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The Risk of Mortality in Patients With Psoriasis: Results From a Population-Based Study
Abstract
To determine the risk of mortality in patients with psoriasis.
Cohort study.
General practitioners participating in the General Practice Research Database in the United Kingdom, 1987-2002.
Mild psoriasis, defined as any patient with a diagnostic code of psoriasis but no history of systemic therapy; severe psoriasis, 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. Control patients were selected in a 5:1 ratio from the same practice and date in practice as the patients with psoriasis.
Hazard ratio (HR) of time to death using Cox proportional hazards models adjusted for age and sex.
There was no overall effect of mild psoriasis on mortality (HR, 1.0; 95% confidence interval [CI], 0.97-1.02), whereas patients with severe psoriasis demonstrated an increased overall mortality risk (HR, 1.5; 95% CI, 1.3-1.7). The association of severe psoriasis with mortality persisted after adjustment for risk factors for mortality (HR, 1.4; 95% CI, 1.3-1.6) and after exclusion of patients with inflammatory arthropathy (HR, 1.5; 95% CI, 1.3-1.8). Male and female patients with severe psoriasis died 3.5 (95% CI, 1.2-5.8) and 4.4 (95% CI, 2.2-6.6) years younger, respectively, than patients without psoriasis (P < .001).
Severe but not mild psoriasis is associated with an increased risk of death.
... The results of the survey exhibited that the age group 19-25 was highly affected with acne, pigmentation, and tan having oily skin. The age group 19-25 has numerous hormonal changes, an unhealthy diet; not having proper skin care with the recent scenario of stressful life and disturbed routine may be the possible reason for these types of skin problems [8,[23][24][25]. The age group 26-35 with normal skin, dry skin, and sensitive skin is commonly associated with pigmentation and tan. ...
... It was found that aging was more above the age of 36. Aging is prominently developed with unhealthy lifestyles, lack of exercise, diet, and many more [24][25][26][27]. ...
... In winter, the cold weather and low humidity can cause the skin to become dehydrated. In response, the sebaceous glands may produce even more oil to compensate for the lack of moisture, further exacerbating acne breakouts [5,21,[24][25][26][27][28]. It was found that oily skin has major issues of pigmentation and aging during summer seasons. ...
Introduction Human skin serves several important functions and is the largest organ in the body. It plays a role of barrier against external elements, regulates body temperature, and helps in the excretion of waste products. The condition of the skin can vary from person to person, and it is often classified into different types based on certain characteristics [1, 2]. Additionally, various skin problems can occur that may require attention and treatment. Skin is typically classified into four main types: normal, dry, oily, and sensitive. These classifications are based on factors such as sebum production, moisture levels, and sensitivity [2,3]. Normal Skin: Normal skin has a balanced sebum production, good moisture retention, and is generally free from major skin problems [2]. Dry Skin: Skin that is dry lacks proper moisture and feels tight, itchy, and rough. It may be caused by factors such as genetics, aging, weather conditions, or excessive use of harsh skincare products [1]. Oily Skin: As a result of excessive sebum production, oily skin looks shiny, has enlarged pores, and is prone to acne and other skin. Abstract Background: The current study survey aims to explore the impact of age groups and seasons on various skin types. A survey was performed by IncNut LifeStyle Pvt. Ltd., City, Country in 2021 and 2022. IncNut LifeStyle Pvt. Ltd. India is the 1st organization that designed customized products as per individual needs. To understand consumers' actual needs over 'wants', the consumer needs to answer the questionnaire, which is about various attributes like skin type, gender, age, food habits, skin issues, etc. For skin type categorization, four options were provided i.e. Oily, Dry, Normal and Sensitive Skin. Data mapping and analysis have been done with the aid of proprietary validated software DiabloTM.
... In terms of physical burden, population-based studies have found an increased mortality risk in psoriatic patients, with an even higher risk for individuals with moderate-to-severe psoriasis (MSP). [2][3][4][5][6] However, the majority of these studies used the mortality rate ratio (hazard ratio) to measure difference in mortality rates. [2][3][4][5][6] Such measures are incomprehensible to lay people and some health authority staff, and incompletely represents life course disease burden of psoriasis. ...
... [2][3][4][5][6] However, the majority of these studies used the mortality rate ratio (hazard ratio) to measure difference in mortality rates. [2][3][4][5][6] Such measures are incomprehensible to lay people and some health authority staff, and incompletely represents life course disease burden of psoriasis. ...
... 13 Nevertheless, data on the number of years of life lost among patients with psoriasis compared with the general population are limited. 5,14 Furthermore, studies that have calculated years of life lost did so based on the difference in mean age at death between patients with psoriasis and either the provincial/national population or an inadequately matched reference group. 5,14 Moreover, these studies measured the age at death from a prevalent cohort. ...
Background
Patients with psoriasis have a significant disease burden throughout the life course. Nevertheless, the lifetime risk and disease burden of psoriasis across the entire lifespan is rarely quantified in an easily understandable way.
Objective
To estimate the cumulative incidence rate, life expectancy, loss-of-life expectancy, and lifetime healthcare expenditures for incident psoriasis.
Design and methods
Using real-world nationwide data from the National Health Insurance Research Database of Taiwan for 2000–2017, along with the life tables of vital statistics, we estimated cumulative incidence rate, life expectancy, loss-of-life expectancy, and lifetime healthcare expenditures for those with psoriasis using a semi-parametric survival extrapolation method.
Results
A total of 217,924 new psoriasis cases were identified. The lifetime risk of psoriasis in patients aged 18–80 for both sexes decreased in Taiwan with a cumulative incidence rate of 7.93% in 2000 to 3.25% in 2017. The mean (±standard error) life expectancy after diagnosis was 27.11 (± 1.15) and 27.14 (±1.17) years for patients with moderate-to-severe psoriasis and psoriatic arthritis, respectively. Patients with moderate-to-severe psoriasis and psoriatic arthritis had a mean (±standard error) loss-of-life expectancy of 6.41 (±1.16) and 6.48 (±1.17) due to psoriasis, respectively. Male patients have higher lifetime and annual lifetime healthcare expenditures than female. Mean life expectancy, loss-of-life expectancy, and lifetime cost were relatively higher for younger patients.
Conclusion
Among psoriatic patients, patients with moderate-to-severe psoriasis and psoriatic arthritis had substantial years of life lost, particularly for younger patients. Our results provide a reliable estimation of lifetime disease burden, and these estimates will help health authorities in cost-effectiveness assessments of public health interventions and allocation of services resources to minimize loss-of-life expectancy, and lifetime healthcare expenditures in patients with psoriasis.
... In patients with severe psoriasis, a higher mortality risk (hazard ratio: 1.5; 95% confidence interval: 1.3-1.7) is found as compared to the general population. 4,6 Affected men and women, respectively, die 3.5 and 4.4 years earlier than healthy controls, probably due to comorbidities, lifestyle (smoke and alcohol abuse), and administered therapies. 6 Psoriasis affects at least 100 millions of people all over the world, mostly Caucasians. ...
... 4,6 Affected men and women, respectively, die 3.5 and 4.4 years earlier than healthy controls, probably due to comorbidities, lifestyle (smoke and alcohol abuse), and administered therapies. 6 Psoriasis affects at least 100 millions of people all over the world, mostly Caucasians. 4,7 Prevalence in Europe varies between 0.6% and 6.5%, and is highest in northern countries. ...
This analysis was aimed at estimating the cost per responder as measured by number needed to treat of ixekizumab as compared with other biologic drugs approved in Italy for the treatment of moderate-to-severe plaque psoriasis. The clinical efficacy was assessed in terms of number needed to treat, based on a network meta-analysis of published efficacy data as measured by Psoriasis Area and Severity Index response (PASI75, PASI90, and PASI100) for relevant biologic comparators. The cost was based on the number of administrations dispensed in the first (induction plus maintenance period) and the second (maintenance period only) year of treatment and the ex-factory price net of discounts of each biologic drug. The cost per responder was adopted as a cost-effectiveness indicator. Independent of the Psoriasis Area and Severity Index response (PASI75, PASI90, and PASI100) used and the year of treatment considered, the cost per number needed to treat for ixekizumab appeared consistently to be the lowest. For example, considering first-year costs and PASI75, the cost per responder for ixekizumab was €16,388, compared to adalimumab (€22,574), etanercept (branded original: €32,420; biosimilar: €21,432), secukinumab (€17,937), and ustekinumab (€20,014). The differences in the cost per responder between ixekizumab and the comparators increased when higher Psoriasis Area and Severity Index response levels were considered. This economic assessment confirmed that ixekizumab is a cost-efficient option from the perspective of the Italian National Health Service for the treatment of moderate-to-severe plaque psoriasis.
... According to this concept, starting from chronic skin inflammation, systemic inflammation follows, leading to vascular dysfunction and insulin resistance, and in further progression to atherosclerosis and its acute manifestations, such as myocardial infarction and stroke [5]. These concomitant diseases did not only cause a reduced quality of life, but also reduced life expectancy of these patients, who die approximately three to six years earlier compared to patients without psoriasis [6]. Therefore, the development of preventive strategies aiming at the cardiovascular comorbidity has been considered as crucial, and implementation of these strategies has been envisaged for psoriasis patients [7]. ...
... In our cohort, hospitalizations for CKD in patients with psoriasis occurred in median 5 years earlier in life than in CKD patients without psoriasis. This finding is highly alarming in itself-and it is consistent with epidemiological data showing a reduction in life expectancy by about the same amount of time in psoriasis patients [6]. Despite the younger age, the prevalence of coronary artery disease, heart failure, diabetes, and hypertensive nephropathy were significantly higher in our cohort of hospitalized ESRD pa-tients with psoriasis. ...
Background and objectives:
During the last decades, growing evidence corroborates that chronic inflammatory disease impairs the body beyond the cutaneous barrier. Linkage between psoriasis and kidney disease, and in particular between psoriasis and end-stage renal disease (ESRD), have not yet been elucidated. We sought to analyze the impact of concomitant psoriasis on the in-hospital outcomes of patients hospitalized with ESRD.
Patients and methods:
We analyzed data on characteristics, comorbidities, and in-hospital outcomes of all hospitalized patients with ESRD stratified for concomitant psoriasis in the German nationwide in-patient sample between 2010 and 2020.
Results:
Overall, 360,980 hospitalizations of patients treated for ESRD in German hospitals were identified from 2010 to 2020 and among these 1063 patients (0.3%) additionally suffered from psoriasis. While the annual number of all ESRD patients increased within this time, the number of patients with ESRD and the additional psoriasis diagnosis decreased slightly. Patients with ESRD and psoriasis were five years younger (66 [IQR, 56-75] vs. 71 [59-79] years, p < 0.001), were more often obese (17.5% vs. 8.2%, p < 0.001) and more frequently had cancer (4.9% vs. 3.3%, p < 0.001), diabetes mellitus (42.7% vs. 38.5%, p = 0.005) and coronary artery disease (31.1% vs. 28.0%, p = 0.026). Multivariate regression models demonstrated that psoriasis was not associated with in-hospital case-fatality in patients with ESRD (OR 1.02 (95%CI 0.78-1.33), p = 0.915).
Conclusions:
ESRD patients with the concomitant psoriasis diagnosis were hospitalized on average 5 years earlier than patients without psoriasis. A higher prevalence of severe life-shortening comorbidities including coronary artery disease and cancer was detected in ESRD patients with psoriasis despite their younger age. Our findings support the understanding of psoriasis as an autoimmune skin disease crossing the boundary between dermatology and internal medicine.
... 7,8 Psoriasis has been demonstrated to be associated with a higher risk of coronary artery disease (CAD), myocardial infarction, and subclinical atherosclerosis. [4][5][6]9 Recent research has uncovered an association between psoriasis and atrial fibrillation (AF), the most common arrhythmia in clinical practice. 10,11 AF has been increasingly demonstrated to have inflammatory components in its pathophysiology. ...
Introduction: Psoriasis is a prevalent inflammatory skin condition characterized by erythematous plaques with scaling. Recent research has demonstrated an increased risk of cardiovascular diseases in patients with psoriasis; however, current evidence on atrial fibrillation (AF) risk in psoriasis is limited. Materials and methods: A systematic literature search was performed on major bibliographic databases to retrieve studies that evaluated AF risk in patients with psoriasis. The DerSimonian and Laird random effects model was used to pool the hazard ratios (HR) with 95% confidence intervals (CI). Subgroup analysis was conducted by dividing the patients into mild and severe psoriasis groups. Publication bias was assessed by visual inspection and Egger's regression test. Statistical significance was set at p<0.05.
Results: Seven studies were included, with 10,974,668 participants (1,94,230 in the psoriasis group and 10,780,439 in the control group). Patients with psoriasis had a significantly higher risk of AF [Pooled HR: 1.28; 95% CI: 1.20, 1.36; p<0.00001]. In subgroup analysis, patients with severe psoriasis [HR: 1.32; 95% CI: 1.23, 1.42; p<0.00001] demonstrated a slightly higher risk of AF, although statistically insignificant (p=0.17), than the mild psoriasis group [HR: 1.21; 95% CI: 1.10, 1.33; p<0.0001]. Egger's regression test showed no statistically significant publication bias (p=0.24). Conclusion: Our analysis demonstrated that patients with psoriasis are at a significantly higher risk of AF and hence should be closely monitored for AF. Further large-scale and multicenter randomized trials are warranted to validate the robustness of our findings.
... Large epidemiological studies from Germany and Taiwan indicate an increased association of other inflammatory systemic comorbidities such as rheumatoid arthritis, inflammatory bowel disease, and systemic lupus erythematosus in patients with psoriasis that support the pathophysiology of psoriasis to be rooted in chronic systemic inflammation (Augustin et al, 2010;Tsai et al, 2011). The elevated inflammatory profile of psoriasis and associated comorbidities may lead to a decreased life expectancy of 3e4 years because a population-based cohort study from the United Kingdom assessed patients with severe psoriasis to have approximately a 50% increased risk of mortality (Gelfand et al, 2007). Although aberrant keratinocyte proliferation is a key hallmark of psoriasis, increased infiltration of T cells within the epidermis and release of inflammatory cytokines (IL-12, IL-22, IL-23) may be driving epidermal hyperplasia (acanthosis) (Torti and Feldman, 2007;Zheng et al, 2007). ...
We have previously identified that a structural membrane protein Caveolin-1 (Cav1) is involved in the regulation of aberrant keratinocyte proliferation and differentiation. The aim of this study was to elucidate the role of Cav1, Caveolin-2 (Cav2), and Cavin-1 in the pathogenesis of psoriasis vulgaris and between psoriasis subtypes. We utilized human biopsies from validated cases of psoriasis vulgaris (n = 21) at the University of Miami Hospital and compared the expression of Cav1, Cav2, and Cavin-1 by immunohistochemistry staining with that in normal healthy age-/sex-/location-matched skin (n = 15) and chronic spongiotic dermatitis skin samples (as control inflammatory skin condition) and quantified using QuPath. Distinct subtypes of psoriasis included guttate, inverse, nail, plaque, palmoplantar, and pustular. All biopsy samples exhibited a trend toward downregulation of Cav1, with nail, plaque, and palmoplantar psoriasis exhibiting the most pronounced effects. Only nail and pustular psoriasis samples exhibited significant downregulation of Cav2 and Cavin-1, suggesting Cav1 to be the main caveolar contributor to the pathogenesis of psoriasis. Together, these data support caveolae as pathophysiological targets in nail and pustular psoriasis, whereas Cav1 seems to be a general biomarker of multiple subtypes of psoriasis.
... Initially reported, an observed non-linear positive correlation emerged between WWI levels and the risk of CVD and all-cause mortality [17]. It is worth noting that individuals with psoriasis face an elevated risk of CVD, a prevalent contributor to morbidity and mortality in psoriasis cases, and a recognized cardiovascular risk factor [45,46,47]. High serum IL-17A levels are linked to greater mortality from coronary heart disease[48]. ...
Background
Evidence has indicated that the correlation between obesity and psoriasis is likely multifactorial in nature.Previously, no reports have been made regarding the correlation between weight-adjusted waist index (WWI) and psoriasis.
Methods
In this cross-sectional research, we examined a cohort of adult participants who provided comprehensive data related to WWI and psoriasis, gathered during the 2009–2014 National Health and Nutrition Examination Survey (NHANES). The calculation for WWI involved dividing waist circumference (WC) by the square root of body weight. We explored the association between WWI and psoriasis through multivariate linear regression modeling and subgroup analyses. The smoothing curve fitting was also applied .
Results
The study included 15,920 participants aged over 19 years, of whom 438 had a history of psoriasis.It revealed a notable positive correlation between WWI and psoriasis(OR = 1.226; 95% CI, 1.071–1.404, P < 0.05).The quartile with the highest WWI value (OR = 1.551; 95% CI, 1.127–2.135, P < 0.05) had a significantly increased risk of developing psoriasis by 55.1% compared with the quartile with the lowest WWI value. A positive nonlinear connection between WWI and psoriasis was observed in the smoothed curve fitting results.
Conclusion
Among U.S. adults, levels of WWI are positively associated with increased odds of developing psoriasis.We propose that adopting obesity management strategies based on the WWI could be beneficial in lowering the risk of psoriasis.
... Recent research has consistently highlighted a strong association between psoriasis and a high risk of major medical morbidities, and even mortality 20,21 . A cohort study found a connection between moderate and severe psoriasis and heightened chronic kidney disease risk 22 . ...
Although a large number of evidence has identified that psoriasis is significantly correlated with type 2 diabetes (T2D), the common molecular mechanism of its occurrence remains unclear. Our study aims to further elucidate the mechanism of the occurrence of this complication. We obtained the gene expression data of psoriasis (GSE30999) and T2D (GSE28829) from the Gene Expression Omnibus (GEO) dataset. Then the common differentially expressed genes (DEGs) of T2D and psoriasis were identified. After that, we performed three types of analyses about these DEGs, including functional enrichment analysis, protein–protein interaction (PPI) network and module manufacture, hub genes identification and co-expression analysis. 132 common DEGs (14 upregulated genes and 118 downregulated genes) were identified for subsequent a series of analyses. Function enrichment analysis demonstrated that Rap1 signaling pathway, PI3K-Akt signaling pathway, and cGMP-PKG signaling pathway may play a significant role in pathogenesis of psoriasis and T2D. Finally, 3 important hub genes were selected by utilizing cytoHubba, including SNRPN, GNAS, IGF2. Our work reveals the potential common signaling pathways of psoriasis and T2D. These Hub genes and common signaling pathways provide insights for further investigation of molecular mechanism about psoriasis and T2D.
... Psoriasis originates from the skin, but it progressively induces systemic inflammation that may accompany psoriatic arthritis, metabolic syndrome, diabetes, overt vascular inflammation, and cardiovascular disease (4-7). Increasing evidence indicates that the systemic impact of psoriasis shortens the lifespan of affected individuals by at least 3-5 years (8). ...
Durable psoriasis improvement has been reported in a subset of psoriasis patients after treatment withdrawal of biologics blocking IL-23/Type 17 T-cell (T17) autoimmune axis. However, it is not well understood if systemic blockade of the IL-23/T17 axis promotes immune tolerance in psoriasis skin. The purpose of the study was to find translational evidence that systemic IL-17A blockade promotes regulatory transcriptome modification in human psoriasis skin immune cell subsets. We analyzed human psoriasis lesional skin 6 mm punch biopsy tissues before and after systemic IL-17A blockade using the muti-genomics approach integrating immune cell-enriched scRNA-seq (n = 18), microarray (n = 61), and immunohistochemistry (n = 61) with repository normal control skin immune cell-enriched scRNA-seq (n = 10) and microarray (n = 8) data. For the T17 axis transcriptome, systemic IL-17A blockade depleted 100% of IL17A ⁺ T-cells and 95% of IL17F ⁺ T-cells in psoriasis skin. The expression of IL23A in DC subsets was also downregulated by IL-17A blockade. The expression of IL-17-driven inflammatory mediators (IL36G, S100A8, DEFB4A, and DEFB4B) in suprabasal keratinocytes was correlated with psoriasis severity and was downregulated by IL-17A blockade. For the regulatory DC transcriptome, the proportion of regulatory semimature DCs expressing regulatory DC markers of BDCA-3 (THBD) and DCIR (CLEC4A) was increased in posttreatment psoriasis lesional skin compared to pretreatment psoriasis lesional skin. In addition, IL-17A blockade induced higher expression of CD1C and CD14, which are markers of CD1c⁺ CD14⁺ dendritic cell (DC) subset that suppresses antigen-specific T-cell responses, in posttreatment regulatory semimature DCs compared to pretreatment regulatory semimature DCs. In conclusion, systemic IL-17A inhibition not only blocks the entire IL-23/T17 cell axis but also promotes regulatory gene expression in regulatory DCs in human psoriasis skin.
... Additional file 1: Methods S1. additional information on cohort design, statistical methods and computer software [77][78][79]. Table S1. Full baseline characteristics of people with and without eczema at cohort entry for anxiety/depression. ...
Background
Psoriasis and atopic eczema are common inflammatory skin diseases. Existing research has identified increased risks of common mental disorders (anxiety, depression) in people with eczema and psoriasis; however, explanations for the associations remain unclear. We aimed to establish the risk factors for mental illness in those with eczema or psoriasis and identify the population groups most at risk.
Methods
We used routinely collected data from the UK Clinical Practice Research Datalink (CPRD) GOLD. Adults registered with a general practice in CPRD (1997–2019) were eligible for inclusion. Individuals with eczema/psoriasis were matched (age, sex, practice) to up to five adults without eczema/psoriasis. We used Cox regression to estimate hazard ratios (HRs) and 95% confidence intervals (CIs) for hazards of anxiety or depression in people with eczema/psoriasis compared to people without. We adjusted for known confounders (deprivation, asthma [eczema], psoriatic arthritis [psoriasis], Charlson comorbidity index, calendar period) and potential mediators (harmful alcohol use, body mass index [BMI], smoking status, and, in eczema only, sleep quality [insomnia diagnoses, specific sleep problem medications] and high-dose oral glucocorticoids).
Results
We identified two cohorts with and without eczema (1,032,782, matched to 4,990,125 without), and with and without psoriasis (366,884, matched to 1,834,330 without). Sleep quality was imbalanced in the eczema cohorts, twice as many people with eczema had evidence of poor sleep at baseline than those without eczema, including over 20% of those with severe eczema. After adjusting for potential confounders and mediators, eczema and psoriasis were associated with anxiety (adjusted HR [95% CI]: eczema 1.14 [1.13–1.16], psoriasis 1.17 [1.15–1.19]) and depression (adjusted HR [95% CI]: eczema 1.11 [1.1–1.12], psoriasis 1.21 [1.19–1.22]). However, we found evidence that these increased hazards are unlikely to be constant over time and were especially high 1-year after study entry.
Conclusions
Atopic eczema and psoriasis are associated with increased incidence of anxiety and depression in adults. These associations may be mediated through known modifiable risk factors, especially sleep quality in people with eczema. Our findings highlight potential opportunities for the prevention of anxiety and depression in people with eczema/psoriasis through treatment of modifiable risk factors and enhanced eczema/psoriasis management.
... Erythematous scaling plaques are the characteristic involvement of skin in this disease. Psoriasis may be accompanied by diseases such as uveitis, Crohn's disease, celiac disease, non-alcoholic fatty liver disease (NAFLD), and metabolic syndrome, which can also result in cardiovascular disease and depression (2)(3)(4)(5). The molecular and cellular pathogenesis of the disease have not been well understood, but it is proposed that autoimmunity of T-cells, particularly Th17 cells, leads to increased production of interleukin-17 (IL-17) and IL-22 (5,(6)(7)(8). ...
Objective:
Mesenchymal stromal cells (MSCs) play immunomodulatory role in various autoimmune diseases. Previous pre-clinical and clinical studies have shown that MSCs could be a therapeutic modality for psoriasis. However, the mechanisms of treatment and its possible side effects are under investigation. In this study, the safety and probable efficacy of injecting allogeneic adipose-derived mesenchymal stromal cells (ADSCs) in psoriatic patients were evaluated.
Materials and methods:
In this phase I clinical study with six months of follow-up, total number of 1×106 or 3×106 cells/cm2 of ADSCs were injected into the subcutaneous tissue of each plaque as a single dose in three males and two females (3M/2F) with a mean age of 32.8 ± 8.18. The primary outcome was safety. Changes in clinical and histological indexes, the number of B and T lymphocytes in local and peripheral blood, and serum levels of inflammatory cytokines were assessed. Paired t test was used to compare variables at two time points (baseline and six months after injection) and repeated measures ANOVA test was utilized for variables at three time points in follow-up visits.
Results:
No major adverse effects such as burning, pain, itching, or any systemic side effects were observed following ADSCs injection, and the lesions showed slight to considerable improvement after injection. The mRNA expression levels of pro-inflammatory factors were reduced in the dermis of the patients after injection. The increased expression level of Foxp3 transcription factor in the patient blood samples suggested modulation of inflammation after ADMSCs administration. Six months after the intervention, no major side effects were reported, but skin thickness, erythema, and scaling of the plaques, as well as the PASI score, were decreased in majority of patients.
Conclusion:
Our study suggested that ADSC injection could be considered as a safe and effective therapeutic approach for psoriatic plaques (registration number: IRCT20080728001031N24).
... Psoriasis seems to be determined by an inadequate immune response, influenced by genetic factors associated with a predisposition to the development of the disease and some environmental factors that act as triggers or aggravating factors [8][9][10] . In chronic inflammatory diseases, it is common to search for biomarkers that can be used to interpret each patient's clinical context, contributing to the diagnosis, evaluation of severity or particular phenotype, or identifying inflammatory activity. ...
Introduction:
Psoriasis is an immune-mediated, chronic, inflammatory, systemic disease that primarily affects the skin and joints. Despite advances in the comprehension of the disease, there is still a lack of biomarkers available for clinical use.
Objective:
To evaluate neutrophil-lymphocyte ratio (NLR) as a marker of systemic inflammatory status in patients with moderate to severe plaque psoriasis vulgaris, compared with controls.
Methods:
Observational case-control study, conducted in a public hospital unit, focused on skin disease. A total of 165 patients with psoriasis and 187 healthy subjects seen between August and December 2020 were studied.
Results:
The group of cases showed a greater median of NLR compared with controls (medium = 1.96, p = 0.032). When stratified by age, the median NLR was higher in individuals between 31 and 60 years, with statistical significance. No differences were identified in gender, presence of arthritis or comorbidities.
Study limitations:
Observational, retrospective, single-center study based on medical records review.
Conclusion:
NLR was higher in individuals with psoriasis when compared with controls. It is simple, inexpensive and available in all levels of care, based on an elementary laboratory test that is already part of the routine care of patients with psoriasis. Its use in evaluating systemic inflammation could contribute to better management of psoriatic disease.
... Recent research has consistently highlighted a strong association between psoriasis and a high risk of major medical morbidities, and even mortality [21,22]. A cohort study found a connection between moderate and severe psoriasis and heightened chronic kidney disease risk [23]. ...
Background
Although a large number of evidence has identified that psoriasis is significantly correlated with type 2 diabetes (T2D), the common molecular mechanism of its occurrence remains unclear. Our study aims to further elucidate the mechanism of the occurrence of this complication.
Methods
We obtained the gene expression data of psoriasis (GSE30999) and T2D (GSE28829) from the Gene Expression Omnibus (GEO) dataset. Then the common differentially expressed genes (DEGs) of T2D and psoriasis were identified. After that, we performed three types of analyses about these DEGs, including functional enrichment analysis, protein-protein interaction (PPI) network and module manufacture, hub genes identification and co-expression analysis.
Results
132 common DEGs (14 upregulated genes and 118 downregulated genes) were identified for subsequent a series of analyses. Function enrichment analysis demonstrated that Rap1 signaling pathway, PI3K-Akt signaling pathway, and cGMP-PKG signaling pathway may play a significant role in pathogenesis of psoriasis and T2D. Finally, 3 important hub genes were selected by utilizing cytoHubba, including SNRPN, GNAS, IGF2.
Conclusions
Our work reveals the common pathogenesis of psoriasis and T2D. These Hub genes and common signaling pathways provide insights for further investigation of molecular mechanism about psoriasis and T2D.
... Psoriatic arthritis occurs most frequently in patients with psoriasis with a prevalence ranging from 3 to 40%. Other comorbidities, such as cardio-metabolic disorders and chronic colitis, Crohn's disease, chronic kidney disease affect the patients' quality of life (Gelfand et al, 2007;Takeshita et al, 2017). Thus, psoriasis can be considered as a systemic inflammatory disorder (Calautti et al, 2018). ...
FAM3C/ILEI is an important cytokine for tumor progression and metastasis. However, its involvement in inflammation remains elusive. Here, we show that ILEI protein is highly expressed in psoriatic lesions. Inducible keratinocyte-specific ILEI overexpression in mice (K5-ILEIind ) recapitulates many aspects of psoriasis following TPA challenge, primarily manifested by impaired epidermal differentiation and increased neutrophil recruitment. Mechanistically, ILEI triggers Erk and Akt signaling, which then activates STAT3 via Ser727 phosphorylation. Keratinocyte-specific ILEI deletion ameliorates TPA-induced skin inflammation. A transcriptomic ILEI signature obtained from the K5-ILEIind model shows enrichment in several signaling pathways also found in psoriasis and identifies urokinase as a targetable enzyme to counteract ILEI activity. Pharmacological inhibition of urokinase in TPA-induced K5-ILEIind mice results in significant improvement of psoriasiform symptoms by reducing ILEI secretion. The ILEI signature distinguishes psoriasis from healthy skin with uPA ranking among the top "separator" genes. Our study identifies ILEI as a key driver in psoriasis, indicates the relevance of ILEI-regulated genes for disease manifestation, and shows the clinical impact of ILEI and urokinase as novel potential therapeutic targets in psoriasis.
... Accordingly, various studies could show that psoriasis is closely related to metabolic syndrome (7,16,(23)(24)(25). As a result of cardiovascular and cardiometabolic comorbidity, patients with severe psoriasis were shown to have a decreased life expectancy of up to 5 years (26,27). Psoriasis is also frequently associated with psychological comorbidities. ...
Background
The rate of seroconversion after COVID-19 vaccination in patients with moderate to severe psoriasis requiring systemic treatment is poorly understood.
Objectives
The aim of this prospective single-center cohort study performed between May 2020 and October 2021 was to determine the rate of seroconversion after COVID-19 vaccination in patients under active systemic treatment for moderate to severe psoriasis.
Methods
Inclusion criteria were systemic treatment for moderate to severe psoriasis, known COVID-19 vaccination status, and repetitive anti-SARS-CoV-2-S IgG serum quantification. The primary outcome was the rate of anti-SARS-CoV-2-S IgG seroconversion after complete COVID-19 vaccination.
Results
77 patients with a median age of 55.9 years undergoing systemic treatment for moderate to severe psoriasis were included. The majority of patients received interleukin- (n=50, 64.9%) or tumor necrosis factor (TNF)-α inhibitors (n=16, 20.8%) as systemic treatment for psoriasis; nine patients (11.7%) were treated with methotrexate (MTX) monotherapy, and one patient each received dimethyl fumarate (1.3%), respectively apremilast (1.3%). All included patients completed COVID-19 vaccination with two doses over the course of the study. Serum testing revealed that 74 patients (96.1%) showed an anti-SARS-CoV-2-S IgG seroconversion. While all patients on IL-17A, -12 or -12/23 inhibitors (n=50) achieved seroconversion, three of 16 patients (18.8%) receiving MTX and/or a TNF-α inhibitor as main anti-psoriatic treatment did not. At follow-up, none of the patients had developed symptomatic COVID-19 or died from COVID-19.
Conclusions
Anti-SARS-CoV-2-S IgG seroconversion rates following COVID-19 vaccination in psoriasis patients under systemic treatment were high. An impaired serological response, however, was observed in patients receiving MTX and/or TNF-α inhibitors, in particular infliximab.
... 1,2 Similar to other diseases of chronic inflammation, patients with PsA or PsO have higher than expected rates of cardiovascular (CV) disease and an increased risk of major adverse cardiovascular events (MACE). 3,4 Indeed, CV disease is the single leading cause of death in patients with PsA and dermatologic psoriasis and may account for [ 50% of all deaths in these populations. 5 Systemic inflammation is thought to be the key mediator in the link between psoriasis and CV disease. ...
Aim
The aim of the study was to evaluate the changes in central vascular inflammation measured by FDG PET and myocardial blood flow reserve (MFR) determined by ⁸² Rb PET following therapy with biologic agents for 6 months in patients with psoriatic arthritis (PsA) and/or cutaneous psoriasis (PsO) (group 1) and compare with PsO subjects receiving non-biologic therapy (group 2) and controls (group 3).
Methods and Results
Target-to-background ratio (TBR) by FDG PET in the most diseased segment of the ascending aorta (TBR max ) was measured to assess vascular inflammation. ⁸² Rb PET studies were used to assess changes in left ventricular MFR. A total of 34 participants were enrolled in the study (11 in group 1, 13 in group 2, and 10 controls). A significant drop in the thoracic aorta uptake was observed in the biologic-treated group (ΔTBR max : − .46 ± .55) compared to the PsO group treated with non-biologic therapy (ΔTBR max : .23 ± .67). Those showing response to biologic agents maintained MFR compared to who showed no response.
Conclusion
In a cohort of psoriasis patients treated with biologics, FDG uptake in the thoracic aorta decreased over the study period. Patients who demonstrated a significant anti-inflammatory response on FDG PET imaging maintained their MFR compared to non-responders.
... 32 Patient value is particularly important, because there currently seems to be a disconnect between patient-perceived and medically-perceived disease severity. [33][34][35] A proposed novel approach to psoriasis management includes addressing the issue of undertreatment, taking an integrated approach to known health issues, screening for other psoriasis-related comorbidities, referring adequately, and paying more attention to the Kidney disease CKD ESRD Malignancy psychosocial and lifestyle-associated factors to ensure a full cycle of care for patients. 33 Treatment decisions are ultimately the shared decision of the healthcare provider and the patient and should occur simultaneously while monitoring for comorbidities. ...
The symposium “Pathways to silencing psoriasis: Remission or Cure?” took place during the 2019 European Society for Dermatological Research (ESDR) annual congress in Bordeaux, France. The presentations reviewed the role of the IL-23 pathway in psoriasis pathogenesis and other immune-mediated inflammatory diseases (IMID), underlined the importance of assessing and treating comorbidities in patients with psoriasis, and concluded with a glimpse into the future of psoriasis management, examining whether drug-free remission from disease is a viable goal for future treatment plans. After defining and giving some examples of familial and poly-autoimmunity, Prof Jörg Prinz described the common pathways shared by several IMID. The involvement of the IL-23/Th(c)17 pathway in the pathogenesis of various IMID may represent opportunities for future therapeutic targets and treatment strategies. The importance of holistic treatment in psoriasis management was illustrated by Prof Jo Lambert, who showed the audience how psoriasis can be linked to several different comorbidities, all of which should be addressed when making treatment decisions. Proper assessments and informed treatment choices could help patients with psoriasis achieve better clinical outcomes and help improve their long-term health expectations. Reducing treatment burden for patients, and the possibility of achieving and maintaining drug-free remission, was discussed by Prof Carle Paul, who underlined the importance of examining several important predictive biomarkers of treatment response. Early, intensive treatment and disease modification could result in long-term remission of severe psoriasis and further decrease the treatment burden for patients.
... However, the link between psoriasis and aging is more mysterious in contrast to other suspected chronic Piezo2 channelopathies, such as DED and osteoporosis. Notably, the life expectancy of psoriatic patients is significantly shorter than healthy controls [162,163]; some studies even estimate a lifespan reduction of 4 to 10 years [162,164,165]. Furthermore, comorbidities, such as cardiovascular diseases and diabetes, are also telling about this association [162,163]. ...
Psoriasis is considered a multifactorial and heterogeneous systemic disease with many underlying pathologic mechanisms having been elucidated; however, the pathomechanism is far from entirely known. This opinion article will demonstrate the potential relevance of the somatosensory Piezo2 microinjury-induced quad-phasic non-contact injury model in psoriasis through a multidisciplinary approach. The primary injury is suggested to be on the Piezo2-containing somatosensory afferent terminals in the Merkel cell-neurite complex, with the concomitant impairment of glutamate vesicular release machinery in Merkel cells. Part of the theory is that the Merkel cell-neurite complex contributes to proprioception; hence, to the stretch of the skin. Piezo2 channelopathy could result in the imbalanced control of Piezo1 on keratinocytes in a clustered manner, leading to dysregulated keratinocyte proliferation and differentiation. Furthermore, the author proposes the role of mtHsp70 leakage from damaged mitochondria through somatosensory terminals in the initiation of autoimmune and autoinflammatory processes in psoriasis. The secondary phase is harsher epidermal tissue damage due to the primary impaired proprioception. The third injury phase refers to re-injury and sensitization with the derailment of healing to a state when part of the wound healing is permanently kept alive due to genetical predisposition and environmental risk factors. Finally, the quadric damage phase is associated with the aging process and associated inflammaging. In summary , this opinion piece postulates that the primary microinjury of our "sixth sense", or the Piezo2 channelopathy of the somatosensory terminals contributing to proprioception, could be the principal gateway to pathology due to the encroachment of our preprogrammed genetic encoding.
... Patienten mit Pso-riasis sind oftvonnochweiterer Komorbidität betroffen, insbesondere dem metabolischen Syndrom [16], Depressionen [10], chronisch entzündlichen Darmerkrankungen [12] oder Uveitis [5]. Die Psoriasis per se gilt auch als ungünstiger kardiovaskulärer Risikofaktor [8,11,13,17], was zu einer Verkürzung der individuellen Lebenserwartung um 3 bis 4 Jahre führt [9]. Die Lebensqualität der Psoriasispatienten ist nicht zuletzt durch Juckreiz, Schmerzen und Stigmatisierung erheblich eingeschränkt [4]. ...
Zusammenfassung
Hintergrund
Patienten mit systemischen Autoimmun- und/oder autoinflammatorischen Erkrankungen (AI/AInf) bedürfen in der Regel einer multidisziplinären Zusammenarbeit durch verschiedene Fachrichtungen.
Ziel der Arbeit (Fragestellung)
Wir evaluierten, ob die Etablierung eines multidisziplinären Boards (sog. Rheumaboard [RB]) zur Optimierung der Versorgung von Patienten mit Psoriasisarthritis (PsA) oder anderen AI/AInf führt.
Material und Methoden
Es wurden n = 272 Patienten mit AI/AInf eingeschlossen, die in 3 Gruppen eingeteilt wurden; Gruppe 1: 41 Patienten mit oder mit Verdacht auf (V. a.) PsA, von der Dermatologie in der Rheumatologie konsiliarisch avisiert; Gruppe 2: 166 Patienten mit oder mit V. a. PsA, vorstellig in der Dermatologie und im RB; Gruppe 3: 65 Patienten mit anderen AI/AInf, vorstellig in der Dermatologie und im RB. Evaluiert wurde die durchschnittliche Zeit von der initialen Vorstellung bis zur Therapieeinleitung nach erfolgter Beurteilung und Diagnostik durch beide Fachrichtungen. Darüber hinaus wurden die Diagnosesicherung/-bestätigung und die Therapieweiterführung/-optimierung bei allen 3 Gruppen analysiert.
Ergebnisse
Die durchschnittliche Zeitspanne von der initialen Vorstellung bis zur Therapieeinleitung betrug in Gruppe 1 85 ± 42,24 (5 bis 173) Tage, in Gruppe 2 15 ± 13,09 (0 bis 78) Tage und in Gruppe 3 20 ± 16,71 (1 bis 75) Tage. In Gruppe 2 und 3 konnte die Diagnose schneller gesichert oder bestätigt sowie die Wartezeit auf Diagnostik und Therapie deutlich reduziert werden.
Diskussion
Durch die Etablierung eines RB zeigt sich eine signifikante Verkürzung der Zeitspanne zwischen Erstvorstellung und Therapieeinleitung und damit eine deutliche Verbesserung des Versorgungsmanagements bei Patienten mit AI/AInf inklusive Diagnosesicherung und Therapieoptimierung.
Graphic abstract
... A higher risk of all-cause mortality for patients with psoriasis and PsA compared with the general population was observed in this study. This finding aligns with several previous studies that reported on excess mortality in patients with psoriasis and PsA compared with the general population (12,(39)(40)(41). For example, both allcause mortality and mortality from malignancies and circulatory system diseases have been reported to be elevated in patients with psoriasis and PsA in Taiwan (12). ...
There is a recognized need to better understand chang-es in the epidemiology of psoriasis and psoriatic arthritis (PsA) over time in Asia. Using the Taiwan National Health Insurance claim records this population-based study examined changes in the prevalence, incidence, and mortality rates in patients with psoriasis or psoriatic arthritis in Taiwan over 12 years. Patients with ≥1 diagnosis code for psoriasis or psoriatic arthritis, recorded either by dermatologists or rheumatologists, were identified. Annual age- and sex-standardized prevalence and incidence rates were calculated using the Taiwan general population as reference. To investigate mortality, each patient in the incident cohort was matched to 10 comparators from the general population by sex and age (at diagnosis). The risk of mortality between study cohorts and comparators was analysed by Cox proportional hazard regression. The prevalence of psoriasis (0.18–0.86%) and psoriatic arthritis (0.01–0.08%) increased steadily b-etween 2006 and 2017. The incidence rates, however, remained stable (psoriasis: 62–65 per 100,000 person-years; psoriatic arthritis: 6–5 per 100,000 person-years). The risk of all-cause mortality for patients with psoriasis (hazard ratio 1.16; 95% confidence interval: 1.13–1.19) was higher than the general population, despite a decreasing trend over time in the all-cause mortality rates for both groups. The steady increase in the prevalence of psoriasis despite stable incidence rates suggests that improvements in life expectancy may be the key determinant of this increase.
... (14) A previous Korean study reported the prevalence of psoriasis in Korea according to the Korean national insurance database was 0.44-0.45% of the general population (15). Psoriasis is associated with increased cardiovascular risk, including myocardial infarction, heart failure, and cardiovascular mortality (16)(17)(18)(19). The association between psoriasis and ocular disease has not been well eludicated. ...
Psoriasis is a chronic inflammatory skin disease imparting increased risk of cardiovascular diseases. Until now, few studies have reported an increased incidence of ophthalmological retinal vasculopathy in individuals with psoriasis. This study aimed to investigate the association between psoriasis and retinal vein occlusion in the Korean population. Data collected by the National Health Insurance Service between 2009 and 2015 in Korea were analysed. Participants who underwent national health examinations from 2009 to 2012 were enrolled in this study and were divided into either the psoriasis group (n = 3,088) or the control group (n = 465,205). All occurrences of retinal vein occlusion were observed, and the incidence rate of retinal vein occlusion was compared between the psoriasis and control groups. A Cox proportional hazards regression analysis was used to assess the association between psoriasis and newly developed retinal vein occlusion. During a mean 4.37-year follow-up period, 2,034 patients developed retinal vein occlusion. According to multivariable Cox proportional hazard models, individuals with psoriasis had a significantly higher risk of retinal vein occlusion compared with controls (hazard ratio 1.72, 95% confidence interval 1.18-2.51) after adjustments for covariates. This study found that psoriasis was positively associated with retinal vein occlusion.
... Psoriasisrelated inflammation may extend beyond the skin [2]. Patients with psoriasis have an increased risk for cardiovascular (CV) disease (CVD), a common cause of morbidity and mortality in psoriasis, and CV risk factors [3][4][5]. In particular, an independent association between psoriasis and an increased risk of myocardial infarction (MI), chronic heart failure (CHF), and cardiac arrythmia has been demonstrated [6][7][8][9]. ...
A convincing deal of evidence supports the fact that severe psoriasis is associated with cardiovascular diseases. However, the precise underlying mechanisms linking psoriasis and cardiovascular diseases are not well defined. Psoriasis shares common pathophysiologic mechanisms with atherosclerosis and cardiovascular (CV) risk factors. In particular, polymorphism in the IL-23R and IL-23 genes, as well as other genes involved in lipid and fatty-acid metabolism, renin–angiotensin system and endothelial function, have been described in patients with psoriasis and with cardiovascular risk factors. Moreover, systemic inflammation in patients with psoriasis, including elevated serum proinflammatory cytokines (e.g., TNF-α, IL-17, and IL-23) may contribute to an increased risk of atherosclerosis, hypertension, alteration of serum lipid composition, and insulin resistance. The nonlinear and intricate interplay among various factors, impacting the molecular pathways in different cell types, probably contributes to the development of psoriasis and cardiovascular disease (CVD). Future research should, therefore, aim to fully unravel shared and differential molecular pathways underpinning the association between psoriasis and CVD.
... (14) A previous Korean study reported the prevalence of psoriasis in Korea according to the Korean national insurance database was 0.44-0.45% of the general population (15). Psoriasis is associated with increased cardiovascular risk, including myocardial infarction, heart failure, and cardiovascular mortality (16)(17)(18)(19). The association between psoriasis and ocular disease has not been well eludicated. ...
Psoriasis is a chronic inflammatory skin disease imparting increased risk of cardiovascular diseases. Until now, few studies have reported an increased incidence of ophthalmological retinal vasculopathy in individuals with psoriasis. This study aimed to investigate the association between psoriasis and retinal vein occlusion in the Korean population. Data collected by the National Health Insurance Service between 2009 and 2015 in Korea were analysed. Participants who underwent national health examinations from 2009 to 2012 were enrolled in this study and were divided into either the psoriasis group (n = 3,088) or the control group (n = 465,205). All occurrences of retinal vein occlusion were observed, and the incidence rate of retinal vein occlusion was compared between the psoriasis and control groups. A Cox proportional hazards regression analysis was used to assess the association between psoriasis and newly developed retinal vein occlusion. During a mean 4.37-year follow-up period, 2,034 patients developed retinal vein occlusion. According to multivariable Cox proportional hazard models, individuals with psoriasis had a significantly higher risk of retinal vein occlusion compared with controls (hazard ratio 1.72, 95% confidence interval 1.18–2.51) after adjustments for covariates. This study found that psoriasis was positively associated with retinal vein occlusion.
... About 20% of patients with PSO have moderate to severe disease, which is commonly defined as involving [ 10% of the body or affecting crucial body parts [2,5]. Severe disease is associated with increased mortality, substantial impact on quality of life and major economic burden to health systems [6,7]. ...
Introduction:
Biologic treatments are increasingly being used in the management of moderate to severe plaque psoriasis (PSO). Bimekizumab is a selective inhibitor of both interleukin (IL)-17A and IL-17F approved for the treatment of moderate to severe PSO. Although bimekizumab trials provide comparisons to secukinumab, adalimumab and ustekinumab, there are no further head-to-head comparisons of bimekizumab to other biologics. This network meta-analysis (NMA) aimed to compare the short-term efficacy of bimekizumab versus other biologic systemic therapies for moderate to severe PSO.
Methods:
A systematic literature review was conducted to identify randomised controlled trials (RCTs) in patients with moderate to severe PSO. MEDLINE, Embase, the Cochrane Central Register of Controlled Trials and the Database of Systematic Reviews and PsycINFO were searched on July 1, 2020. An enhanced multinomial Bayesian NMA model was used to evaluate the comparative efficacy in 50%, 75%, 90% and 100% improvement from baseline Psoriasis Area and Severity Index (PASI 50/75/90/100) at 10-16 weeks. The model was also adjusted for baseline risk, given the variable placebo responses across the trials.
Results:
Eighty-six RCTs (including 34,476 patients) were included in the NMA. IL-17 and IL-23 inhibitors were the most effective treatments across all PASI levels. At 10-16 weeks, bimekizumab had the highest probability of achieving PASI 75 (92.3%), PASI 90 (84.0%) and PASI 100 (57.8%). Bimekizumab demonstrated statistical superiority over all biologics in achieving PASI 90 and PASI 100 thresholds. For PASI 75, the benefit of bimekizumab was statistically significant compared to all other treatments except risankizumab and ixekizumab.
Conclusion:
This analysis demonstrated that IL-17 and IL-23 inhibitors were highly effective in achieving short-term improvement among patients with moderate to severe PSO. Patients receiving bimekizumab were significantly more likely to achieve PASI 90 or PASI 100 within 10-16 weeks of the first injection than all other biologics.
... In the past decades, it has become clear that psoriasis, as a systemic inflammatory condition, may be accompanied by various systemic comorbidities, including psoriatic arthritis, cardiovascular and cerebrovascular diseases, hyperlipidemia, hypertension, obesity, diabetes and psychiatric disorders like depression and anxiety [258,259]. Among the comorbid conditions associated with psoriasis, cardiovascular diseases are of particular importance as they contribute to higher mortality rates of psoriasis patients compared to controls [191,[260][261][262]. The incidence of both myocardial infarction (MI) and cerebrovascular accident (CVA) has been reported to be increased in psoriasis patients, correlating with the duration of this autoimmune disease, as well as clinical severity assessed by PASI, body surface area (BSA) and the need for systemic therapy or phototherapy for psoriasis [263][264][265][266][267][268][269][270][271]. ...
Although oxidative stress is recognized as an important effector mechanism of the immune system, uncontrolled formation of reactive oxygen and nitrogen species promotes excessive tissue damage and leads to disease development. In view of this, increased dietary salt intake has been found to damage redox systems in the vessel wall, resulting in endothelial dysfunction associated with NO uncoupling, inflammation, vascular wall remodeling and, eventually, atherosclerosis. Several studies have reported increased systemic oxidative stress accompanied by reduced antioxidant capacity following a high salt diet. In addition, vigorous ionic effects on the immune mechanisms, such as (trans)differentiation of T lymphocytes are emerging, which together with the evidence of NaCl accumulation in certain tissues warrants a re-examination of the data derived from in vitro research, in which the ionic influence was excluded. Psoriasis vulgaris (PV), as a primarily Th17-driven inflammatory skin disease with proven inflammation-induced accumulation of sodium chloride in the skin, merits our interest in the role of oxidative stress in the pathogenesis of PV, as well as in the possible beneficial effects that could be achieved through modulation of dietary salt intake and antioxidant supplementation.
Background
Psoriasis is a chronic systemic disorder with ocular involvement.
Objectives
The aim of the present study is to evaluate the risk of glaucoma among psoriatic patients.
Methods
Subjects of this cohort study were selected based on Chang Gung Research Database from January 1, 2003, to December 31, 2012. Follow-up ended on December 31, 2017. The participants of the control group were matched with the psoriatic group by gender, age, and index date at a 4:1 ratio. The hazard ratios of glaucoma were estimated using Cox regression analysis. We also evaluated the relationship between the risk of glaucoma and systemic therapies as well as phototherapy and topical corticosteroid in patients with psoriasis.
Results
A total of 6,682 patients with psoriasis and 26,728 matched controls were enrolled. The study population is composed of mainly Males accounting for 64.2% of the study population. The psoriatic group had higher incidence rates than the control group for glaucoma (adjusted hazard ratio 1.405 [95% confidence interval, 1.051-1.879]). Psoriatic patients receiving psoralen and ultraviolet-A (PUVA) therapy for more than 200 sessions had an increased risk of glaucoma.
Conclusions
Psoriatic patients had an increased risk of glaucoma. Long-term PUVA therapy raised the risk of glaucoma in psoriatic populations.
Patients with psoriasis frequently have comorbidities, which are linked to higher mortality rates. An in‐depth investigation of comorbidities and their effects on health can help improve the management of patients with psoriasis. We conducted a comprehensive and unbiased investigation of comorbidities in patients with psoriasis and explored the pattern of association between comorbidities. A nationwide population‐based study included 384 914 patients with psoriasis and 384 914 matched controls between 2011 and 2021. We used automated mass screening of all diagnostic codes to identify psoriasis‐associated comorbidities and applied association rule analysis to explore the patterns of comorbidity associations in patients with psoriasis. Patients with psoriasis had an increased risk of autoimmunity‐related diseases such as inflammatory arthritis, Crohn's disease, type 1 diabetes, and acute myocardial infarction. The comorbidities of patients with psoriasis with a history of cardiovascular events demonstrated strong interrelationships with other cardiovascular risk factors including type 2 diabetes mellitus, essential hypertension, and dyslipidemia. We also found comorbidities, such as malignant skin tumors and kidney and liver diseases, which could have adverse effects of anti‐psoriasis therapy. In contrast, patients with psoriasis showed a decreased association with upper respiratory tract infection. Our results imply that comorbidities in patients with psoriasis are associated with the systemic inflammation of psoriasis and the detrimental effects of its treatment. Furthermore, we found patterns of associations between the cardiovascular risk factors and psoriasis. Mass screening and association analyses using large‐scale databases can be used to investigate impartially the comorbidities of psoriasis and other diseases.
Importance
Evolving evidence suggests that patients receiving Janus kinase–signal transducer and activator of transcription inhibitors (JAK-STATi) may be at higher risk of major adverse cardiovascular events (MACE) and venous thromboembolism (VTE). Most existing literature has focused on indications that may confer a higher MACE and VTE risk than that among patients with isolated dermatological indications.
Objective
To evaluate risk of MACE, VTE, serious adverse events (SAEs), and tolerability of systemic JAK-STATi compared with placebo, in those with a dermatologic indication.
Data Sources
A systematic review of the literature was carried out to June 2023, using databases Embase, MEDLINE, SCOPUS, Cochrane Library of Registered Trials, and registered Clinical Trials. The analysis was reported in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-analyses ( PRISMA ) reporting guidelines. The analysis itself took place in June 2023.
Study Selection
Placebo-controlled randomized clinical trials that compared systemic JAK-STATi with placebo, and investigated the safety in patients with alopecia areata, psoriasis, vitiligo, atopic dermatitis, lichen planus or hidradenitis suppurativa.
Data Extraction and Synthesis
Study selection and data extraction by 2 authors working independently using a standardized template. Crude numbers for MACE, VTE, SAEs, and study discontinuation due to treatment emergent adverse events (TEAEs) were pooled and underwent meta-analysis.
Main Outcomes and Measures
Incidence of MACE, VTE, SAE, and study discontinuation due to TEAEs. Analysis of these values against person exposure years to determine the incidence rate (IR). Risk ratios (RRs) compared incidence rates among treatment and placebo comparator arms.
Results
Forty-five randomized clinical trials were eligible for inclusion, with 12 996 patients receiving active JAK-STATi therapy and 4925 allocated to placebo treatment. Meta-analysis found no significant increase in MACE ( I ² = 0.00%; RR, 0.47; 95% CI, 0.28-0.80) or VTE ( I ² = 0.00%; RR, 0.46; 95% CI, 0.26-0.80) between placebo and JAK-STATi comparator arms. There was also no significant difference in SAEs ( I ² = 12.38%; RR, 0.92; 95% CI, 0.72-1.20) and discontinuations between JAK-STATi and placebo ( I ² = 23.55%; RR, 0.94; 95% CI, 0.76-1.19).
Conclusions and Relevance
This meta-analysis did not identify a significant increase in the risk of MACE and VTE in dermatology patients receiving JAK-STATi for median duration of 16 weeks. The results of this review suggest there is insufficient evidence that JAK-STATi confer an increased risk of cardiovascular complications in dermatological patients, especially when used for short time frames.
Measurements of skin surface biomarkers have enormous value for the detailed assessment of skin conditions, both for clinical application and in skin care. The main goals of the current study were to assess whether expression patterns of skin surface hBD-1, hBD-2, IL-1α, CXCL-1, and CXCL-8, examples of proteins known to be involved in psoriasis pathology, are associated with disease severity and whether expression patterns of these proteins on the skin surface can be used to measure pharmacodynamic effects of biological therapy. In this observational study using transdermal analysis patch (TAP), levels of skin surface IL-1α, hBD-1, hBD-2, CXCL-1/2, and CXCL-8 of psoriasis vulgaris (PV) patients over biological therapy were assessed. The Psoriasis Area Severity Index (PASI) and local score for erythema, induration, and desquamation were determined from the exact same skin area as FibroTx TAP measurements. Thirty-seven adult PV patients were included, of which twenty-three were subjected to anti-TNF-α, seven to anti-IL-17A, and seven to anti-IL12/IL-23 therapy. Significantly higher levels of hBD-1, hBD-2, CXCL-1/2, and CXCL-8 were detected on lesional skin compared to the non-lesional skin of the PV patients. In contrast, lower levels of IL-1α were found in lesional skin compared to non-lesional skin. In addition, we observed that the biomarker expression levels correlate with disease severity. Further, we confirmed that changes in the expression levels of skin surface biomarkers during biological therapy correlate with treatment response. Biomarker expression patterns in response to treatment differed somewhat between treatment subtypes. We observed that, in the case of anti-TNF-α therapy, an increase after a steady decrease in the expression levels of CXCL-1/2 and CXCL-8 occurred before the change in clinical scores. Moreover, response kinetics of skin surface proteins differs between the applied therapies—hBD2 expression responds quickly to anti-IL-17A therapy, CXCL-1/2 to anti-IL-12/23, and levels of CXCL-8 are rapidly down-regulated by IL-17A and IL-12/23 therapy. Our findings confirm that the skin surface hBD-2, IL-1α, CXCL-1/2, and CXCL-8 are markers for the psoriasis severity. Further, data obtained during this study give the basis for the conclusion that skin surface proteins CXCL-1/2 and CXCL-8 may have value as therapeutic biomarkers, thus confirming that measuring the ‘molecular root’ of inflammation appears to have value in scoring disease severity on its own.
Psoriasis encompasses a group of related immune‐mediated inflammatory skin diseases that affect up to 3% of the population. These diseases are heritable and over 40 genetic susceptibility loci have been identified, many of which are involved in antigen presentation, cytokine signalling or innate antimicrobial responses. The commonest presentation of psoriasis is plaque psoriasis but the disease is clinically hetereogeneous in its manifestations and natural history depending on the age of the patient, environmental triggers and the sites affected. Distinct but related phenotypes include psoriatic arthritis, palmoplantar pustulosis and generalized pustular psoriasis. Psoriasis is associated with co‐morbidities including obesity, diabetes, vascular disease, depression and inflammatory bowel disease, which contribute to the considerable morbidity and increased mortality. Treatments include topical agents for disease of limited extent, phototherapy (UVB, PUVA) and systemic therapy (methotrexate, ciclosporin, acitretin, fumarates) for more extensive disease, and biological treatment (tumour necrosis factor α inhibitors, ustekinumab) for severe resistant psoriasis.
Vitiligo is a common autoimmune skin disorder; however, there is limited information about risks of mortality among patients with vitiligo. Therefore, we aimed to investigate the mortality in patients with vitiligo. Population-based cohort study was conducted using the data linkage of the National Health Insurance Service database and the National Death Registry. Patients with incident vitiligo were matched with sociodemographic factors-matched controls without vitiligo in a 1:5 ratio. All-cause and cause-specific mortality were compared between patients with vitiligo and controls. In total, 107,424 patients with incident vitiligo and 537,120 matched controls were included. The mortality rates were 34.8 and 45.3 per 10,000 person-years in patients and controls, respectively. Patients with vitiligo showed a significantly lower risk of mortality (adjusted HR, 0.75; 95% confidence interval, 0.72-0.78). The cause-specific mortality from infectious diseases, oncologic diseases, hematologic diseases, endocrine diseases, neurologic diseases, cardiovascular diseases, respiratory diseases, and renal/urogenital disease was significantly lower in patients with vitiligo. Patients with vitiligo were associated with a lower risk of mortality, suggesting that vitiligo-associated autoimmunity might contribute to reduced morbidity and mortality.
Objective:
The objective of this study was to review the safety and efficacy of deucravacitinib, a tyrosine kinase 2 (TYK2) inhibitor for moderate to severe plaque psoriasis.
Data sources:
Literature was reviewed from MEDLINE and Clinicaltrials.gov up to December 2022 using the terms "deucravacitinib" and "BMS-986165."
Study selection:
Relevant articles in English relating to the pharmacodynamics, pharmacokinetics, efficacy, and safety of deucravacitinib were included. A total of 6 trial results were included.
Study selection and data extraction:
Deucravacitinib showed clinical efficacy across all the phase II and III clinical trials. Excluding the long-term extension study, there were 2248 subjects across all studies, with 63.2% of patients receiving deucravacitinib 6 mg daily. Of these subjects, the average proportion achieving a PASI 75 (a reduction of greater than 75% in the Psoriasis Area and Severity Index) at week 16 was 65.1%. Patients receiving deucravacitinib 6 mg once daily had a higher rate of achieving both PASI 75 response and a Static Physician's Global Assessment (sPGA) score of 0 or 1, compared with oral apremilast 30 mg twice daily. The safety profile of deucravacitinib includes mild adverse events (AEs), most commonly nasopharyngitis, with serious AEs reported ranging from 1.35% to 9.5%.
Relevance to patient care and clinical practice in comparison with existing medications:
While many available therapies for moderate to severe plaque psoriasis rely on an injectable dosage form or extensive monitoring, deucravacitinib can potentially reduce patient medication-related burden. This review summarizes the efficacy and safety of oral deucravacitinib for the treatment of severe plaque psoriasis.
Conclusion:
Deucravacitinib shows a consistent efficacy and safety profile as the first oral TYK2 inhibitor approved for adult patients with moderate to severe plaque psoriasis who are eligible for systemic therapy or phototherapy treatment.
There is a lack of consensus about the association between psoriasis (PSO) and carotid intima-media thickness (cIMT) in literature, since previous studies considered dermatologic clinic patients or general population. This study aimed to compare cIMT levels according to PSO in a sample of 10,530 civil servants form the ELSA-Brasil cohort study and analyze its association with the disease. The PSO cases and disease duration were identified by medical diagnosis self-reported at study enrollment. A paired group was identified by propensity score matching among all the participants without PSO. Mean cIMT values were considered for continuous analysis while cIMT above 75th percentile was considered for categorical analysis. Multivariate conditional regression models were used to analyze association between cIMT and PSO diagnosis, by comparing PSO cases against paired controls and overall sample without disease. A total of n = 162 PSO cases were identified (1.54%) and no difference in cIMT values was observed between participants with PSO and overall sample or control group. PSO was not associated with linear increment of cIMT (vs. overall sample: β = 0.003, p = 0.690; vs. matched controls: β = 0.004, p = 0.633) neither with increased chance of having cIMT above 75th percentile (vs. overall sample: OR = 1.06, p = 0.777; vs. matched controls: OR = 1.19, p = 0.432; conditional regression: OR = 1.31, p = 0.254). There was no relationship between disease duration and cIMT (β = 0.000, p = 0.627). Although no significant relationship between mild cases of psoriasis and cIMT was observed among a wide cohort of civil servants, longitudinal investigation about cIMT progression and severity of disease are still needed.
Objective
A strong association exists between metabolic syndrome and psoriasis. The current study was performed to explore the gene regulation of metabolic syndrome in patients with psoriasis.
Methods
Patients were assessed for psoriasis and metabolic syndrome clinically (Psoriasis Area and Severity Index, height, weight, waist circumference, and blood pressure) and biochemically (lipid profile and fasting blood sugar concentration). Systemic gene regulation was first explored by microarray and analyzed using Transcriptome Analysis Console Software, after which two selected upregulated genes were further validated using polymerase chain reaction and enzyme-linked immunosorbent assay and analyzed using independent sample t test.
Results
The analysis showed 7,269 upregulated and 3 downregulated genes at a fold change of 2 and P value of < 0.05; only 17 genes were upregulated and none were downregulated at a fold change of 8 and P value of < 0.005. Comparison with 22 previously reported potential biomarkers of metabolic syndrome in patients with psoriasis showed that the levels of 16 biomarkers aligned with the gene regulation observed in the current study. In particular, the REL transcript was upregulated 12-fold ( P = 8.16 × 10 ⁻¹⁷ ), while the WSB1 transcript was upregulated 9-fold ( P = 9.87 × 10 ⁻¹³ ). Validation showed that REL was also upregulated 2-fold in the polymerase chain reaction, and its protein was expressed at 7.140 ng/mL vs . undetectable levels in the cases ( P = 0.048). However, WSB1 was upregulated 2-fold in the polymerase chain reaction compared with controls, and unexpectedly, its protein was undetectable in cases but detectable in controls ( P = 0.018).
Conclusion
The upregulation of REL and WSB1 was observed in patients with psoriasis and metabolic syndrome, the clinical application of REL and WSB1 as biomarkers needs further validation for potential future implications in clinical practice.
This article is based on a presentation given by authors at the Satellite Symposium titled ‘Tailoring topical psoriasis treatments to patients' needs and expectations’ held during the 30th European Academy of Dermatology and Venereology Congress. During this session, the factors affecting adherence and outcomes to topical treatments were presented, with a particular focus on the patients' point of view. Psoriasis is not just a skin condition. Psoriasis can cause negative psychosocial effects, such as depression and anxiety. The risk of suicidality in patients with psoriasis is higher than in the background population. Psychosocial comorbidities can be prevented by patient involvement in psoriasis management and need to be treated in a multidisciplinary manner. Adherence may be the largest barrier to treatment success with topical therapies. Improvement in several areas of disease management may lead to benefits in treatment adherence and hence clinical benefit. There are several treatment‐related factors for non‐adherence, such as patient dissatisfaction, side effects, treatment regimen or the drug vehicle. Delivering comprehensive treatment information to the patient will help develop realistic objectives and expectations. Patients need to be involved in the selection of treatment strategies, as psoriasis patients have various preferences for their use of topical treatments. A shared decision‐making with the patient has been shown to improve medication adherence and treatment success. Prescribing therapy in line with a patient preference for treatment vehicle and improving the communication between healthcare professionals and patients may be key factors to maximize adherence. The calcipotriol (CAL) and betamethasone dipropionate (BDP) cream, a novel formulation of the CAL/BDP fixed‐dose combination based on Poly‐Aphron Dispersion (PAD) Technology, is a topical treatment of mild‐to‐moderate plaque psoriasis, including scalp psoriasis, that has high cosmetic acceptance and overall treatment satisfaction.
Systemic auto-immune inflammatory arthritides are associated with increased cardiovascular (CV) risk compared to those without these conditions, and is a leading cause of morbidity and mortality. Newer biologic drug modifying antirheumatoid drugs (bDMARD) and small molecules have transformed treatment paradigms enabling tighter control of disease activity and in some cases, remission. There is evidence to suggest that the majority of bDMARDs may also reduce cardiovascular risk, although prospective interventional data remain sparse. Additionally, recent results raise concern for treatments targeting specific pathways that may negatively affect cardiovascular risk. This review will cover key biologic pathways targeted in rheumatoid arthritis, psoriatic arthritis, and spondyloarthropathies.
Previously considered as just a skin condition, psoriasis has come to be regarded as a complex, systemic inflammatory disorder that affects multiple other systems. The association of psoriasis with cardiovascular disease and the increased prevalence of cardiovascular risk factors in psoriasis patients is increasingly recognised. Psoriasis is also associated with sleep apnoea, chronic obstructive pulmonary disease, chronic kidney disease, and liver disease. Increased awareness by both patients and physicians of these associations is vital to maximise optimal health outcomes in psoriasis patients. Screening for associated comorbidities and implementation of appropriate interventions is necessary. Furthermore, there is a considerably increased prevalence of depression and anxiety in psoriasis patients that is often not detected by physicians. Patients should be opportunistically assessed and treated, or referred appropriately, for psychological and mental health issues. Further studies are required to expand our knowledge of the systemic manifestations of psoriatic disease, and to allow us to further improve the health outcomes of psoriasis patients.
Dermatologists today have more tools than ever at their disposal for managing psoriasis, including newer-generation biologics, which target molecular drivers of psoriatic inflammation that were scarcely known a decade ago. With a deeper understanding of epidermal immunology, we now recognise key pathogenic roles for multiple cytokines and cytokine receptors. Among current treatment targets, we now include not only the tumour necrosis factor pathway, but also interleukins (IL) of the IL-17 family (which are produced by T helper 17 [Th17] cells, among other skin cells) and IL-23 (which polarises the immune response toward Th17 production), as well as the corresponding receptors and intracellular signalling molecules. Rapid and complete skin clearance has become increasingly feasible, as suggested by studies of the newer biologics, including ustekinumab (targeting Th1 and Th17 cell development), secukinumab and ixekizumab (targeting the IL-17A cytokine), and brodalumab (targeting the IL-17 receptor subunit A). Paralleling the improved skin-related outcomes, we see a lightening of the burden of disease that patients experience with this chronic condition. The bar is being raised when it comes to treatment goals investigated as endpoints in Phase III trials, and we see a shift from control to partial, or even complete, clearance. A similar evolution toward ambitious and personally tailored treatment goals is needed in the clinic. The speakers in this symposium addressed the promise of the new approaches, and the continuing challenge of choosing the optimal therapeutic approach, to ensure that each patient gets the best results from their therapies, whether old or new.
Does age substantially affect the emergence of human immune-mediated arthritis? Children do not usually develop immune-mediated articular inflammation during their first year of life. In patients with juvenile idiopathic arthritis, this apparent 'immune privilege' disintegrates, and chronic inflammation is associated with variable autoantibody signatures and patterns of disease that resemble adult arthritis phenotypes. Numerous mechanisms might be involved in this shift, including genetic and epigenetic predisposing factors, maturation of the immune system with a progressive modulation of putative tolerogenic controls, parallel development of microbial dysbiosis, accumulation of a pro-inflammatory burden driven by environmental exposures (the exposome) and comorbidity-related drivers. By exploring these mechanisms, we expand the discussion of three (not mutually exclusive) hypotheses on how these factors can contribute to the differences and similarities between the loss of immune tolerance in children and the development of established immune-mediated arthritis in adults. These three hypotheses relate to a critical window in genetics and epigenetics, immune maturation, and the accumulation of burden. The varied manifestation of the underlying mechanisms among individuals is only beginning to be clarified, but the establishment of a framework can facilitate the development of an integrated understanding of the pathogenesis of arthritis across all ages.
Objectives:
The main goal of the study was to describe the demographic, epidemiological, clinical and laboratory characteristics of a monitored group of patients with psoriasis to assess the prevalence of cardiovascular comorbidities and to define the cardiovascular risk profile.
Methods:
One hundred and ninety outpatients aged over 18 were included in the prospective observational cross-sectional study. Demographic and clinical data were obtained from patients. The severity of psoriasis was evaluated using the Psoriasis Area and Severity Index (PASI) and the Dermatology Life Quality Index (DLQI). The results of laboratory testing were identified based on patient health records.
Results:
Based on an evaluation of psoriasis phenotypes, 150 patients (78.95%) suffered from plaque psoriasis, 18 (9.5%) from palmoplantar psoriasis, 11 (5.8%) from guttate psoriasis, 6 (3.2%) from generalized pustular psoriasis, and 5 (2.6%) from erythrodermic psoriasis. The personal medical history discovered the occurrence of arterial hypertension in 83 patients (43.7%), the occurrence of depression in 49 patients (25.8%), type 2 diabetes in 29 patients (15.3%), and dyslipidaemia in 48 patients (25.3%).
Conclusion:
It is noteworthy that psoriasis may be demonstrated as a multi-system disease which does not only affect the skin and its adnexa. The association of psoriasis with comorbidities may significantly increase morbidity and total mortality as well as the demands for health care provision.
Background:
Psoriasis is associated with multiple comorbidities, including cardiovascular disease. Identifying biomarkers such as N-terminal fragment of the BNP precursor (NT-pro-BNP) with preventive, diagnostic, and prognostic implications in the cardiovascular diseases of psoriatic patients may be helpful in these patient's management. However, their predictive ability for future cardiovascular events in psoriatic patients is still unknown. Therefore, the study aimed to determine whether NT-pro-BNP levels were increased in psoriatic patients.
Methods:
To do so, 140 psoriatic patients without cardiovascular disease and 140 healthy control patients were enrolled.
Results:
The NT-pro-BNP level was significantly correlated with lipid profile but not with disease duration; or the ongoing biologic therapy.
Conclusions:
Our work demonstrates that pro-BNP values are higher in patients with psoriasis than in controls, and emphasizes the correlation between psoriasis and cardiovascular disease and the importance of biomarkers that can identify those patients most at risk of developing cardiovascular disease.
Background
Psoriasis is an immune-mediated disease associated with excess risk for cardiovascular disease (CVD). Guidelines recognize psoriasis as a CVD risk enhancer; however, psoriasis patients often do not have CVD risk factors identified nor managed.
Objective
This study examines strategies to improve CVD prevention care from the perspective of physicians and patients with psoriasis.
Methods
Qualitative interviews were conducted using the Consolidated Framework for Implementation Research to examine the perspectives of physicians (N = 16) and patients with psoriatic disease (N = 16) on barriers and facilitators to CVD prevention. Interviews were transcribed and coded using an integrated approach designed to enhance reliability and validity using NVivo software.
Results
We found 3 major themes suggesting areas to target for the future: (1) Appropriateness: perceptions of whether CVD care should be deployed in this setting by both physicians and patients, (2) Feasibility: whether CVD prevention care could be integrated into the current structure of specialist practice, and (3) Care Coordination: an interest by all parties to better integrate a team approach in CVD preventative care to reduce duplicative efforts, work practically in an already existing system rather than reinventing the wheel, and progress with the patients’ best interests in mind.
Conclusions
These findings will inform the design of a clinical trial comparing the effectiveness of specialist clinician implementation of CVD guideline-based prevention care in patients with psoriasis. Ultimately, this study aims to increase the lifespan and health of patients living with psoriatic disease by decreasing barriers to their receiving appropriate CVD prevention care.
Resumen
La psoriasis es una enfermedad que va más allá de la afectación exclusivamente cutánea, cada día se reconoce más la importancia del compromiso sistémico, en especial por las comorbilidades asociadas. Dichas comorbilidades se explican por la marcada respuesta inflamatoria sistémica crónica mediada por citoquinas proinflamatorias (principalmente TNF-α, IL-23 e IL-17), las cuales desempeñan un papel importante en la inducción de la resistencia a la insulina, la disfunción endotelial, la aterosclerosis acelerada y el aumento del riesgo de eventos cardio-cerebrovasculares. La relación con estos desenlaces ha sido demostrada, y es allí donde surge el concepto de marcha psoriásica, un término que cobra cada día más importancia, cuyo objetivo es mantener y reforzar el enfoque de una enfermedad cutánea con compromiso sistémico, morbimortalidad asociada que puede ser prevenible y manejable. Los mecanismos fisiopatológicos que explican estos fenómenos son variables, sin embargo, se han dilucidado nuevos conceptos que han permitido mejorar el enfoque actual de la enfermedad, y así establecer mecanismos para disminuir el riesgo cardiovascular en pacientes con psoriasis.
Discrepancies between the results of different studies looking at mortality in similar disease cohorts led us to consider the impact of methodology upon outcome.
Cohort studies were carried out using age, sex, practice, and calendar time matched control groups in the general practice research database. Data were used on all subjects with inflammatory bowel disease, coeliac disease, or Barrett's oesophagus. Mortality data for the population of England and Wales were obtained from the UK Office for National Statistics. The study compared hazard ratios (HR) for mortality using the matched controls to those found when an indirect standardisation to the mortality experience of England and Wales was carried out.
For all three conditions the mortality risk was slightly lower when the national population data were used compared with the internal comparison group (coeliac disease HR 1.33 v standardised mortality ratios (SMR) 1.25, Barrett's oesophagus HR 1.32 v SMR 1.32, inflammatory bowel disease HR 1.50 v SMR 1.34).
A bias was found towards underestimating mortality risk when cohort studies use national population death rates as a comparator. Estimates obtained when an internal comparison group has been used are probably more appropriate.
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.
The prevalence of psoriasis in a defined semi-urban general practice population of 5395 was estimated by means of a postal questionnaire, describing the features of psoriasis followed by physical examination of positive responders, and by a practice disease register, which directly identified psoriatic patients. A point prevalence of 1.48% was found based on examination at the time of study with an equal sex distribution. The mean age of development of the disease was 33 years. At the time of examination, the disease was mild in most patients (mean PASI 2.87). However, there was evidence of marked variability in severity within individuals with time. At some stage, 60% of individuals had required referral to a consultant dermatologist, and approximately 50% of these had received second-line, i.e. non-topical, treatments. Approximately 25% of patients had been in remission at some stage. Forty-one per cent of patients were aware that psoriasis was a genetically determined disease and 37% thought that stress was an exacerbating factor. Seventy per cent of patients were aware that the condition was not curable, but 63% thought that treatment was worthwhile. Fifty-three per cent described themselves as 'bothered' by the appearance of the condition. This concern was positively (and inversely) related to current age, and to stress as an exacerbating factor, but not to sex, PASI, duration of psoriasis, previous hospital referral, or the presence of pruritus. In this study of psoriasis in the community, the findings, particularly in relation to patients' attitude to the disease, disease severity, fluctuation in severity and referral requirements, are of potential interest in health care planning.
Administrative databases are increasingly used for studying outcomes of medical care. Valid inferences from such data require the ability to account for disease severity and comorbid conditions. We adapted a clinical comorbidity index, designed for use with medical records, for research relying on International Classification of Diseases (ICD-9-CM) diagnosis and procedure codes. The association of this adapted index with health outcomes and resource use was then examined with a sample of Medicare beneficiaries who underwent lumbar spine surgery in 1985 ( n = 27,111). The index was associated in the expected direction with postoperative complications, mortality, blood transfusion, discharge to nursing home, length of hospital stay,and hospital charges. These associations were observed whether the index incorporated data from multiple hospitalizations over a year's time, or just from the index surgical admission. They also persisted after controlling for patient age. We conclude that the adapted comorbidity index will be useful in studies of disease outcome and resource use employing administrative databases.
The analysis of censored failure times is considered. It is assumed that on each individual are available values of one or more explanatory variables. The hazard function (age-specific failure rate) is taken to be a function of the explanatory variables and unknown regression coefficients multiplied by an arbitrary and unknown function of time. A conditional likelihood is obtained, leading to inferences about the unknown regression coefficients. Some generalizations are outlined. LIFEtables are one of the oldest statistical techniques and are extensively used by medical statisticians and by actuaries. Yet relatively little has been written about their more formal statistical theory. Kaplan and Meier (1958) gave a comprehensive review of earlier work and many new results. Chiang in a series of papers has, in particular, explored the connection with birth-death processes; see, for example, Chiang (1968). The present paper is largely concerned with the extension of the results of Kaplan and Meier to the comparison of life tables and more generally to the incorporation of regression-like arguments into life-table analysis. The arguments are asymptotic but are relevant to situations where the sampling fluctuations are large enough to be of practical importance. In other words, the applications are more likely to be in industrial reliability studies and in medical statistics than in actuarial science. The procedures proposed are, especially for the two-sample problem, closely related to procedures for combining contingency tables; see Mantel and Haenzel (1959), Mantel (1963) and, especially for the application to life tables, Mantel (1966). There is also a strong connection with a paper read recently to the Society by R. and J. Peto (1972). We consider a population of individuals; for each individual we observe either the time to "failure" or the time to ccloss" or censoring. That is, for the censored individuals we know only that the time to failure is greater than the censoring time. Denote by T a random variable representing failure time; it may be discrete or continuous. Let F(t) be the survivor function, %(t) = pr (T2 t)
This review will focus on the incidence and prevalence of psoriasis, the risk factors for psoriasis and diseases that may be associated with psoriasis. Psoriasis is a heterogeneous disease and, for the purposes of this review, the focus will be plaque psoriasis. Prevalence studies indicate that psoriasis is a common disease and its frequency varies based on age, ethnicity and geography. Family history is the strongest risk factor for the development of psoriasis. Additionally, emerging evidence suggests that some potentially modifiable exposures such as smoking, alcohol, stress and obesity may increase a patient's risk of developing psoriasis. The evolving literature suggests that psoriasis is associated with multiple other diseases including cancer, cardiovascular, autoimmune and psychiatric disease. Epidemiological studies of psoriasis contribute to measuring the public health burden of this disease and guide the care of patients with psoriasis through a better understanding of its natural history.
Studies have been carried out to evaluate the quality and completeness of the data recorded by GPs on VAMP computers for the purpose of carrying out drug safety studies. In an earlier study of 58 practices we found that clinical diagnoses reflecting the diagnoses noted in the consultant letters were present on the computer 87% of the time. We have now evaluated a further 35 practices. Agreement between the information in the consultant letter and that on the computer was present in 121 of 126 (96%) instances.
Administrative databases are increasingly used for studying outcomes of medical care. Valid inferences from such data require the ability to account for disease severity and comorbid conditions. We adapted a clinical comorbidity index, designed for use with medical records, for research relying on International Classification of Diseases (ICD-9-CM) diagnosis and procedure codes. The association of this adapted index with health outcomes and resource use was then examined with a sample of Medicare beneficiaries who underwent lumbar spine surgery in 1985 (n = 27,111). The index was associated in the expected direction with postoperative complications, mortality, blood transfusion, discharge to nursing home, length of hospital stay, and hospital charges. These associations were observed whether the index incorporated data from multiple hospitalizations over a year's time, or just from the index surgical admission. They also persisted after controlling for patient age. We conclude that the adapted comorbidity index will be useful in studies of disease outcome and resource use employing administrative databases.
In a retrospective study we tried to evaluate the number of severe psoriasis with a lethal outcome observed in France in a 20-year period from 1965 to 1985. Among 992 psoriatic in-patients on care during this period in the Dermatology Clinic of Strasbourg, 7 died of different complications directly related to the skin disease or its therapy; 39 further cases could be gathered through different departments of dermatology of France. Patients who died had generalized psoriasis (13 cases), psoriatic erythroderma (15 cases) and generalized pustular psoriasis (18 cases); 18 (39 p. 100) also had psoriatic polyarthritis. Circumstances leading to death (table I) were metabolic disorders, related to erythroderma in most cases, non-specific complications (infections, amyloidosis) or complications of specific treatments (methotrexate, etretinate, corticosteroids, mechlorethamine). A comprehensive review of the literature over a century showed that only 72 lethal psoriasis cases have been reported: this rather low number may be due to the fact that some rare pathologies, such as visceral amyloidosis (12 cases) (table III) and fatal complications of methotrexate therapy (38 cases) (table V), paradoxically are more often published than non-specific complications occurring in severe psoriasis, such as cardiovascular failure or cachexy in erythrodermic patients. However, the review of the literature shows, as our own inquiry, the poor prognosis of generalized pustular forms and of psoriasis-associated polyarthropathies: among 42 lethal cases where enough data were available, 23 (55 p. 100) had psoriatic polyarthritis.(ABSTRACT TRUNCATED AT 250 WORDS)
After 10 years of prospective study of a cohort of 1,380 patients with psoriasis enrolled in the Photochemotherapy (PUVA) Follow-up Study, our data show that the incidence of death and causes of death were comparable to those expected in the general population. We noted no increase in cardiovascular mortality, but observed that cirrhosis caused more deaths among our cohort than in the general population (Standard Mortality Ratio: 4.7, P less than 0.05). The overall incidence of non-cutaneous cancer was slightly but not significantly elevated in our population (Standard Mortality Ratio = 1.2, P greater than 0.05). In an analysis of individual sites, we observed significant increases in the incidence of colonic cancer and primary neoplasms of the central nervous system. We found no significant increase in the incidence of lymphoma, leukemia, or malignant melanoma within our cohort. Because of the possible long latency time and the low incidence of these malignancies only continued follow-up of this cohort can assure us that PUVA therapy does not substantially alter the risk for the development of these conditions.
Background: Methotrexate (MTX) may induce liver damage, which in some psoriatics will lead to fibrosis or cirrhosis. Studies performed 10 years ago on 25 patients with MTX-induced liver cirrhosis indicated that this type of cirrhosis was not of an aggressive nature. Objective: The aim of this study was to evaluate the present status of surviving patients 10 years later, together with the latest clinical and histological data on patients who had died. Methods: The investigations were carried out on 186 liver biopsies and 5 autopsies. All biopsies were studied by the same pathologist. Eleven surviving patients were also studied by analysis of serum aminoterminal propeptide of type III procollagen (PIIINP), which is an indicator of fibrogenesis, which is especially suitable for follow-up of fibrotic liver disease. Results: Thirteen patients had died; 1 of these died of liver failure. Another patient died from an overdose due to misunderstanding of the prescribed dosage given elsewhere. The remaining deaths were non-MTX related, but all 5 autopsies showed some degree of cirrhosis. On the other hand, 13 patients had no histologically verified liver cirrhosis in their latest biopsy, and PIIINP was within the normal range in all 11 patients investigated, this in spite of total cumulative MTX doses from 1,120 to 18,645 mg (mean 7,171 mg). Conclusions: This study confirmed that in most patients MTX-induced liver cirrhosis is not aggressive. However, continued low-dose MTX led, in spite of normal liver tests, 8 years after the last biopsy to liver failure and death in 1 of our patients. Our data support the continued use of liver biopsies in the surveillance of MTX-treated psoriatics.
Methotrexate (MTX) may induce liver damage, which in some psoriatics will lead to fibrosis or cirrhosis. Studies performed 10 years ago on 25 patients with MTX-induced liver cirrhosis indicated that this type of cirrhosis was not of an aggressive nature.
The aim of this study was to evaluate the present status of surviving patients 10 years later, together with the latest clinical and histological data on patients who had died.
The investigations were carried out on 186 liver biopsies and 5 autopsies. All biopsies were studied by the same pathologist. Eleven surviving patients were also studied by analysis of serum aminoterminal propeptide of type III procollagen (PIIINP), which is an indicator of fibrogenesis, which is especially suitable for follow-up of fibrotic liver disease.
Thirteen patients had died; 1 of these died of liver failure. Another patient died form an overdose due to misunderstanding of the prescribed dosage given elsewhere. The remaining deaths were non-MTX related, but all 5 autopsies showed some degree of cirrhosis. On the other hand, 13 patients had no histologically verified liver cirrhosis in their latest biopsy, and PIIINP was within the normal range in all 11 patients investigated, this in spite of total cumulative MTX doses from 1,120 to 18,645 mg (mean 7,171 mg).
This study confirmed that in most patients MTX-induced liver cirrhosis is not aggressive. However, continued low-dose MTX led, in spite of normal liver tests, 8 years after the last biopsy to liver failure and death in 1 of our patients. Our data support the continued use of liver biopsies in the surveillance of MTX-treated psoriatics.
Psoriasis is seen as a disease that does not kill. However, it is associated with alcohol intake and smoking. Thus, there could be excess mortality due to causes related to alcohol intake and smoking among patients with psoriasis.
A cohort was identified from the nationwide Hospital Discharge Register from January 1, 1973, through December 31, 1984, and mortality was followed up for 22 years by linkage with the Cause-of-Death Register, from January 1, 1973, through December 31, 1995.
A cohort of 3132 men and 2555 women admitted to inpatient treatment with psoriasis as the principal diagnosis.
Date and underlying cause of death.
We observed 1918 deaths in contrast to the 1211 deaths expected on the basis of the national mortality rates. The all-cause standardized mortality ratio (SMR) for men was 1.62 (95% confidence interval [CI], 1.52-1.71); for women, 1.54 (95% CI, 1.43-1.64). Among men, the highest SMRs were found for alcohol psychosis (8.91 [95% CI, 2.89-20.70]) and liver disease, ie, cirrhosis, fatty liver, and hepatitis (6.98 [95% CI, 5.34-8.96]). Among women, the highest SMR was found for liver disease (5.06 [95% CI, 2.70-8.65]). Excess mortality was high for all causes of death directly related to alcohol; the SMR for men was 4.46 (95% CI, 3.60-5.45); for women, 5.60 (95% CI, 2.98-8.65).
Patients with moderate to severe psoriasis are at increased risk for death. Alcohol is a major cause for this excess mortality.
This study investigated whether efficacious methotrexate (MTX) treatment has an impact on mortality of patients with severe rheumatoid arthritis (RA).
In this prospective, observational, one-center study, patients with severe RA refractory to other disease-modifying antirheumatic drugs started MTX treatment between 1980 and 1987. Patients were divided into 4 different groups according to their response to MTX treatment after 1 year (>50% improvement [n = 99], 20-50% improvement [n = 70], no improvement [n = 52], and discontinued treatment [n = 35]). After a followup of 7.5-15.3 years (mean 10 years), the numbers of deaths were assessed in the different groups. Standardized mortality ratios (SMR) were calculated by comparing the number of observed deaths in the study with the number of expected deaths in an age- and sex-matched sample of the general population.
Two hundred seventy-one patients entered the study between 1980 and 1987. In 1995/1996, outcomes for 256 patients (94.5%) could be documented; 88 patients (34.4%) had died. In patients with >50% improvement after 1 year, the SMR was 1.47, while in patients with 20-50% improvement, the SMR was 1.85. In both groups combined, the SMR was 1.64 (95% confidence interval [95% CI] 1.11-2.17), compared with 4.11 (95% CI 2.56-5.66) in patients without improvement. Patients who had discontinued MTX treatment during the first year had an SMR of 5.56 (95% CI 3.29-7.83).
Patients with severe RA who do not respond to MTX treatment have a poor prognosis, with >4-fold increased mortality compared with the general population, while RA patients who respond to MTX treatment have only a moderately increased mortality rate.
Studies of clinical series of psoriasis patients have suggested an increased risk of nonmelanoma skin cancer and melanoma; the risk of other neoplasms has rarely been studied. In order to assess the incidence of cancer in a nationwide series of psoriasis patients from Sweden, we followed up, for the years 1965-89, 9773 patients with a hospital discharge diagnosis of psoriasis made during 1965-83, who were alive and free from malignancy 1 y after first discharge. We compared their incidence of neoplasms with that of the national population by computing standardized incidence ratios (SIR). We observed a total of 789 neoplasms [SIR 1.37, 95% confidence interval (CI) 1.28, 1.47]. There was an increase in the risk of cancers of the oral cavity and pharynx (SIR 2.80, 95% CI 1.96, 3.87), liver (SIR 1.91, 95% CI 1.28, 2.74), pancreas (SIR 1.56, 95% CI 1.02, 2.23), lung (SIR 2.13, 95% CI 1.71, 2.61), skin (squamous cell carcinoma, SIR 2.46, 95% CI 1.82, 3.27), female breast (SIR 1.27, 95% CI 1.00, 1.58), vulva (SIR 3.24, 95% CI 1.18, 7.06), penis (SIR 4.66, 95% CI 1.50, 10.9), bladder (SIR 1.43, 95% CI 1.03, 1.92), and kidney (SIR 1.56, 95% CI 1.04, 2.25). The risk of malignant melanoma was decreased (SIR 0.32, 95% CI 0.10, 0.74). Despite some limitations (possible diagnostic misclassification, lack of data on treatment, relatively short follow-up), our study provides evidence against an increased risk of melanoma among patients hospitalized for psoriasis. In addition to nonmelanoma skin and genital cancers, patients hospitalized for psoriasis were at increased risk of several malignancies, in particular those associated with alcohol drinking and tobacco smoking.
Methotrexate is the most frequent choice of disease-modifying antirheumatic therapy for rheumatoid arthritis. Although results of studies have shown the efficacy of such drugs, including methotrexate, on rheumatoid arthritis morbidity measures, their effect on mortality in patients with the disease remains unknown. Our aim was to prospectively assess the effect on mortality of methotrexate in a cohort of patients with rheumatoid arthritis.
Our cohort included 1240 patients with rheumatoid arthritis seen at the Wichita Arthritis Center, an outpatient rheumatology facility. Patients' details were entered into a computerised database at the time of their first clinic visit. We also obtained and recorded demographic, clinical, laboratory, and self-reported data at each follow-up visit (average interval 3.5 months). We estimated the mortality hazard ratio of methotrexate with a marginal structural Cox proportional hazards model.
191 individuals died during follow-up. Patients who began treatment with methotrexate (n=588) had worse prognostic factors for mortality. After adjustment for this confounding by indication, the mortality hazard ratio for methotrexate use compared with no methotrexate use was 0.4 (95% CI 0.2-0.8). Other conventional disease-modifying antirheumatic drugs did not have a significant effect on mortality. The hazard ratio of methotrexate use for cardiovascular death was 0.3 (0.2-0.7), whereas that for non-cardiovascular deaths was 0.6 (0.2-1.2).
Our data indicate that methotrexate may provide a substantial survival benefit, largely by reducing cardiovascular mortality. This survival benefit of methotrexate would set a standard against which new disease-modifying antirheumatic drugs could be compared.
The Journal of Investigative Dermatology publishes basic and clinical research in cutaneous biology and skin disease.
The United Kingdom General Practice Research Database (GPRD) is an office-based, computer-generated, medical resource designed from its inception to be used for epidemiologic research. A distinct version of the GPRD is maintained by the Boston Collaborative Drug Surveillance Program and has been the source of more than 130 scientific articles primarily addressing drug safety issues. We reviewed evidence related to the validity of the GPRD. Specifically, with our extensive experience with this automated database, we evaluated the quality and completeness of the data that it contains.
To determine if the rate of lymphoma in patients with a history of psoriasis is different from the rate of lymphoma in patients without psoriasis.
Cohort study.
Outpatient practices of general practitioners in the United Kingdom who contribute to the General Practice Research Database.
The population studied was a sample of 10% of the patients 65 years or older registered with a general practitioner contributing to the General Practice Research Database between 1988 and 1996.
The rate of lymphoma in patients with psoriasis compared with the rate of lymphoma in patients without psoriasis.
There were 2718 patients who had psoriasis and 105 203 patients (the reference population) who did not have psoriasis. The median follow-up time was 46 months. We noted 276 lymphomas. Patients with psoriasis had a 2.95 relative rate of developing lymphoma (95% confidence interval, 1.83-4.76) compared with those without psoriasis. This estimate did not change after controlling for age and sex using the Cox multivariable proportional hazards model. The rate of lymphoma changed little when the patients treated with methotrexate or those who developed mycosis fungoides were excluded. Compared with the reference population, we found an additional 122 lymphomas per 100 000 patients annually among patients with psoriasis who were 65 years or older.
These results indicate that patients with psoriasis are at increased risk for developing lymphoma. Additional studies are necessary to determine if the increased rate of lymphoma is related to psoriasis severity, psoriasis treatment, or an interaction between these risk factors.
The impact of psoriasis on quality of life has been studied in select patient populations. Population-based data detailing the distribution of extent of disease, associated problems in everyday life, and treatment satisfaction for the US population have been lacking. Our population-based survey indicates that approximately 4.5 million adults have been diagnosed as having psoriasis. Most (59%) have little or no involvement, but 650,000 adults have at least three palms of body surface involved and more than 1,000,000 indicate substantial dissatisfaction with their treatment. Only 5% of patients (56,000) who report severe dissatisfaction with current therapy have extensive disease (10 palms). Many individuals with little psoriasis at the time of interview considered the disease to be a large problem in everyday life.
Methotrexate (MTX) is a folate analogue used in the treatment of moderate to severe psoriasis and rheumatoid arthritis (RA). It oppositely affects inflammation and hyperhomocysteinemia-two independent risk factors for vascular disease. To date, there are no published reports evaluating the impact of these potentially paradoxical action of MTX.
The purpose of this study was to evaluate the effect of MTX therapy on the incidence of vascular disease in patients with psoriasis and RA.
We conducted a retrospective cohort study in which we analyzed computerized records of 7,615 outpatients diagnosed with psoriasis and 6,707 with RA at the Veterans Integrated Service Network 8.
Patients prescribed MTX therapy had a significantly reduced risk of vascular disease compared to those who were not prescribed MTX (psoriasis: RR = 0.73, 95% CI = 0.55-0.98; RA: 0.83, 0.71-0.96). This reduction was most evident for patients prescribed a low cumulative dose of MTX (psoriasis: RR = 0.50, 95% CI = 0.31-0.79; RA = 0.65, 0.52-0.80). Concomitant use of folic acid (FA) with MTX also reduced the incidence of vascular disease in patients prescribed MTX (psoriasis: RR = 0.56, 95% CI = 0.39-0.80; RA: 0.77, 0.38-1.56).
MTX therapy reduced the incidence of vascular disease in veterans with psoriasis or RA. Low to moderate cumulative dose appears more beneficial than the higher dose. We hypothesize that this effect is caused by its anti-inflammatory properties. In addition, a combination of MTX and FA led to a further reduction in the incidence of vascular disease.
To study cases of low-dose methotrexate-induced pancytopenia with special reference to clinical outcome and factors predisposing to bone marrow suppression.
Patient files of 14 cases of methotrexate-induced pancytopenia reported to the National Agency for Medicines in Finland from 1991 to 1999 were reviewed. A review of four additional cases was included.
Of the 18 patients (median age 72 years), 12 had rheumatoid arthritis, one psoriatic arthritis, five psoriasis without arthritis, and one pemphigus erythematosus. Major co-morbidity was recorded in 12 patients, and 16 patients used significant concomitant drugs. Eight patients had a mildly or moderately elevated serum creatinine concentration. In every patient the occurrence of cytopenia was abrupt. Eight patients (44%) died, and the most frequent cause of death was infection.
Our data show that methotrexate-induced pancytopenia is associated with high mortality especially in cases with significant co-morbidity and concomitant medications.
Estimates of the prevalence of psoriatic arthritis vary widely and are usually not determined by population-based studies.
We sought to determine the prevalence of psoriatic arthritis and the impact of the disease on quality of life in the US population.
Patients were selected randomly from the US population and were interviewed by telephone. Cases were defined as patients who reported a physician diagnosis of psoriasis and psoriatic arthritis.
Interviews of 27,220 persons were conducted; 601 of the interviewees had psoriasis and 71 had psoriasis and psoriatic arthritis. The prevalence of psoriatic arthritis was 0.25% (95% confidence interval [CI]: 0.18%, 0.31%). The prevalence of psoriatic arthritis among patients with psoriasis was 11% (95% CI: 9%, 14%) and varied substantially based on self-reporting of the extent of skin involvement with psoriasis. Thirty-nine percent of patients with psoriatic arthritis indicated that it was a large problem in everyday life.
Psoriatic arthritis was classified on the basis of the patient's self-report.
Psoriatic arthritis affects an estimated 520,000 patients in the US population, and many rate it as a large problem in everyday life. The prevalence varies widely based on the extent of skin involvement, which demonstrates the importance of performing broadly representative studies to measure the prevalence of psoriatic arthritis.
To measure the prevalence and treatment of psoriasis in the United Kingdom.
Cross-sectional study to determine prevalence and cohort study to determine treatment patterns.
Outpatient practices of general practitioners.
We included in the analysis all patients who were registered with a general practitioner in the General Practice Research Database from 1987 to 2002.
The prevalence and treatment of psoriasis.
We identified 114 521 patients with psoriasis of a total population of 7 533 475 patients, yielding a prevalence of 1.5%. The prevalence of psoriasis increases more rapidly in young female patients compared with young male patients and declines significantly in patients 70 years and older, regardless of sex. Overall, 91.8% of patients with a diagnosis of psoriasis received a prescription for psoriasis treatment on or after the date of their first diagnostic code of psoriasis in the General Practice Research Database. Most of the patients (55.2%) received only 1 or 2 prescriptions for psoriasis in the first year after psoriasis was documented in the General Practice Research Database.
The epidemiology of psoriasis in the General Practice Research Database population is similar to that of other epidemiologic studies of psoriasis performed in the United Kingdom, the United States, and other Western countries. Psoriasis carries a substantial burden given its high prevalence and its associated need for prescription therapy. Additional studies are necessary to determine why the prevalence of psoriasis increases more rapidly in female patients and to determine why the prevalence decreases in patients 70 years and older.
To study the impact of obesity and smoking on psoriasis.
Cross-sectional study.
University of Utah Department of Dermatology clinics.
A case series of patients with psoriasis enrolled in the prospective Utah Psoriasis Initiative (UPI) (which carefully performs phenotyping of patients with psoriasis) was compared with 3 population databases: the Behavioral Risk Factor Surveillance System of the Utah population, the 1998 patient-member survey from the National Psoriasis Foundation, and 500 adult patients who attend our clinics and do not have psoriasis (non-psoriatic population).
The prevalence of obesity in patients within the UPI population was higher than that in the general Utah population (34% vs 18%; P<.001) and higher than that in the non-psoriatic population attending our clinics. Assessment of body image perception with a standardized diagram in the UPI group resulted in the median body image score of normal weight at 18 years of age and the onset of psoriasis, but it changed to overweight at the time of enrollment in the UPI. Thus, obesity appears to be the consequence of psoriasis and not a risk factor for onset of disease. We did not observe an increased risk for psoriatic arthritis in patients with obesity; furthermore, obesity did not positively or negatively affect the response or the adverse effects of topical corticosteroids, light-based treatments, and systemic medications. The prevalence of smoking in the UPI population was higher than in the general Utah population (37% vs 13%; P<.001) and higher than in the non-psoriatic population (37% vs 25%; P<.001). We found a higher prevalence of smokers in the obese population within the UPI than in the obese population within the Utah population (25% vs 9%; P<.001).
Patients with psoriasis attending the University of Utah Dermatology Clinics were more likely to be obese and to smoke compared with non-psoriatic patients and more likely to be obese compared with other large cohorts with psoriasis. Smoking appears to have a role in the onset of psoriasis, but obesity does not. The high prevalence of obesity and smoking in a psoriasis cohort has not been previously noted; if confirmed, it supports the prediction that a significant portion of patients with psoriasis will have the comorbid conditions and public health issues of those with obesity and smoke.
Psoriasis is the most common T-helper cell type 1 (T(H)1) immunological disease. Evidence has linked T(H)1 diseases to myocardial infarction (MI). Psoriasis has been associated with cardiovascular diseases, but has only been investigated in hospital-based studies that did not control for major cardiovascular risk factors.
To determine if within a population-based cohort psoriasis is an independent risk factor for MI when controlling for major cardiovascular risk factors.
A prospective, population-based cohort study in the United Kingdom of patients with psoriasis aged 20 to 90 years, comparing outcomes among patients with and without a diagnosis of psoriasis. Data were collected by general practitioners as part of the patient's medical record and stored in the General Practice Research Database between 1987 and 2002, with a mean follow-up of 5.4 years. Adjustments were made for hypertension, diabetes, history of myocardial infarction, hyperlipidemia, age, sex, smoking, and body mass index. Patients with psoriasis were classified as severe if they ever received a systemic therapy. Up to 5 controls without psoriasis were randomly selected from the same practices and start dates as the patients with psoriasis. A total of 556,995 control patients and patients with mild (n = 127,139) and severe psoriasis (n = 3837) were identified.
Incident MI.
There were 11,194 MIs (2.0%) within the control population and 2319 (1.8%) and 112 (2.9%) MIs within the mild and severe psoriasis groups, respectively. The incidences per 1000 person-years for control patients and patients with mild and severe psoriasis were 3.58 (95% confidence interval [CI], 3.52-3.65), 4.04 (95% CI, 3.88-4.21), and 5.13 (95% CI, 4.22-6.17), respectively. Patients with psoriasis had an increased adjusted relative risk (RR) for MI that varied by age. For example, for a 30-year-old patient with mild or severe psoriasis, the adjusted RR of having an MI is 1.29 (95% CI, 1.14-1.46) and 3.10 (95% CI, 1.98-4.86), respectively. For a 60-year-old patient with mild or severe psoriasis, the adjusted RR of having an MI is 1.08 (95% CI, 1.03-1.13) and 1.36 (95% CI, 1.13-1.64), respectively.
Psoriasis may confer an independent risk of MI. The RR was greatest in young patients with severe psoriasis.
Previous studies suggest that patients hospitalized for psoriasis have an increased frequency of a variety of cardiovascular comorbidities. Limited population-based data exist on this association, and few studies have determined which factors are independently associated with psoriasis.
We sought to determine whether the prevalence of the major cardiovascular risk factors was higher in mild and severe psoriasis than in patients without psoriasis.
We conducted a population-based study in the United Kingdom using the General Practice Research Database. Patients were classified as having severe psoriasis if they received a code for psoriasis as well as systemic therapy. Patients were defined as having mild psoriasis if they ever received a psoriasis code but no systemic therapy. Control subjects were selected from the same practices and start dates as psoriasis patients. Patients were classified as having risk factors if they received codes for diabetes, hypertension, hyperlipidemia, obesity, or smoking. Analyses were performed by using conditional logistic regression, and adjustments were made considering age, gender, person-years, and all cardiovascular risk factors.
We identified 127,706 patients with mild psoriasis and 3854 with severe psoriasis. Respective prevalence rates of risk factors in those with severe psoriasis, mild psoriasis, and in controls were as follows: diabetes (7.1%, 4.4%, 3.3%), hypertension (20%, 14.7%, 11.9%), hyperlipidemia (6%, 4.7%, 3.3%), obesity (20.7%, 15.8%, 13.2%), and smoking (30.1%, 28%, 21.3%). Patients with mild psoriasis had a higher adjusted odds of diabetes (odds ratio [OR], 1.13; 95% confidence interval [CI], 1.08-1.18]), hypertension (OR, 1.03; 95% CI, 1.01-1.06), hyperlipidemia (OR, 1.16; 95% CI, 1.12-1.21), obesity (OR, 1.27; 95% CI, 1.24-1.31), and smoking (OR, 1.31; 95% CI, 1.29-1.34) than controls. Patients with severe psoriasis had a higher adjusted odds of diabetes (OR, 1.62; 95% CI, 1.3-2.01), obesity (OR, 1.79; 95% CI, 1.55-2.05), and smoking (OR, 1.31; 95% CI, 1.17-1.47) than controls. Additionally, diabetes (OR, 1.39; 95% CI, 1.22-1.58) and obesity (OR, 1.47; 95% CI, 1.32-1.63) were more prevalent in those with severe psoriasis than with mild psoriasis.
The study was cross-sectional and therefore the directionality of the associations could not be determined.
Multiple cardiovascular risk factors are associated with psoriasis. Cardiovascular risk factors that are key components of the metabolic syndrome are more strongly associated with severe psoriasis than with mild psoriasis.
Psoriasis can be associated with severe, life-threatening exacerbations. We sought to approximate the mortality associated with hospitalizations for psoriasis.
We analyzed data from two sources to estimate a death rate associated with psoriasis.
There were 471 hospital admissions for psoriasis from 1988 to 2001 with a corresponding mortality rate of 1.5%. Documented on nationwide death certificates, there were a total of 29, 33, and 25 deaths attributable to psoriasis in 2001, 2000, and 1999, respectively.
Though effective therapies for severe psoriasis are available, access to them is not guaranteed. It is disturbing to think that the deaths observed here could, at least in part, be prevented with the appropriate use of treatments.
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