Psoriasis Comorbidities Research Articles

Adiponectin levels in a large pooled plaque psoriasis study population

Background: Adiponectin is an adipocyte-secreted protein potentially relevant in the context of cardiometabolic comorbidity of psoriasis patients.Objective: This post-hoc analysis aimed to assess the impact of obesity, metabolic syndrome, psoriasis severity and treatment with secukinumab/etanercept on adiponectin.Methods: Three phase III trials in moderate to severe plaque psoriasis were included. Correlations of Psoriasis Area and Severity Index (PASI), body mass index (BMI), and associated comorbidity with adiponectin levels as well as the impact of secukinumab, etanercept, and placebo were analyzed.Results: Data of 3010 patients were included of whom 71.2% had a BMI >25. Adiponectin levels were significantly higher in patients with lower BMI (r = −0.23; p < .0001) and in patients without metabolic syndrome compared to patients with higher BMI and with metabolic syndrome. PASI score was negatively associated with adiponectin levels (r = −0.065; p = .0004). However, the correlation was extremely weak and thus clinically irrelevant. During treatment with secukinumab or etanercept over 52 weeks adiponectin levels remained stable.Conclusion: Metabolic syndrome and BMI are key determinants of adiponectin levels in psoriasis patients. Psoriasis severity and anti-psoriatic treatment had no relevant impact on adiponectin levels.

Characteristics and prevalence of plaque psoriasis in patients with palmoplantar pustulosis.

Palmoplantar pustulosis (PPP) is a chronic pustular skin condition on the palms and soles. The disease is often seen in combination with plaque psoriasis, and whether PPP is a variant of psoriasis has been debated. The disease prevalence of PPP and co-occurring psoriasis is not yet established and the patient group remains understudied. To estimate the prevalence of PPP and co-occurring psoriasis in three population-based cohorts and to provide information on patient demographics and characteristics. Administrative healthcare registries and insurance databases from the U.S.A., Denmark and Germany were used as data sources. Patients with PPP were defined by a single International Classification of Diseases 10th Revision code for PPP during a 1-year period. Information regarding co-occurring plaque psoriasis and other comorbidities was extracted. Furthermore, use of antipsoriatic medication was identified. In total 1435, 751 and 1832 patients with PPP were identified in the U.S., Danish and German populations, with estimated 1-year prevalences of 0·009%, 0·005% and 0·08%, respectively. Plaque psoriasis was present in 14·2-61·3% of patients with PPP. Patients with co-occurring psoriasis had an overall higher prevalence of psoriatic arthritis. Similarly, medication use was more prevalent in patients with PPP with co-occurring psoriasis, and especially pronounced was the use of biologic therapies. This large observational study on patients with PPP provides detailed information regarding patient demographics, comorbidities and medication use. The 1-year prevalence of PPP varied in the three studied populations, possibly due to differences in diagnostics and recording practices. Psoriasis frequently co-occurred in patients with PPP. What's already known about this topic? Palmoplantar pustulosis (PPP) is a skin disease of the palms of the hands and soles of the feet and is known to be related to psoriasis. Whether PPP is a distinct disease or a variant of psoriasis is not yet established. The condition is understudied in terms of disease prevalence, disease predictors, patient characteristics and comorbidity. What does this study add? In this study using data from three large population-based cohorts we found low prevalence rates (< 0·1%) of PPP. The prevalence of psoriasis was estimated at between 14·2% and 61·3% in patients with psoriasis. Patients with PPP with co-occurring psoriasis have a higher prevalence of psoriatic arthritis and use of antipsoriatic drugs.

Increased risk of psoriasis in subjects with abdominal obesity: A nationwide population-based study.

Psoriasis is a chronic inflammatory skin disease known to be associated with a variety of systemic comorbidities, such as metabolic syndrome and obesity. Obesity represents a major comorbidity and has been suggested to be related to psoriasis. This nationwide population-based prospective cohort study was performed to investigate the impacts of body mass index (BMI) and waist circumference (WC) on psoriasis. We used the health check-up database and the study population consisted of subjects who had undergone health screening between January 2009 and December 2012. This study investigated patients newly diagnosed with psoriasis (International Classification of Disease, Tenth Revision, code L40) by dermatologists during the follow-up period (5.32years), based on claims data. The total population consisted of 22633536 subjects, among whom 399461 had newly developed psoriasis. Subjects with BMI of more than 30 had a higher risk of psoriasis (hazards ratio [HR], 1.118; 95% confidence interval [CI], 1.100-1.137) compared with the BMI 18.5-23 group. WC showed a dose-dependent association with psoriatic risk. Subjects with WC over 105cm showed the highest risk of psoriasis (HR, 1.305; 95% CI, 1.261-1.349) compared with subjects with WC lower than 80/75 after adjusting for confounding factors, including BMI. The risk of psoriasis was highest in males with normal BMI and abdominal obesity (HR, 1.175; 95% CI, 1.150-1.200). Our study indicates that WC is a specific factor affecting psoriatic risk and highlights the association between abdominal obesity and psoriasis, thus increasing awareness of the role of abdominal obesity in the pathogenesis and comorbidities of psoriasis.

Osteoporosis y psoriasis

Psoriasis is a chronic inflammatory disease associated with multiple comorbidities, particularly in patients with arthritis or more severe forms of the disease. The link between all these comorbidities is probably systemic inflammation. Several recent studies have indicated that patients with psoriasis may be at an increased risk of pathologic fractures and osteoporosis. Current guidelines on comorbidities in psoriasis do not recommend assessment of bone health. In this article, we review the available evidence on the association between psoriasis and osteoporosis. We first examine the concept of osteoporosis and the role of vitaminD in bone health and then propose an algorithm for managing and treating this condition in patients with psoriasis.

Lp-PLA2 as a promising predictor of comorbidities in patients with severe psoriasis

Objective: Lipoprotein-associated phospholipase A2 (Lp-PLA2) is a well- known risk factor of atherosclerotic vascular diseases which are common comorbidities in psoriasis. The aim of this study was to evaluate serum Lp-PLA2 level in psoriatic patients and elucidate possible associations with disease activity, metabolic or inflammatory parameters and systemic treatment.Methods: We enrolled 33 patients with active plaque-type psoriasis and 11 healthy controls. Blood samples were collected before and after 3 months of systemic treatment with acitretin or methotrexate. Serum Lp-PLA2 level were evaluated by enzyme-linked immunosorbent assay.Results: Serum Lp-PLA2 level in patients with psoriasis did not statistically differ comparing to the control group (p = .2). However, in patients with severe psoriasis Lp-PLA2 was significantly higher than in the controls before and after treatment (p = .03, p = .01, respectively). The lipase did not correlate with BMI (p = .22); however, a statistical significance was noted between psoriatics with obesity compared to the controls (p = .03). No significant effect of systemic treatment combined (p = .5) nor separately with acitretin (p = .5) or methotrexate (p = .1) on the Lp-PLA2 level was found, despite clinical improvement.Conclusion: Lp-PLA2 assay might be helpful in assessment of the risk of cardiometabolic comorbidities development especially in patients with severe psoriasis and obesity.

Narrowband UVB treatment induces expression of WNT7B, WNT10B and TCF7L2 in psoriasis skin

WNT/β-catenin signaling pathways play a pivotal role in the human immune defense against infections and in chronic inflammatory conditions as psoriasis. Wnt gene alterations are linked to known comorbidities of psoriasis as obesity, diabetes and Crohn’s disease. The objective of this study was to investigate WNT7B, WNT10B, WNT16 and TCF7L2 gene and protein expression in lesional and non-lesional skin and in the peripheral blood of patients with chronic plaque psoriasis compared with healthy individuals. To investigate the effect of narrowband UVB radiation, expression of these genes were analyzed before and after narrowband UVB treatment. Associations between single nucleotide polymorphisms for WNT7B, WNT10B, WNT16 and TCF7L2 genes and psoriasis were tested. Our results show significantly decreased WNT7B, WNT10B and TCF7L2 gene expression in lesional skin compared with non-lesional skin and healthy controls. Narrowband UVB treatment significantly increased expression of these genes in lesional skin. Immunohistochemistry shows increased WNT16 expression in lesional skin. No significant differences in allele or genotype frequencies for Wnt or TCF7L2 gene polymorphisms were found between patient and control group. This study shows for the first time significant UVB induced upregulation of WNT7B, WNT10B and TCF7L2 in patients with psoriasis and suggests a potential role of these genes in psoriasis pathogenesis.

648 Machine-based learning identifies fish oil as a putative psoriasis drug: Efficacy in KC-Tie2 psoriasis mice via RXR activation and increases in fatty acid metabolism

We previously identified via metabolomics the oxidative product of linoleic acid, 13-HODE, as a possible link between psoriasis and CVD comorbidities. Here, using novel computer algorithms and the STITCH and MGD databases, we identified ‘increased monocyte cell number’ as a phenotype caused by 13-HODE related target genes and MPO, IL4R, ICAM1 and PTPN11 as target genes associated with 13-HODE. These targets were integrated bioinformatically to generate a drug/chemical list, which included methotrexate, cyclosporin and dexamethasone, known effective psoriasis treatments, but also fatty acids and fish oils. To test the hypothesis that fish oil could improve psoriasis, we fed a diet enriched in 10% fish oil to KC-Tie2 psoriasis mice for a 6-wk period. Strikingly, acanthosis decreased by 70% (54±3 to 16±2μm) returning to control mouse levels (13±1μm; n=12-13/grp, P<0.001), as did skin CD4+ T cell numbers (18±1 to 4±1cells/field of view; n=4/grp, P<0.001). KC-Tie2 mice fed the enriched fish oil diet also showed lengthened (improved) times to thrombus formation in an experimental thrombosis assay vs. KC-Tie2 mice fed a regular diet (34±6 vs. 66±10min; n=5-6/grp, P<0.05), suggesting fish oil could improve skin inflammation and CVD comorbidities. To discover mechanisms of action mediating these improvements, RNASeq was performed on skin of mice from each group. Increases in transcripts (P<0.05 for all hits) associated with RXR activation (PXR/LXR/FXR), specifically IL1R2, CYP2EID, ALDH1A1 and IDI1 were observed, as were increases in genes associated with fatty acid metabolism/oxidation, specifically FABP3, and decreases in FAPB7. Moreover, keratin transcripts and IL-23 proinflammatory cytokine gene expression was decreased. Taken together, our results demonstrate our ability to combine machine-based learning and target prediction to identify new psoriasis drugs, to test these using preclinical psoriasis mouse models, and then iteratively identify the mechanisms of action using systems biology.

Cardiovascular disease in patients with psoriatic arthritis: correlation or causation?

Psoriatic arthritis (PsA) is a pleiotropic inflammatory disease from the spectrum of spondyloarthritides which can potentially affect many organ systems. The chronic nature of the inflammatory milieu presented in rheumatic diseases, is similar to that of atherosclerosis, suggesting a common pathogenic basis. Effector cells of innate and adaptive immunity along with pro-inflammatory cytokines and other immune mediators may work together to potentiate endothelial damage and accelerate cardiovascular diseases (CVD). Thus, the risk of CVD and associated complications in PsA might be elevated, especially in patients with severe psoriasis, long-standing disease, and multiple comorbidities. This narrative review focuses on the prevalence of CVD in PsA patients, the overlapping molecular features in the pathogenesis of both conditions, and summarizes the benefits of the current treatments on impairments resolution.

The Function of Large Vessels in Normal-Weight and Overweight Children With Psoriasis During Methotrexate Therapy

Background.In recent years, the opinion has been established that skin manifestations of psoriasis are associated with the damage of other organs and systems, and that psoriatic lesions have a systemic nature, and therefore the term ‘psoriatic disease’ is increasingly used in scientific literature. Among psoriasis comorbidities, metabolic disorders and cardiovascular diseases are of particular clinical importance.Our aim wasto study the effect of systemic cytostatic therapy with methotrexate on the remodelling processes of large vessels in children with psoriasis who have normal and increased body mass index.Methods.The primary data was collected by extracting data from medical records and case follow-up records. The subsequent accumulation, storage, grouping and primary sorting of research data were carried out using a personal computer and Excel application package. Clinical evaluation of the severity of psoriasis and skin lesions was assessed by calculating the PASI index. Non-invasive oscillometric arteriography was performed on a portable ArterioGraph (TensioMed Ltd, Hungary).Results.A direct significant correlation has been established between the revealed impairments of the function of large arteries and the indicators of fat metabolism, the severity of psoriasis and body mass index. During the systemic pathogenetic cytostatic therapy with methotrexate, a significant positive dynamics of the function parameters of large arteries was revealed in children with psoriasis who have both normal and increased body mass index.Conclusion.The undertaken studies showed that methotrexate is an effective and safe agent for treating psoriasis in children aged from 3 to 18 years, has a positive effect on the function of large vessels.Nikolay N. Murashkin — receiving research funding from pharmaceutical companies Jansen, Eli Lilly. Receiving fees for scientific advice from Galderma, Pierre Fabre, Bayer, Astellas, Libriderm.Alexander I. Materikin — receiving research funding from pharmaceutical company Eli Lilly. Receiving fees for scientific advice from Bioderma, Libriderm.

Efficacy of Adding Oral Simvastatin to Topical Therapy for Treatment of Psoriasis: The Vietnamese Experience.

BACKGROUND:Psoriasis, the prevalence of which ranges from 2% to 3% of the general population, has been recently recognised as not only a chronic inflammatory skin disorder but also an immunometabolic systemic disease. Dyslipidemia is one of the most important comorbidities of psoriasis. Statins, frequently used as anti-hyperlipidemic agents, may be beneficial in the treatment of several autoimmune diseases, including psoriasis, due to their anti-inflammatory and immunomodulatory characteristics. Hence, we hypothesised that using this medication was not only beneficial for reducing hyperlipidemia but also improving psoriatic conditions.AIM:We conducted a study to determine the prevalence of dyslipidemia in psoriatic patients as well as whether the addition of statins (simvastatin prescribed forms) to standard topical antipsoriatic treatment can improve skin lesions in psoriatic patients.METHODS:A group of 128 psoriatic patients and 128 healthy controls who were matched with the patients regarding ethnicity, age, and sex were enrolled, and their lipid concentrations were determined. Furthermore, sixty patients were randomly selected from the former group and divided into two treatment subgroups to evaluate the effect of statins on the severity of psoriasis using the PASI score.RESULTS:We found that the rate of dyslipidemia in the patient group was significantly higher than in the healthy group (53.9% versus 21.9%, p < 0.001), particularly the triglyceride concentration (1.86 ± 1.17 versus 1.43 ± 0.79 mg/dL, p < 0.001). Also, the PASI score reduction in the simvastatin-treated subgroup was significantly different from that in the placebo-treated one after eight weeks of therapy (8.63 ± 4.78 versus 5.34 ± 3.59, p < 0.01).CONCLUSION:This study showed that simvastatin might play a role in controlling hyperlipidemia and in turn decrease the PASI score in psoriatic patients.

Topology of psoriasis in routine care: results from high-resolution analysis of 2009 patients.

Different phenotypes have been described in psoriasis. Few details are known about the topology of patients in routine care. To characterize the frequency and distribution of body sites affected by psoriasis in Germany. Data from a national cross-sectional study (PsoHealth2) were analysed. Each practice consecutively recruited 20 patients independently of treatment. Topical distribution was identified with a detailed grid scheme of 1424 squares filled by the patient. Psoriasis history, clinical findings, comorbidity and patient-reported outcomes were obtained. In total, 2009 patients with psoriasis were observed. Nineteen per cent of patients had psoriatic arthritis, 65·4% had scalp involvement and 35·6% had nail involvement; in 40·5% of patients, their first-degree relatives also had psoriasis. In total, 1927 (95·9%) provided complete grid data. The mean number of grids marked was 152·4 ± 193·2, corresponding to 10·7% of body surface area. The most frequently affected body areas were the elbows, knees, lower legs and scalp (65-78%). In a linear regression analysis (corrected R² = 0·093), the strongest predictors of reductions in health-related quality of life (HRQoL), measured by the Dermatology Life Quality Index, were having the hands (β = 0·147; P = 0·000), arms (β = 0·097; P = 0·008), genitals (β = 0·080; P = 0·010), neck (β = -0·072; P= 0·043), scalp (β = 0·068; P = 0·010) and nails affected (β = 0·064; P = 0·005). Typical psoriatic lesions are found in real-world care. However, smaller areas are important determinants of reductions in HRQoL.

Study of epidemiology, clinical features and comorbidities in psoriasis

Study of epidemiology, clinical features and comorbidities in psoriasis

Psoriasis as a Predictor of Cardiometabolic Comorbidity in Women: A Study Based on the Danish National Birth Cohort.

Psoriasis is associated with cardiometabolic comorbidity; however, whether this is due to common lifestyle-related risk factors is unclear. This study investigated the association between psoriasis and cardiometabolic comorbidity, taking body mass index and smoking into account. The population comprised expectant mothers in the Danish National Birth Cohort (established 1996-2002). During pregnancy, the women were asked about physician-diagnosed psoriasis. Any association with self-reported cardiometabolic comorbidity 11 years later was assessed using logistic regression. The cohort was also followed up for hospital-diagnosed comorbidity, including cardiac death, until 31 December 2014, and the risk was assessed using Cox regression. A total of 2,435 women with psoriasis (2.90%) and 81,388 women without were identified. Psoriasis was significantly associated with self-reported hypercholesterolaemia (adjusted odds ratio 1.31; 1.01-1.70) and hospital-diagnosed hypertension (adjusted hazard ratio 1.33; 1.08-1.65). Women with psoriasis have an increased risk of developing cardiometabolic comorbidity in early adult life.

Large-scale mining disease comorbidity relationships from post-market drug adverse events surveillance data

BackgroundSystems approaches in studying disease relationship have wide applications in biomedical discovery, such as disease mechanism understanding and drug discovery. The FDA Adverse Event Reporting System (FAERS) contains rich information about patient diseases, medications, drug adverse events and demographics of 17 million case reports. Here, we explored this data resource to mine disease comorbidity relationships using association rule mining algorithm and constructed a disease comorbidity network.ResultsWe constructed a disease comorbidity network with 1059 disease nodes and 12,608 edges using association rule mining of FAERS (14,157 rules). We evaluated the performance of comorbidity mining from FAERS using known disease comorbidities of multiple sclerosis (MS), psoriasis and obesity that represent rare, moderate and common disease respectively. Comorbidities of MS, obesity and psoriasis obtained from our network achieved precisions of 58.6%, 73.7%, 56.2% and recalls 87.5%, 69.2% and 72.7% separately. We performed comparative analysis of the disease comorbidity network with disease semantic network, disease genetic network and disease treatment network. We showed that (1) disease comorbidity clusters exhibit significantly higher semantic similarity than random network (0.18 vs 0.10); (2) disease comorbidity clusters share significantly more genes (0.46 vs 0.06); and (3) disease comorbidity clusters share significantly more drugs (0.64 vs 0.17). Finally, we demonstrated that the disease comorbidity network has potential in uncovering novel disease relationships using asthma as a case study.ConclusionsOur study presented the first comprehensive attempt to build a disease comorbidity network from FDA Adverse Event Reporting System. This network shows well correlated with disease semantic similarity, disease genetics and disease treatment, which has great potential in disease genetics prediction and drug discovery.

Editor’s Pick: Beneath the Skin: The Relationship Between Psychological Distress and the Immune System in Patients with Psoriasis

Psoriasis is a chronic autoimmune skin disease with significant physical and psychiatric comorbidities. Research into psoriasis-associated depression has revealed several possible pathways linking the two very different diseases. Questions of causality arise when exploring the complex relationship of psoriasis and mood disorders, and studies have revealed that inflammation may serve as the common denominator linking psoriasis and depression. Conversely, many investigators have reported that psoriasis severity may fluctuate with perceived psychological distress, suggesting that psychological factors, rather than inflammation, may be the driving force behind disease exacerbation in these cases. The truth is likely a combination of both schools of thought: a bidirectional relationship between cutaneous and psychological disease manifestations with an overlapping biological mechanism associated with inflammation. Evidence has revealed multiple pathways by which this relationship can be explained, including hypothalamic–pituitary–adrenal axis hyperactivity, glucocorticoid receptor desensitisation, sympathetic nervous system activation, and altered expression of various chemical signals in the central nervous system. This review summarises the existing evidence and seeks to elucidate how the physiologic disturbances in psoriasis may contribute to both the cutaneous disease manifestations and associated psychological comorbidities. Evidence suggests that treating the psychiatric comorbidities of psoriasis can significantly improve cutaneous disease severity and treating the underlying inflammation could have profound effects on psychological health and quality of life. Therefore, conceptualising psoriasis as more than a purely dermatologic disease is useful in formulating a comprehensive treatment plan; furthermore, addressing both the cutaneous and psychological facets of this disease could prove profoundly beneficial for decreasing the associated negative impacts on patient quality of life.

Psoriasis and Respiratory Comorbidities: The Added Value of Fraction of Exhaled Nitric Oxide as a New Method to Detect, Evaluate, and Monitor Psoriatic Systemic Involvement and Therapeutic Efficacy.

Psoriasis is a chronic inflammatory systemic disease characterized by a wide range of comorbidities. Respiratory comorbidities are currently poorly characterized and with discordant results. The systemic state of inflammation caused by psoriasis acts de novo on respiratory tissues and amplifies preexisting inflammation from asthma or chronic obstructive pulmonary disease. Because the lungs act as a gas exchanger between the internal and external environment, the impact of chronic psoriasis inflammation may be easily assessed through the analysis of exhaled breath. The fraction of exhaled nitric oxide test (FeNO) is a potential noninvasive solution that can provide quantitative and qualitative indices of respiratory airway inflammation. FeNO is routinely used to screen and manage asthmatic patients. Recent pilot studies contain encouraging data that underscore its possible use with systemic inflammatory nonpulmonary diseases, such as psoriasis. FeNO may therefore be a useful tool to evaluate underestimated airway inflammation and at the same time globally evaluate the impact of systemically antipsoriatic therapies.

Position statement for the management of comorbidities in psoriasis

The association between psoriasis and some diseases has become relevant in recent years. Providing appropriate management of psoriasis from an early stage requires prompt diagnosis and treatment of concomitant diseases and to prevent any potential comorbidity. This approach should consider the adverse events of the drugs used to treat psoriasis potentially related to the onset of comorbidities. To provide the dermatologist with an accurate and friendly tool for systematizing the diagnosis of psoriasis-associated comorbidities, which generally escapes the scope of the dermatology setting, and to facilitate decision-making about the referral and treatment of patients with comorbidities. These position statement recommendations were developed by a working group composed of ten experts (four dermatologists, one cardiologist, one rheumatologist, one gastroenterologist, one nephrologist, one endocrinologist and one psychiatrist) and two health services researchers. The expert group selected the psoriasis comorbidities considered according to their relevance in the dermatology setting. The recommendations on diagnostic criteria are based on the current clinical practice guidelines for each of the comorbidities. The information regarding the repercussion of psoriasis medical treatments on associated comorbid diseases was obtained from the summary of product characteristics of each drug. Recommendations were developed to detect and refer the following psoriasis comorbidities: psoriatic arthritis, cardiovascular risk factors (diabetes, dyslipidaemia, obesity, hypertension and metabolic syndrome), non-alcoholic fatty liver disease, inflammatory bowel disease, kidney disease and psychological disorders (anxiety and depression). In addition, alcohol consumption and tobacco consumption were included. The tables and figures are precise, easy-to-use tools to systematize the diagnosis of comorbidities in patients with psoriasis and facilitate the decision-making process regarding referral and treatment of patients with an associated disease. The application of these position statement recommendations will facilitate the dermatologist practice, and benefit psoriasis patients' health and quality of life.

Psoriasis: From Gene to Clinic

Substantial developments over the last decade have advanced our knowledge and understanding of psoriasis, from both a basic scientific and clinical perspective. Identification of immunopathological mechanisms involved in disease development and the elucidation of cellular processes have been, and continue to be, integral in the development of novel therapies and therapeutic approaches. Significant progress has been made in highlighting key biological pathways, some of which are shared with other autoimmune diseases. Evidence suggests a relationship between psoriasis and specific comorbidities, some with a confirmed biological basis and others, such as obesity, with intriguing but complex links to psoriasis. A new class of biologic agents selectively targeting interleukin (IL)-23p19 have shown additional efficacy in improving disease severity, even compared with those targeting both IL-12 and IL-23, highlighting the significance of IL-23 in psoriasis.1 The true relationships between comorbid conditions in patients with psoriasis and determination of the mechanisms involved will be important in the long-term management of the condition.

An Investigation of Comorbid Disease and Health Service Utilization Among Patients With Moderate to Severe Psoriasis in Newfoundland and Labrador.

Psoriasis is an inflammatory skin condition affecting 2% to 3% of the population and is associated with several comorbidities, including cardiovascular disease, depression, inflammatory bowel disease, metabolic syndrome, mood disorder, psoriatic arthritis, and weight gain. Psoriasis is treated with a number of topical and systemic therapies, including biologic drugs that directly target proinflammatory cytokines. This cross-sectional retrospective study investigated comorbid conditions reported in the Newfoundland and Labrador psoriasis population, outcomes associated with therapeutic treatment, and use of health care resources. Of the psoriasis comorbidities investigated, psoriatic arthritis was significantly associated with the use of biologic therapy while a failure to respond to biologics was associated with a higher incidence of cardiovascular disease. Patients responsive to biologic treatment had fewer hospital stays than patients treated with other therapies. Our results suggest that biologic therapies have a cardioprotective effect and reduce the number of hospital visits in patients whose symptoms are responsive to treatment.

Double trouble: psoriasis and cardiometabolic disorders.

SummaryPsoriasis (PsO) is a chronic immune-mediated inflammatory skin disorder associated with numerous co-morbidities. This descriptive review focuses on the cardiometabolic co-morbidities of PsO with reference to the epidemiology and pathogenetic mechanisms linking PsO and cardiometabolic disease (CMD). Registry-based studies have shown PsO to be associated with an increased risk of cardiovascular morbidity and mortality. Factors linking PsO and CMD include: chronic inflammation, obesity, classic cardiovascular risk factors, and the effects of systemic therapy used to treat PsO. Chronic inflammation is associated with PsO itself, and with obesity. Adipose tissue is responsible for the secretion of various adipokines, which together with pro-inflammatory cytokines arising from the psoriatic plaque, contribute to the proinflammatory and pro-atherogenic environment. Systemic therapy aimed at decreasing inflammation has been shown to improve CMD in PsO. Screening for and treating CMD and initiating lifestyle modifications will remain the most important interventions until further data emerge regarding the effect of systemic therapy on CMD progression.