2014-KY-001) and Third Hospital of Hangzhou (B2014-026-01)). The findings will be disseminated to the public through conference presentations and open-access journals.
Trial registration number:
Chinese Clinical Trial Registry (ChiCTR-TRC-14005185); Pre-results.
... Пс ассоциируется с другими воспалительными заболеваниями, которые имеют общие с ним генетические и воспалительные механизмы [1,3,[5][6][7][8]. В частности, при Пс могут выявляться артрит, увеит, воспалительные заболевания кишечника и метаболический синдром (МС) или его компоненты (центральное ожирение, атерогенная дислипидемия, резистентность к инсулину, высокое артериальное давление) [3,9,10]. ...
Psoriasis (Ps) is a chronic systemic disease that affects the skin. Investigation could reveal the high prevalence of nonalcoholic fatty liver disease (NAFLD) in patients with Ps compared with the general population, especially in those who have moderate to severe Ps with a high Ps area severity index (PASI). Similar pathogenic processes play a definite role in this relationship. The most likely causes are recognized to be insulin resistance and elevated levels of proinflammatory cytokines. According to recent evidence, the prevalence of NAFLD and metabolic syndrome in patients with Ps is higher than that in the general population. In addition, patients with NAFLD and Ps are at higher risk of severe liver fibrosis than those with NAFLD without Ps. Therapy for this condition certainly needs not only to modify traditional risk factors, but also to reliably suppress inflammation. Obesity and NAFLD have a negative impact on the results of treatment in patients with psoriatic arthritis with biological agents.
... Clinical picture includes distal interphalangeal joint involvement, asymmetric oligoarthritis, symmetric polyarthritis, dactylitis, enthesitis, and spondyloarthritis, and arthritis mutilans. The prevalence in patients with psoriasis is 7-42% 6 . In many patients, skin lesions precede psoriatic lesions (75%). ...
... It is acknowledged that, to varying degrees, inflammatory skin disorders have a systemic inflammatory component (11)(12)(13)(14)(15). In mice, the infusion of bacterial lipopolysaccharides results in systemic inflammation, neuro-inflammation and depression-like symptoms, sometimes referred to as "sickness behaviour" (16). ...
There is increasing evidence of clinically relevant anti-inflammatory effects of monoaminergic antidepressants. PubMed and Ovid databases were searched systematically for the use and efficacy of antidepressants in association with 5 common inflammatory skin disorders: chronic urticaria, psoriasis, atopic dermatitis, other eczema, and alopecia areata. From January 1984 to June 2016, publications included a total of 1,252 dermatological patients in 28 trials or case reports. These unambiguously reported a reduced burden of dermatological symptoms in relation to treatment with antidepressants. Several randomized controlled trials of first-generation antidepressants have been published, while studies of modern antidepressants are usually open-label, yet more informative, regarding patients' characteristics and study procedures. These overall positive findings may indicate a rationale, beyond treating comorbid psychiatric disorders, for the use of antidepressants in dermatology. Further research into modern tolerable antidepressants, including selective serotonin re-uptake inhibitors, mirtazapine and bupropion, is required.
İlanbaşı cinsinin Azərbaycan florasında 4 növü vardır ki, onlardan da D. austriacum daha çox yayılmışdır. Tədqiqat işində
bitkinin makroskopik və mikroskopik analizi həyata keçirilmişdir. Bitki Quba rayonunun Qrız kəndi ətrafında, subalp çəmənlikdə,
dəniz səviyyəsindən 1900 m hündürlükdə toplanmışdır: 41°14'48.6"N 48°17'01.9"E. Kökün perisikli birqat
hüceyrələrdən ibarətdir, hüceyrələr nazikdivarlıdır, mərkəzi silindrin periferiyasında aydın müşahidə edilən bütöv halqa əmələ
gətirir. Yarpaqda mezofilin süngər və çəpər toxumalarına differensasiya olunması müşahidə olunur. Həmçinin birhüceyrəli, ikihüceyrəli
və başcıqlı tükcüklər müşahidə olunur, ağızcıqlar anomosit tiplidir. Avstriya ilanbaşının morfolojianatomik
quruluşunda
müəyyən edilmiş fərqli diaqnostik əlamətlər onu digər bitki növlərindən fərqləndirməyə şərait yaradır və bitkinin
eyniliyini təyin etməyə imkan verir.
Background
The relationship between psoriasis and cardiomyopathy is understudied in Indian patients.
Objective
We evaluated psoriasis patients for cardiomyopathy and other echocardiographic abnormalities.
Methods
About 98 (M:F = 67:31) patients with mild to moderate psoriasis aged 18‐75 years (mean ± SD = 42.12 ± 12.79 years) having no pre‐existing metabolic syndrome and cardiovascular disorders were studied. X‐ray chest, electrocardiogram and echocardiography were performed and interpreted by cardiologist for size of the left and right ventricles, left ventricle ejection fraction, diastolic function, pulmonary artery pressure and valve abnormality/regurgitation and their severity as per current guidelines/recommendations. The cardiomyopathies were defined according to standard diagnostic guidelines.
Results
Echocardiographic abnormalities were noted in 13 (13.3%) patients aged 19‐75 years (mean ± SD = 43.30 ± 15.71 years). The left ventricular diastolic dysfunction (grade 1) was observed in nine patients (moderate severe psoriasis in four patients) and one of them also had concentric left ventricular hypertrophy; a precursor of restrictive cardiomyopathy. Mild tricuspid valve regurgitation was present in other four patients. There was no statistically significant difference in age, gender, duration and the severity of psoriasis when compared with patients having normal echocardiography. The mitral or aortic valves, pulmonary artery pressure, mid‐right‐ventricular diameter and the left atrial volume showed no abnormality.
Conclusions
Psoriasis perhaps plays a role in left ventricular dysfunction and possibly cardiomyopathy even with moderately severe disease and in the absence of clinical symptoms. However, these observations need to be interpreted with caution in the absence of any statistically significant difference between age, gender, duration and severity of psoriasis in the patients having normal and abnormal echocardiography.
Objectives:
To investigate foveal avascular zone (FAZ) area and retinal vascular density (VD) in patients with psoriasis according to disease severity using optical coherence tomography angiography (OCTA).
Methods:
Twenty-seven patients with mild psoriasis (Group 1), 28 with moderate to severe psoriasis (Group 2) and 30 healthy controls (Group 3) were evaluated with OCTA. Foveal and parafoveal VD and FAZ area were measured and compared.
Results:
FAZ values were significantly higher in Group 2 (0.20 ± 0.1, 0.31 ± 0.07, 0.20 ± 0.09; P < .001, respectively.). The mean VD value were significantly lower in the deep capillary plexus in parafoveal area in Group 2 (35.5 ± 8.7, 28.7 ± 4.6, 35.0 ± 3.5; P < .001, respectively.). These changes showed significant correlation with Psoriasis Area and Severity Index (PASI) scores of patients.
Conclusions:
Our results suggest that OCTA may have a future role as alert of potentially more severe disease in cases clinically classified as mild disease.
Psoriasis is a systemic, immune-metabolic disease with strong genetic predispositions and autoimmune pathogenic traits. During psoriasis progression, a wide spectrum of comorbidities comes into play with the leading role of the cardio-metabolic syndrome (CMS) that occurs with the frequency of 30–50% amongst the psoriatic patients. Both conditions—psoriasis and CMS—have numerous common pathways, mainly related to proinflammatory pathways and cytokine profiles. Surprisingly, despite the years of research, the exact pathways linking the occurrence of CMS in the psoriasis population are still not fully understood. Recently published papers, both clinical and based on the basic science, shed new light into this relationship providing an insight into novel key-players proteins with plausible effects on above-mentioned interplay. Taking into account recent advances in this important medical matter, this review aims to discuss comprehensively the role of four proteins: proprotein convertase subtilisin/kexin type-9 (PSCK9), angiopoietin-like protein 8 (ANGPLT8), sortilin (SORT1), and cholesteryl ester transfer proteins (CEPT) as plausible links between psoriasis and CMS.
Lo studio dei pattern di co-morbilità può essere utile per migliorare la gestione clinica di ciascun sottogruppo specifico di pazienti con una de-terminata patologia indice, per il miglior risultato di cura. La valutazione dei pazienti complessi non può basarsi solamente su pochi elementi di giudizio. Essa dovrebbe richiedere una valutazione multi-dimensio-nale, quale quella oggi disponibile con diversi strumenti, utili anche ai fini della prognosi e della pianificazione delle cure.
IL CLUSTERING DISEASES IN MEDICINA INTERNA Co-morbilità, multi-morbilità, associazioni di malattie e complessità in Medicina Interna F. Tangianu, P. Gnerre, M. La Regina, F. Berti, G. Scanelli, F. Colombo, G. Pinna, R. Nardi Fragilità, disabilità e gruppi di malattie associate A. Marengoni, A. Zucchelli, D.L. Vetrano, G. Onder, A. Nobili MALATTIE INDICE E CLUSTERING DISEASES IN MEDICINA INTERNA Fibrillazione atriale e clustering diseases C. Tieri Ipertensione arteriosa e clustering diseases A. Abenante, F. Tangianu Clustering diseases e scompenso cardiaco N. Tarquinio Diabete-obesità-sindrome metabolica e clustering diseases E. Barbagelata, I. Ambrosino, M. Poggiano Iperuricemia e gotta M. Giuliani, A. Cerasari, L. Sanesi Ictus ischemico T. Ciarambino Demenza e clustering diseases C.A. Usai, A. Filippi Depressione come malattia sistemica D. Tirotta Trombo-embolismo venoso M. Gino, F. Pasin Broncopneumopatia cronica ostruttiva e clustering diseases O. Para, M. Ronchetti Insufficienza renale cronica A. Bianco Anemia C. Zaninetti Cirrosi epatica G.A. Vassallo, V.A. Vassallo, C. Tarli, F. Bernardini, S. Rotunno Artrite reumatoide: clustering diseases A. Tamburello, L. Castelnovo, P. Faggioli Psoriasi: punta d’iceberg di malattie associate o sottese A. Guastalla Clustering diseases delle neoplasie P. Crispino, D. Colarusso CONCLUSIONI Multimorbilità, clustering diseases e politerapia: criteri di appropriatezza prescrittiva A. Nobili, F. Croset, A. Marengoni, P.M. Mannucci
Eye involvement in psoriasis is little known to many dermatologists, although psoriasis has been acknowledged as a systemic disease for decades. The ophthalmic complications of psoriasis are numerous and can affect almost any part of the eye. The most common ocular changes in patients with psoriasis, including blepharitis, conjunctivitis, keratitis, iridocyclitis, UV-induced cataracts, uveitis, and birdshot chorioretinitis, have been described in the literature. Recognition of the ocular complications of psoriasis is of significant clinical importance, because various pathogenic mechanisms may contribute to the development of ocular manifestations, including direct eye involvement with psoriatic plaques, psoriasis-related immune-mediated inflammatory processes, and complications of psoriasis treatments.
Psoriasis is a systemic disease associated with metabolic syndrome and cardiometabolic diseases. Adipocyte fatty acid‐binding protein (A‐FABP, FABP4) is a relevant mediator of lipid metabolism and several comorbidities development. Aim of the study was to explore the possible role of FABP4 in psoriasis and assess its relationship with disease activity, inflammation or metabolic disturbances, and impact of systemic treatment. Fasting blood samples were obtained from 33 patients with active plaque‐type psoriasis before and after 12 weeks of therapy and from 11 healthy volunteers. Serum FABP4 concentrations were analyzed by the enzyme‐linked immunosorbent assay (ELISA) and statistically analyzed for their correlations with clinical outcomes and the treatment introduced. Serum FABP4 levels were significantly increased in psoriatics compared to controls (p = 0.03). No relationship between the protein and psoriasis severity expressed through psoriasis area and severity index (PASI) was noted (p = 0.57). FABP4 did not correlate with CRP (p = 0.41), lipid profile, and body mass index (BMI) nor the glucose level or liver enzyme activity. FABP4 significantly correlated with morphotic blood elements. After total therapy, FABP4 did not statistically change (p = 0.07), but significantly decreased after administering acitretin (p = 0.03). FABP4 is a potential marker of psoriasis and clinical outcome after therapy with acitretin. Adipocyte‐type FABP may be related to hematological disorders or obesity‐mediated comorbidities in psoriasis.
Psoriasis is a chronic autoimmune skin disease affecting 2‐3% of people worldwide¹. While, tumor necrosis factor (TNF), interleukin(IL)‐12/23 and IL‐17 inhibitors have revolutionized the management of moderate‐to‐severe psoriasis many patients still remain untreated, do not respond, or experience treatment‐related toxicities.
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Objective
Secukinumab, a fully human monoclonal IgG1 antibody that selectively neutralizes the proinflammatory cytokine IL-17A, has been approved in Europe in 2015 for the treatment of adult patients with moderate-to-severe plaque psoriasis, psoriatic arthritis (PsA), and ankylosing spondylitis (AS). This analysis assessed the budget impact of introduction of secukinumab to the Italian market for all three indications from the perspective of the Italian National Health Service.
Materials and methods
A cross-indication budget impact model was developed and included biologic-treated adult patients diagnosed with psoriasis, PsA, and AS. The analyses were conducted over a 3-year time horizon and included direct costs (drug therapy costs, administration costs, diseases-related costs, and adverse events costs). Model input parameters (epidemiology, market share projections, resource use, and costs) were obtained from the published literature and other Italian sources. The robustness of the results was tested via one-way sensitivity analyses: secukinumab cost, secukinumab market share, intravenous administration costs, and adverse events costs were varied by ±10%.
Results
The total patient population for secukinumab over the 3-year timeframe was projected to be 6,648 in the first year, increasing to 12,001 in the third year, for all three indications combined (psoriasis, PsA, and AS). Compared to a scenario without secukinumab in the market, the introduction of secukinumab in the market for the treatment of psoriasis, PsA, and AS showed a cumulative 3-year incremental budget impact of −5%, corresponding to savings of €66.1 million and per patient savings of about €1,855. The majority of the cost savings came from the adoption of secukinumab in AS (58%), followed by PsA (29%) and psoriasis (13%). Sensitivity analyses confirmed the robustness of the results.
Conclusion
Results from this cross-indication budget impact model show that secukinumab is a cost-saving option for the treatment of PsA, AS, and psoriasis patients in Italy.
Background: Bioelectrical impedance analysis (BIA) is an inexpensive, non-invasive and fast method to assess body composition. Little is known of the interaction between anti IL 12/23 treatment and body composition. The aim of this study was to evaluate 6- and 12-month changes in body weight, Body Mass Index (BMI) and body composition assessed by BIA in psoriatic patients treated with anti-IL-12/23.
Research design and methods: Demographic and clinical data were collected for each enrolled patient. Physical examination, anthropometric assessment, Psoriasis Area and Severity Index (PASI) assessment and body composition by BIA (single-frequency 50 kHz), were assessed at baseline and at 6 and 12 months of treatment.
Results: A significant decrease in body weight, compared to baseline, in BMI, Fat Mass at month 6 and a significant increase at month 12 for body cellular mass (BCM) and Phase Angle (PhA) were observed. In addition, a significant increase was found for intracellular water.
Conclusion: At baseline, psoriatic patients showed a lower BCM and a lower mean PhA score. During ustekinumab treatment, the mean PhA and BCM scores increased with an improvement in psoriatic disease. Thus, ustekinumab can be an effective drug for improving not only psoriasis but also the general clinical status of patients.
In recent years the concept of psoriasis as a systemic disease has gained acceptance due to its association with numerous comorbid conditions, particularly atherosclerosis and cardiovascular disease. Several studies have shown that patients with psoriasis, especially younger patients and those with more severe forms of psoriasis or with psoriatic arthritis, have a higher prevalence of risk factors and metabolic syndrome, as well as an increased risk of major cardiovascular events such as myocardial infarction, cerebrovascular disease, and peripheral arterial disease. Furthermore, it remains unclear which of the current treatments might be more effective in reducing cardiovascular risk in these patients. It is therefore important for dermatologists to be aware of this increased risk, to be able to detect modifiable risk factors early and, when appropriate, refer patients to other specialists for the prevention of major cardiovascular events.
In recent years the concept of psoriasis as a systemic disease has gained acceptance due to its association with numerous comorbid conditions, particularly atherosclerosis and cardiovascular disease. Several studies have shown that patients with psoriasis, especially younger patients and those with more severe forms of psoriasis or with psoriatic arthritis, have a higher prevalence of risk factors and metabolic syndrome, as well as an increased risk of major cardiovascular events such as myocardial infarction, cerebrovascular disease, and peripheral arterial disease. Furthermore, it remains unclear which of the current treatments might be more effective in reducing cardiovascular risk in these patients. It is therefore important for dermatologists to be aware of this increased risk, to be able to detect modifiable risk factors early and, when appropriate, refer patients to other specialists for the prevention of major cardiovascular events.
Copyright © 2017 AEDV. Publicado por Elsevier España, S.L.U. All rights reserved.
Recent studies support the relation of psoriasis with obesity and cardiovascular disease. Leptin, a peptide hormone secreted predominantly from adipose tissue, is involved in the regulation of energy intake and expenditure. Recently, it has been shown to have several immunological effects including induction of proinflammatory cytokine production.
To investigate the possible role of leptin in psoriasis pathogenesis.
Forty-three patients with psoriasis, 10 diseased and 10 healthy controls with normal body mass index were included. Serum fasting leptin levels of the study group were examined by enzyme-linked immunosorbent assay. Tissue leptin and leptin receptor expression of both patients and controls were investigated by immunohistochemistry.
Serum leptin levels, tissue leptin and leptin receptor expression were significantly higher in patients with severe psoriasis than patients with mild-moderate psoriasis and controls (P < 0.05). Serum leptin levels showed a positive correlation with Psoriasis Area and Severity Index and involved body surface area in patients with psoriasis. In addition, serum leptin levels, tissue leptin and leptin receptor expression showed a positive correlation with disease duration in patients with psoriasis (P < 0.01, r = 0.979; P < 0.01, r = 0.691; P < 0.01, r = 0.428, respectively).
We assume that leptin might serve as a marker of severity in psoriasis and also may be a pathogenetic cofactor contributing to chronicity of the disease. Consequently, its role in obesity and cardiovascular disease in patients with psoriasis deserves to be studied. In addition, drugs targeting the proinflammatory effects of leptin may be a new adjuvant therapeutic approach in psoriasis.
The prevalence of obesity increased in the United States between 1976-1980 and 1988-1994 and again between 1988-1994 and 1999-2000.
To examine trends in obesity from 1999 through 2008 and the current prevalence of obesity and overweight for 2007-2008.
Analysis of height and weight measurements from 5555 adult men and women aged 20 years or older obtained in 2007-2008 as part of the National Health and Nutrition Examination Survey (NHANES), a nationally representative sample of the US population. Data from the NHANES obtained in 2007-2008 were compared with results obtained from 1999 through 2006.
Estimates of the prevalence of overweight and obesity in adults. Overweight was defined as a body mass index (BMI) of 25.0 to 29.9. Obesity was defined as a BMI of 30.0 or higher.
In 2007-2008, the age-adjusted prevalence of obesity was 33.8% (95% confidence interval [CI], 31.6%-36.0%) overall, 32.2% (95% CI, 29.5%-35.0%) among men, and 35.5% (95% CI, 33.2%-37.7%) among women. The corresponding prevalence estimates for overweight and obesity combined (BMI > or = 25) were 68.0% (95% CI, 66.3%-69.8%), 72.3% (95% CI, 70.4%-74.1%), and 64.1% (95% CI, 61.3%-66.9%). Obesity prevalence varied by age group and by racial and ethnic group for both men and women. Over the 10-year period, obesity showed no significant trend among women (adjusted odds ratio [AOR] for 2007-2008 vs 1999-2000, 1.12 [95% CI, 0.89-1.32]). For men, there was a significant linear trend (AOR for 2007-2008 vs 1999-2000, 1.32 [95% CI, 1.12-1.58]); however, the 3 most recent data points did not differ significantly from each other.
In 2007-2008, the prevalence of obesity was 32.2% among adult men and 35.5% among adult women. The increases in the prevalence of obesity previously observed do not appear to be continuing at the same rate over the past 10 years, particularly for women and possibly for men.
T memory/effector cells (Tmem/eff) isolated from psoriatic patients are chronically activated and poorly suppressed by regulatory T cells (Treg). The proinflammatory cytokine IL-6, which signals through Stat3, allows escape of Tmem/eff cells from Treg-mediated suppression in a murine system. We show here that IL-6 protein is markedly elevated and most highly expressed by CD31(+) endothelial cells and CD11c(+) dermal dendritic cells (DCs) in lesional psoriatic skin. We hypothesized that exposure to high IL-6 in lesional tissue may lead to the dampened Treg function observed in psoriasis patients. Indeed, we found that IL-6, but not other Stat3-activating cytokines, was necessary and sufficient to reverse human T cell suppression by Treg in an in vitro model using activated DCs as a source of IL-6. IL-6Ralpha and gp130 expression was significantly elevated in psoriatic effector T cells compared with normal controls. Overall, IL-6Ralpha expression on Treg exceeded that of effector T cells, and both populations phosphorylated Stat3 in response to IL-6. Phosphorylation of Stat3 in T cells contributes to Th17 differentiation and we identify cells within lesional tissue that coexpress CD3, IL-17, and IL-6, indicating that Th17 cells are present in vivo within the psoriatic Tmem/eff population and contribute to IL-6-mediated resistance to Treg suppression. Taken together, T lymphocytes trafficking into lesional psoriatic skin encounter high IL-6 from endothelial cells, DCs, and Th17 cells, enabling cutaneous T cell escape from Treg suppression and Th17 participation in inflammation. Targeting IL-6 signaling pathways in psoriasis may rebalance Treg/T effector activity and ameliorate disease.
Inflammation is increasingly regarded as a key process underlying metabolic diseases in obese individuals. In particular, obese adipose tissue shows features characteristic of active local inflammation. At present, however, little is known about the sequence of events that comprises the inflammatory cascade or the mechanism by which inflammation develops. We found that large numbers of CD8(+) effector T cells infiltrated obese epididymal adipose tissue in mice fed a high-fat diet, whereas the numbers of CD4(+) helper and regulatory T cells were diminished. The infiltration by CD8(+) T cells preceded the accumulation of macrophages, and immunological and genetic depletion of CD8(+) T cells lowered macrophage infiltration and adipose tissue inflammation and ameliorated systemic insulin resistance. Conversely, adoptive transfer of CD8(+) T cells to CD8-deficient mice aggravated adipose inflammation. Coculture and other in vitro experiments revealed a vicious cycle of interactions between CD8(+) T cells, macrophages and adipose tissue. Our findings suggest that obese adipose tissue activates CD8(+) T cells, which, in turn, promote the recruitment and activation of macrophages in this tissue. These results support the notion that CD8(+) T cells have an essential role in the initiation and propagation of adipose inflammation.
Obesity is accompanied by chronic, low-grade inflammation of adipose tissue, which promotes insulin resistance and type-2 diabetes. These findings raise the question of how fat inflammation can escape the powerful armamentarium of cells and molecules normally responsible for guarding against a runaway immune response. CD4(+) Foxp3(+) T regulatory (T(reg)) cells with a unique phenotype were highly enriched in the abdominal fat of normal mice, but their numbers were strikingly and specifically reduced at this site in insulin-resistant models of obesity. Loss-of-function and gain-of-function experiments revealed that these T(reg) cells influenced the inflammatory state of adipose tissue and, thus, insulin resistance. Cytokines differentially synthesized by fat-resident regulatory and conventional T cells directly affected the synthesis of inflammatory mediators and glucose uptake by cultured adipocytes. These observations suggest that harnessing the anti-inflammatory properties of T(reg) cells to inhibit elements of the metabolic syndrome may have therapeutic potential.
Psoriasis is a chronic Th-1 and Th-17 inflammatory disease. Chronic inflammation has also been associated with atherosclerosis and thrombosis. The purpose of this study was to determine the risk of stroke in patients with psoriasis. We conducted a population-based cohort study of patients seen by general practitioners participating in the General Practice Research Database in the United Kingdom, 1987–2002. Mild psoriasis was defined as any patient with a diagnostic code of psoriasis, but no history of systemic therapy. Severe psoriasis was defined as any patient with a diagnostic code of psoriasis and a history of systemic therapy consistent with severe psoriasis. The unexposed (control) population was composed of patients with no history of a psoriasis diagnostic code. When adjusting for major risk factors for stroke, both mild (hazard ratio (HR) 1.06, 95% confidence interval (CI) 1.0–1.1) and severe (1.43, 95% CI 1.1–1.9) psoriasis were independent risk factors for stroke. The excess risk of stroke attributable to psoriasis in patients with mild and severe disease was 1 in 4,115 per year and 1 in 530 per year, respectively. Patients with psoriasis, particularly if severe, have an increased risk of stroke that is not explained by major stroke risk factors identified in routine medical care.
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Chronic plaque psoriasis is frequently associated with obesity. The effect of a hypoenergetic diet on psoriasis has not been investigated.
The objective was to investigate whether moderate weight loss (ie, 5-10% of body weight) increases the therapeutic response to a low dose of cyclosporine in obese patients with moderate-to-severe chronic plaque psoriasis.
A 24-wk randomized, controlled, investigator-blinded clinical trial was conducted in 61 patients. The efficacy of 2.5 mg x kg(-1)d(-1) cyclosporine combined with a low-calorie diet (intervention group) was compared with cyclosporine alone (control group) in obese patients [body mass index (in kg/m(2)) > 30] with moderate-to-severe psoriasis. The primary endpoint was an improvement from baseline of >or=75% in the Psoriasis Area and Severity Index (PASI 75 response) at week 24.
At week 24, the mean (+/- SD) reduction in body weight was 7.0% +/- 3.5 in the intervention group and was 0.2% +/- 0.9 in the control group (P < 0.001). The PASI 75 response was achieved by 20 of 30 patients (66.7%) treated with cyclosporine plus a low-calorie diet and by 9 of 31 (29.0%) patients treated with cyclosporine alone (P < 0.001). Four patients (13.3%) from the intervention group and 14 (45.1%) from the control group withdrew prematurely from the study (P < 0.001).
Obese patients with moderate-to-severe psoriasis increase their response to low-dose cyclosporine if a calorie-controlled diet is included in the treatment regimen. Lifestyle modifications, including a low-calorie diet, may supplement the pharmacologic treatment of obese psoriasis patients. This trial was registered at clinicaltrials.gov as NCT00512187.
Our aim was to assess the role of the body mass index (BMI) in the clinical response to systemic treatment for psoriasis.
A nationwide cohort study of patients receiving a new systemic treatment for plaque psoriasis at reference centres in Italy was conducted. Information was gathered through a web-based electronic form. Patients being maintained on the same medication and with data available at 8 and 16 weeks by March 31, 2007, were eligible. The outcome was a reduction in the Psoriasis Area Severity Index (PASI) of at least 75% at follow-up compared to baseline (PASI-75).
Out of 8,072 patients enrolled, 2,368 were eligible and analysable at 8 weeks and 2,042 at 16 weeks. PASI-75 was achieved by 819 patients (34.5%) at 8 weeks and 1,034 (50.6%) at 16 weeks. The proportion steadily decreased with increased values of BMI. Compared to normal weight (BMI = 20-24) the adjusted odds ratio for achieving PASI-75 in obese patients was 0.73 (95% CI = 0.58-0.93) at 8 weeks and 0.62 (95% CI = 0.49-0.79) at 16 weeks. The impact of the BMI did not show remarkable variations according to the drug prescribed at entry.
The BMI affects the early clinical response to systemic treatment for psoriasis.
Psoriasis is a common, chronic, inflammatory disease. Psoriasis has been hypothesized to be associated with an increased risk of lymphoma due to its pathophysiology, its treatments, or a combination of these factors. We performed a large population-based cohort study of the risk of lymphoma in psoriasis patients using the General Practice Research Database. We identified 153,197 patients with psoriasis and 765,950 corresponding subjects without psoriasis. Psoriasis patients who received a systemic treatment consistent with extensive disease were classified as severe (N=3,994) and those who did not receive systemic therapies were classified as mild (N=149,203). The analyses were adjusted for age, gender, and person-time using a Cox proportional hazards model. For mild and severe psoriasis patients, the respective adjusted relative risks for lymphoma and its subtypes were as follows: all lymphoma 1.34 (1.16, 1.54) and 1.59 (0.88, 2.89); non-Hodgkin's lymphoma 1.15 (0.97, 1.37) and 0.73 (0.28, 1.96); Hodgkin's lymphoma (HL) 1.42 (1.00, 2.02) and 3.18 (1.01, 9.97); cutaneous T-cell lymphoma (TCL) 4.10 (2.70, 6.23) and 10.75 (3.89, 29.76). Psoriasis is associated with an increased risk of lymphoma. The association is strongest for HL and CTCL. The excess risk of lymphoma attributed to psoriasis was 7.9/100,000 psoriasis patients per year. Although patients with psoriasis have an increased relative risk of lymphoma, the absolute risk attributable to psoriasis is low given that lymphoma is a rare disease and the magnitude of association is modest.
Achronic inflammatory process, initiated by lipoprotein extravasation and oxidation in the intimal space, builds up atherosclerotic plaques in the arterial wall.
See page 2090
Cytokines are fundamental actors of inflammation as they exert autocrine and paracrine effects and allow intercellular communication between effector and target cells. More than fifty cytokines have been identified by now. Shortly after their discovery, novel and unexpected biological actions of cytokines are brought to light by cross-disciplinary studies.
Thus, the intersection between the cardiovascular and the immunology research fields has prompted an increasing number of studies focusing on the identification of either proatherogenic or antiatherogenic effects of cytokines (please see Tedgui and Mallat 1 for extensive review).
Blumberg et al2 …
Non-alcoholic fatty liver disease has been associated with metabolic disorders, including central obesity, dyslipidemia, hypertension and hyperglycemia. Metabolic syndrome, obesity, and insulin resistance are major risk factors in the pathogenesis of non-alcoholic fatty liver disease. Non-alcoholic fatty liver disease refers to a wide spectrum of liver damage, ranging from simple steatosis to non-alcoholic steatohepatitis, advanced fibrosis and cirrhosis.
In a 12.5 cM genome-wide scan for psoriasis susceptibility loci, recombination-based tests revealed linkage to the HLA region (Z max = 3.52), as well as suggestive linkage to two novel regions: chromosome 16q (60-83.1 cM from pter, Z max = 2.50), and chromosome 20p (7.5-25 cM from pter, Z max = 2.62). All three regions yielded P values ≤ 0.01 by non-parametric analysis. Recombination-based and allele sharing methods also confirmed a previous report of a dominant susceptibility locus on distal chromosome 17q (108.2 cM from pter, Z max = 2.09, GENEHUNTER P = 0.0056). We could not confirm a previously reported locus on distal chromosome 4q; however, a broad region of unclear significance was identified proximal to this proposed locus (153.6-178.4 cM from pter, Z max =1.01). Taken together with our recent results demonstrating linkage to HLA-B and -C, this genome-wide scan identifies a psoriasis susceptibility locus at HLA, confirms linkage to 17q, and recommends two novel genomic regions for further scrutiny. One of these regions (16q) overlaps with a recently-identified susceptibility locus for Crohn's disease. Psoriasis is much more common in patients with Crohn's disease than in controls, suggesting that an immunomodulatory locus capable of influencing both diseases may reside in this region.
Experts on psoriasis convened with authorities from other medical specialties to discuss the recently described association between psoriasis, obesity and subsequent cardiovascular comorbidity. Similar to other diseases of increased systemic inflammation, psoriasis has been linked to a heightened risk of myocardial infarction, especially in the more severely affected, younger patients. However, unlike in other inflammatory diseases – such as rheumatoid arthritis – more severely affected patients with psoriasis are much more likely to be obese. Importantly, the pathophysiology of both psoriasis and obesity shows many shared cytokines that are known to contribute to features of the metabolic syndrome, such as hypertension, dyslipidaemia and insulin resistance. The strong association between psoriasis and obesity potentially makes psoriasis an important healthcare issue that requires an update in its standard of care. This meeting reviewed the evidence-based literature and addressed how, moving forward, dermatologists and other specialists may redefine the magnitude of health risk associated with more severe psoriasis and its comorbidities, while clarifying both the epidemiology and pathophysiology of the association with obesity.
Background Previous reports have demonstrated an association between psoriasis and the metabolic syndrome. Chronic obstructive pulmonary disease (COPD) has also been associated with the metabolic syndrome.
Objectives To assess the association between psoriasis and COPD in a population-based case–control study.
Methods A case–control study was performed utilizing the database of Clalit Health Services, a large healthcare provider organization in Israel. Patients over the age of 20 years who were diagnosed with psoriasis (‘cases’) were compared with a sample of age- and gender-matched enrollees without psoriasis (‘controls’) regarding the prevalence of COPD. Group matching was performed. Data on health-related lifestyles and other comorbidities were collected. χ2 tests, t-tests and logistic regression models were used to compare between study groups.
Results The study included 12 502 psoriasis cases and 24 287 controls. The prevalence of COPD was significantly higher in patients with psoriasis [5·7% vs. 3·6%, P < 0·001, odds ratio (OR) 1·63, 95% confidence interval (CI) 1·47–1·81]. A multivariate logistic regression model demonstrated that psoriasis was significantly associated with COPD, after controlling for confounders, including age, sex, socioeconomic status, smoking and obesity (adjusted OR 1·27, 95% CI 1·13–1·42, P < 0·001).
Conclusions In this large, population-based case–control study, psoriasis was found to be associated with COPD. Dermatologists caring for patients with psoriasis should be aware of this association, consult an internist or pulmonologist, and advise the patients to stop smoking and reduce additional risk factors for COPD.
Several studies have shown increased prevalence of obesity in patients with psoriasis.
To characterize both inflammatory- and oxidative stress-related differences between obese patients with psoriasis (OPP) and normal-weight patients with psoriasis (NWPP).
The plasma concentrations of adiponectin and interleukin (IL)-6 were analysed by quantitative sandwich enzyme immunoassay technique in 10 patients with a body mass index (BMI)<25 and 12 patients with a BMI>30. Total glutathione and oxidized glutathione levels were measured spectrophotometrically.
Plasma concentration of adiponectin in NWPP was more than twice the level in healthy normal-weight controls (P<0.001), while such an elevation did not occur in OPP. OPP were characterized by a significantly increased IL-6 level, which correlated negatively with the adiponectin level (r=-0.85, P<0.001). The glutathione redox status, which was also inversely correlated with the adiponectin level (r=-0.63, P<0.05), was associated with significantly increased oxidative stress in the OPP compared with the NWPP or controls.
Obesity in patients with psoriasis is associated with both decreased plasma levels of protective adiponectin compared with NWPP, and enhanced systemic inflammation and oxidative stress. These findings are in concordance with high prevalence of diseases related to lower adiponectin levels among psoriasis patients.
Many epidemiological studies have associated psoriasis with an increased risk of coronary artery disease, resulting from a higher prevalence of cardiovascular risk factors in psoriasis patients compared with unmatched controls. However, the results of epidemiological studies vary depending upon the populations studied. The aim of this systemic review was to evaluate the risk of diabetes, hypertension, dyslipidaemia and obesity in adults with plaque psoriasis. In addition, we assessed the relationship between the risk of cardiovascular risk factors and psoriasis severity.
A systematic search was performed on Pubmed, Cochrane and Embase databases, using the key-words 'psoriasis', 'diabetes', 'hypertension', 'high blood pressure', 'dyslipidaemia', 'metabolic syndrome' and 'obesity', during the period from 1980 to June 2009.
The initial literature search identified 353 articles. The final selection included 18 cross-sectional case-control studies. An increased risk of metabolic syndrome was observed in psoriatic patients (OR = 1.3-5.92), and a trend for a higher risk of obesity (OR = 1.18-5.49), especially in patients with severe psoriasis. For hypertension, hypertriglyceridaemia, and diabetes, the association was not significant in all studies.
There was important heterogeneity in study design preventing from pooling results. Most often lifestyle factors such as smoking, alcohol consumption, physical activities were not taken into account.
There is an increased risk of obesity and metabolic syndrome in psoriasis. For hypertension, diabetes and dyslipidaemia no consistency was found across studies. Prospective epidemiological studies with thorough recording of cardiovascular risk factors are required in psoriasis patients.
Psoriasis is a chronic inflammatory disorder that affects approximately 2% of the general population. Numerous studies have evaluated the increased prevalence of comorbid diseases and risk factors in psoriatic patients, including obesity, metabolic syndrome, cardiovascular disease, psoriatic arthritis, autoimmune disease, psychiatric illness, liver disease, smoking, malignancy, chronic obstructive pulmonary disease, sleep apnea, and alcohol abuse. Insight into the overlapping pathogenesis of these comorbidities of psoriasis highlights the importance of immune-mediated mechanisms in these disease states. Psoriasis, with its comorbidities, must be approached in a multidisciplinary manner to effectively and comprehensively understand, manage, and treat those with this complex disorder.
Psoriasis may significantly reduce quality of life. Previous studies reported an association of psoriasis and cardiovascular risk factors and cardiovascular events. The extent to which psoriasis is associated with psychiatric morbidity and the role of psychiatric comorbidity as a potential confounder of the association between psoriasis and cardiovascular morbidity require further investigation.
To study the association between psoriasis, psychiatric morbidity and cardiovascular morbidity.
Case-control study utilizing an interdisciplinary administrative outpatient database from Germany. Patients with confirmed diagnosis of prevalent psoriasis within the study period (2003-2004) (n = 3147, mean age 57 years) were individually matched for age and gender with 3147 controls without psoriasis. The relationship of psoriasis with psychiatric morbidities (depression, stress-related disorders, behaviour disorders and schizophrenic disorders), cardiovascular risk factors (diabetes, hypertension, obesity and dyslipidaemia) and cardiovascular events [myocardial infarction (MI), stroke] was investigated using logistic and linear regression models.
Crude analyses suggested an association of psoriasis with depression, stress-related disorders, behaviour disorders and cardiovascular risk factors, but not with MI [odds ratio (OR) 1.14; 95% confidence interval (95% CI) 0.81-1.62] or stroke (OR 0.97; 95% CI 0.61-1.54). Multivariate models controlling for age, gender and consulting behaviour indicated that psoriasis is independently associated with depression (OR 1.49; 95% CI 1.20-1.86), stress-related disorders (OR 1.41; 95% CI 1.22-1.62), behaviour disorders (OR 1.58; 95% CI 1.05-2.39), diabetes (OR 1.21 95% CI 1.04-1.40), hypertension (OR 1.34; 95% CI 1.18-1.51), dyslipidaemia (OR 1.29; 95% CI 1.07-1.55), and obesity (OR 1.63; 95% CI 1.39-1.90). For each psychiatric condition, the likelihood of being affected significantly increased with each physician visit due to psoriasis, suggesting that the risk of psychiatric comorbidity increases with the severity of psoriasis.
Psoriasis appears to be independently associated with major psychiatric disorders and with cardiovascular risk factors, but not with cardiovascular events.
Non-alcoholic fatty liver disease (NAFLD) and chronic plaque psoriasis are both associated with metabolic syndrome and increased risk of incident cardiovascular disease. We assessed the frequency and characteristics of NAFLD in patients with chronic plaque psoriasis.
One hundred and thirty consecutive patients with chronic plaque psoriasis and 260 apparently healthy controls matched for age, sex and body mass index were enrolled. NAFLD was diagnosed by abdominal ultrasound after excluding other secondary causes of chronic liver disease.
The frequency of NAFLD was remarkably greater in psoriasis patients than in controls (47% vs. 28%; p<0.0001). Patients with psoriasis and NAFLD (n=61) were more likely to have metabolic syndrome and had higher serum C-reactive protein concentrations and greater severity of psoriasis according to the Psoriasis Area and Severity Index (PASI) score (14.2+/-12.6 vs. 9.6+/-7.4; p<0.01) than those with psoriasis alone (n=69). In a subgroup of psoriasis patients (n=43), those with NAFLD (n=21) also had significantly higher serum interleukin-6 and lower serum adiponectin levels. Notably, in multivariate regression analysis, NAFLD was associated with higher PASI score independently of age, gender, body mass index, psoriasis duration, and alcohol consumption.
NAFLD is frequent in patients with chronic plaque psoriasis - affecting up to nearly half of these patients - and is strongly associated with psoriasis severity. Early recognition of NAFLD by radiological imaging tests in this group of patients is warranted.
To examine the cardiovascular risk factors in patients with psoriasis and the association between psoriasis and coronary artery, cerebrovascular, and peripheral vascular diseases.
Observational study.
Large Department of Veterans Affairs hospital.
The study included 3236 patients with psoriasis and 2500 patients without psoriasis (controls).
Using International Classification of Diseases, Ninth Revision, Clinical Modification, codes, we compared the prevalence of traditional cardiovascular risk factors and other vascular diseases as well as mortality between patients with psoriasis and controls.
Similar to previous studies, we found a higher prevalence of diabetes mellitus, hypertension, dyslipidemia, and smoking in patients with psoriasis. After controlling for these variables, we found a higher prevalence not only of ischemic heart disease (odds ratio [OR], 1.78; 95% confidence interval [CI], 1.51-2.11) but also of cerebrovascular (OR, 1.70; 95% CI, 1.33-2.17) and peripheral vascular (OR, 1.98; 95% CI, 1.32-2.82) diseases in patients with psoriasis compared with controls. Psoriasis was also found to be an independent risk factor for mortality (OR, 1.86; 95% CI, 1.56-2.21).
Psoriasis is associated with atherosclerosis. This association applies to coronary artery, cerebrovascular, and peripheral vascular diseases and results in increased mortality.
Psoriasis is a common, chronic, inflammatory, multisystem disease with predominantly skin and joint manifestations affecting approximately 2% of the population. In this fourth of 6 sections of the guidelines of care for psoriasis, we discuss the use of traditional systemic medications for the treatment of patients with psoriasis. Treatment should be tailored to meet individual patients' needs. We will discuss in detail the efficacy and safety, and offer recommendations for the use of the 3 most commonly used, and approved, traditional systemic agents: methotrexate, cyclosporine, and acitretin. We will also briefly discuss the available data for the use of azathioprine, fumaric acid esters, hydroxyurea, leflunomide, mycophenolate mofetil, sulfasalazine, tacrolimus, and 6-thioguanine in psoriasis.
Psoriasis is a chronic inflammatory, immune-mediated skin disease affecting 2 to 3% of the general population and may cause significant quality-of-life impairment. Psoriasis and psoriatic arthritis are associated with increased atherothrombotic diseases, including myocardial infarction, deep venous thrombosis, and reduced life span. Both disease-specific and non-disease-specific risk factors are likely to fuel one another in deleterious vicious circles. Disease-specific risk factors are those that are a direct consequence of psoriasis inflammation and include hyperhomocysteinemia, elevated C-reactive protein, elevated blood inflammatory cytokines, and platelet hyperactivity. Non-disease-specific risk factors include insulin resistance/diabetes, obesity, dyslipidemia, hypertension, metabolic syndrome, and habitual tobacco smoking. The presence of cardio-metabolic comorbidities has also relevant implication in the therapy and global approach to patients with psoriasis. Traditional systemic antipsoriatic agents frequently negatively affect cardio-metabolic comorbidities and may have important interactions with drugs commonly used by psoriasis patients. Thus, patients with psoriasis should be treated effectively and encouraged to aggressively correct their modifiable cardiovascular risk factors.
To evaluate the independent association between psoriasis and risk of diabetes and hypertension.
A prospective study of female nurses who were followed up from 1991 to 2005.
Nurses' Health Study II, a cohort of 116 671 US women aged 27 to 44 years in 1991.
The study included 78 061 women who responded to a question about a lifetime history of physician-diagnosed psoriasis in 2005. Women who reported a diagnosis of diabetes or hypertension at baseline were excluded. Main Outcome Measure New diagnosis of diabetes or hypertension, obtained from biennial questionnaires.
Of the 78 061 women, 1813 (2.3%) reported a diagnosis of psoriasis. During the 14 years of follow-up, a total of 1560 incident cases (2%) of diabetes and 15 724 incident cases (20%) of hypertension were documented. The multivariate-adjusted relative risk of diabetes in women with psoriasis compared with women without psoriasis was 1.63 (95% confidence interval, 1.25-2.12). Women with psoriasis were also at an increased risk for the development of hypertension (multivariate relative risk, 1.17; 95% confidence interval, 1.06-1.30). Age, body mass index, and smoking status did not significantly modify the association between psoriasis and risk of diabetes or hypertension (P values for interaction, > or =.07).
In this prospective analysis, psoriasis was independently associated with an increased risk of diabetes and hypertension. Future studies are needed to find out whether psoriasis treatment will reduce the risk of diabetes and hypertension.
To evaluate the role of leptin, a 16-kDa adipocyte-derived hormone, in the development of metabolic dysregulation of psoriasis.
Case-control study.
Referral centers. Patients Seventy-seven patients with psoriasis and 81 age- and sex-matched control subjects were included in the study. Intervention Enzyme-linked immunoassay of serum samples from study subjects.
Serum leptin levels and proportions of comorbidities (including hypertension, diabetes mellitus, metabolic syndrome, hypertriglyceridemia, and reduced high-density lipoprotein cholesterol concentrations) in cases vs controls were compared using chi(2) and Mann-Whitney tests. The clinical significance of leptin in psoriasis was analyzed using logistic regression models.
Significantly more obesity (odds ratio [OR], 2.67) and hypertension (2.17) (P =.04 for both) were observed in subjects with psoriasis. High serum leptin levels (>or=7397.43 pg/mL) were found in female subjects (OR, 6.05; P < .001) and in subjects with obesity (3.45; P =.01), hypertension (2.19; P =.04), metabolic syndrome (3.58; P =.008), and psoriasis (2.25; P =.02). On multivariate analysis, psoriasis (OR, 4.57; P =.009) was significantly associated with hyperleptinemia independent of female sex (26.36; P < .001), metabolic syndrome (4.37; P =.04), and obesity (2.83; P =.12). Finally, patients with psoriasis who had hyperleptinemia tended to be female (P < .001) and manifested obesity (P =.002) and metabolic syndrome (P =.003).
Hyperleptinemia is associated with psoriasis independent of female sex and other conventional cardiovascular risk factors such as obesity and metabolic syndrome. Hyperleptinemia in psoriasis may contribute to metabolic syndrome.
Psoriasis is a multifactorial disease affected by both genetic and environmental factors. Several comorbid conditions, such as smoking, depression and obesity have been found to be associated with psoriasis. This study addressed the association of psoriasis and obesity using same-gender full siblings as controls, correlating between body mass index (BMI) and severity of psoriasis as determined by body surface area (BSA) and the Physician's Global Assessment (PGA).
In total, 88 patients undergoing outpatient treatment for psoriasis were surveyed for demographic information, psoriasis history, social history, personal and family medical history, whether they had a same-gender full sibling and if so, the age, weight and height of the sibling. Height, weight, PGA scores and percentage of BSA affected by psoriasis, were recorded for each patient. BMI was calculated for each patient and their same-gender full sibling.
A positive association between psoriasis severity and BMI was found. PGA score increased with BMI (Spearman's correlation, r(s) = 0.29, P = 0.007). There was also a positive correlation between BMI and BSA%, r(s) = 0.24, P = 0.02. A significant difference in BMI between patients with psoriasis and the same-gender full sibling control was seen for women (mean +/- SD 30.2 +/- 10.2 vs. 27.6 +/- 7.3 kg/m(2), respectively, P = 0.02), but not for men.
In this study, psoriasis severity was found to be related to the level of obesity. Using same-gender siblings as genetic controls for predisposition to both obesity and psoriasis, patients with psoriasis were more likely to have a higher BMI, particularly for women. This study reinforces the need to treat the whole patient and to encourage healthy living, such as maintaining an appropriate weight, proper eating habits and exercise. Limitations of this study include the relatively small number of patients enrolled, potential inaccuracies in sibling BMIs calculated from information provided by patients, and a lack of information about dietary habits, exercise and lifestyle.
Cross-sectional studies, mostly in hospitalized patients, reported a possible positive association between psoriasis and diabetes mellitus (DM). However, information on the temporal relation is scarce, and incidence rates of new-onset DM in patients with psoriasis are lacking.
To assess and compare incidence rates of new-onset DM between patients with psoriasis and a comparison group without psoriasis, and to explore the role of psoriasis severity and body mass index (BMI).
We conducted a follow-up study with a nested case-control analysis within the U.K.-based General Practice Research Database. The study population consisted of patients with a first-time diagnosis of psoriasis between 1994 and 2005 and a matched group of psoriasis-free patients. We used psoriasis duration and treatment as proxy for disease severity, and we applied conditional logistic regression to obtain odds ratios (ORs) with 95% confidence intervals (CIs).
Within the study population of 65 449 patients we identified 1061 incident cases of DM. Of these, 59% had a history of psoriasis, yielding a crude incidence rate ratio of 1.36 (95% CI 1.20-1.53). The adjusted OR for patients with >or=2 years disease duration and >2 prescriptions per year for oral psoriasis treatment was 2.56 (95% CI 1.11-5.92). In an analysis restricted to patients with normal BMI, the adjusted OR was 2.02 (95% CI 1.31-3.10).
In this large observational study the risk of incident DM was increased for patients with psoriasis as compared with a psoriasis-free comparison group. The risk increased with psoriasis duration and severity and was not driven by high BMI alone.
In a double-blind trial, 21 patients with severe plaque psoriasis were randomly assigned to receive oral cyclosporine, 14 mg/kg/d, or its vehicle. After four weeks of therapy the 11 cyclosporine recipients had the following response to treatment: two had total clearing and six improved markedly, two moderately, and one minimally; whereas ten vehicle-treated patients showed no change or minimal improvement. Vehicle-treated patients, after a switch to cyclosporine for four weeks, demonstrated impressive improvement similar to that seen in patients who initially received only cyclosporine. Moderate or marked improvement or total clearing was noted in 17 (81%) of 21 and 20 (95%) of 21 after one and four weeks of therapy, respectively. Mitotic figures and leukotriene B4 levels in lesions decreased 86% and 64%, respectively, after seven days of cyclosporine therapy. Mononuclear (including activated T cells) and polymorphonuclear leukocyte infiltrates were markedly reduced in lesions of all patients after seven days of cyclosporine therapy. These results suggest that psoriasis may have an immunologic basis mediated by activated T cells and/or other immune cells; if a long-term regimen with a favorable efficacy-side effect ratio can be determined, cyclosporine would be a significant advance in the treatment of psoriasis.