Psoriasis Comorbidities Research Articles

Psoriasis and comorbidities: links and risks.

Psoriasis is a chronic inflammatory skin disease affecting approximately 2% of the population worldwide. In the past decade, many studies have drawn attention to comorbid conditions in psoriasis. This literature review examines the epidemiological evidence, pathophysiological commonalities, and therapeutic implications for different comorbidities of psoriasis. Cardiovascular disease, obesity, diabetes, hypertension, dyslipidemia, metabolic syndrome, nonalcoholic fatty liver disease, cancer, anxiety and depression, and inflammatory bowel disease have been found at a higher prevalence in psoriasis patients compared to the general population. Because of the wide range of comorbid conditions associated with psoriasis, comprehensive screening and treatment must be implemented to most effectively manage psoriasis patients.

Cardiovascular psoriasis comorbidities, treatment with atorvastatin

Cardiovascular psoriasis comorbidities, treatment with atorvastatin

Understanding therapeutic pathways and comorbidities in psoriasis.

Psoriasis is now recognized as an immunologically mediated systemic disease that may be expressed in cutaneous and joint symptoms. Medications that were once thought to control psoriasis by reducing keratinocyte proliferation are now known to act on immunologic pathways. In recent years, the emerging understanding of immunologic pathways in psoriasis has resulted in the use of biologic medications (eg, inhibitors of tumor necrosis factor) to treat psoriasis. More recently, other pathophysiologic pathways have been identified that have the potential to expand the therapeutic armamentarium. Other avenues of research within the past decade have demonstrated that a range of health risks and comorbid inflammatory diseases are associated with psoriasis, and they have the potential to increase morbidity and mortality and adversely affect quality of life.

Cardiovascular comorbidities in childhood psoriasis.

Psoriasis is a common, chronic, systemic inflammatory skin disease associated with numerous cardiovascular comorbidities. Much evidence of this association exists in the adult population, data available in childhood psoriasis is more limited. To analyze the prevalence of excess adiposity, cardiovascular risk factors, metabolic syndrome and lipid profile in children with psoriasis comparing to control group with similar age and sex distribution. A case-control study was conducted with children, 5-15 years-old, with moderate-to-severe plaque-type psoriasis and a control group comprising children with other skin diseases without systemic inflammatory diseases. Psoriatic children had a significantly higher prevalence and greater odds of excess adiposity compared to controls: BMI (≥85(th) percentile; OR 4.4; 95%CI 1.2-15.6), waist circumference (>75(th) percentile; OR 7.4; 95%CI 2.0-27.7) and waist-to-height ratio (>0.490; OR 4.6; 95%CI 1.3-17.0). A higher prevalence of metabolic syndrome was observed in children with psoriasis compared to controls (25% vs 3.7%; P = 0.07), and two components of the metabolic syndrome were significantly higher in the psoriasis group: waist circumference (75% vs 29.6%; P = 0.002) and the high blood pressure component (30% vs 3.7% P = 0.032). Finally, an altered and more atherogenic lipid profile was observed among psoriatic patients without excess adiposity. This study demonstrates that comorbidities known to be associated with adult psoriasis are also observed in childhood psoriasis, reinforcing the need for screening cardiovascular comorbidities in children with psoriasis and promoting healthy lifestyle choices in these patients. Moreover, it also suggests that its association with psoriasis may be in part genetically determined rather than uniquely acquired.

Study on Certain Biomarkers of Inflammation in Psoriasis Through “OMICS” Platforms

Background:In recent years, research on psoriasis has focused on the identification of biomarkers for the diagnosis, pathogenesis, prognosis, or therapeutic response of the disease. These studies could provide insights into the susceptibility and natural history of psoriasis. The identification of biomarkers related to comorbidities in psoriasis, such as arthritis, cardiovascular disease, and the metabolic syndrome, is of special clinical interest.Materials and Methods:We performed an extensive review on psoriasis biomarkers, including cytokine and growth factors, in the literature published between 1997 and 2013, including cross-references of any retrieved articles. We also included some data from our own studies.Results:This review presents current knowledge of soluble biomarkers in psoriasis, including cytokines, chemokines, proangiogenic mediators, growth factors, antimicrobial proteins, neuropeptides, and oxidative stress markers.Conclusion:In conclusion, a number of studies have been conducted with the aim of establishing soluble biomarkers for psoriasis. Most of the biomarkers that have been studied do not meet the criteria for a clinically useful biomarker. Further work is needed to establish a role for soluble biomarkers in the diagnosis and treatment of psoriasis, with a special focus on biomarkers for psoriasis comorbidities, such as arthritis, cardiovascular disease, and the metabolic syndrome.

Multiple sclerosis is associated with psoriasis. A case–control study

BackgroundMS and psoriasis are both autoimmune diseases putatively mediated mainly by T cells. ObjectiveWe conducted a case control study to investigate whether patients with MS have a high rate of comorbid psoriasis. MethodsThe cohort consisted of 214 consecutive MS patients and a control group of 192 consecutive patients with headache. ResultsThere was a higher than expected frequency of psoriasis among the MS patients. There was no gender effect and none of the 9 affected MS patients were among the 22 MS patients with primary progressive disease. Six of those 9 patients started interferon-β treatment after being diagnosed with MS, and 4 of them experienced exacerbation of psoriasis during exposure to interferon-β. There was no exacerbation in the co-morbid patients during treatment with other disease-modifying drugs. ConclusionsOur observation confirms other reports on an association of MS with autoimmune diseases and supports the hypothesis of autoimmune pathogenesis for MS. The current findings should raise the level of awareness of psoriasis among patients with MS, and of the need to consider a potential exacerbation of psoriasis by interferon-β therapy.

Clopidogrel: A possible exacerbating factor for psoriasis

A 64-year-old man developed palmoplantar pustulosis eventuating into palmoplantar pustular psoriasis following treatment with diltiazem, atenolol, aspirin and atorvastatin for suspected coronary artery disease (CAD). Treatment for psoriasis, stopping atenolol and substituting aspirin with clopidogrel did not benefit. Subsequently, he stopped all his drugs and did not develop psoriasis or symptoms/signs of CAD. Re-challenge with oral clopidogrel precipitated his skin lesions. This case has implications for patients having psoriasis and cardiovascular comorbidity where clopidogrel/ticlopidine or aspirin may not be a useful alternative.

Psoriasis beyond the skin: an expert group consensus on the management of psoriatic arthritis and common co‐morbidities in patients with moderate‐to‐severe psoriasis

BackgroundPsoriatic arthritis (PsA) and co-morbidities of psoriasis represent a significant clinical and economic burden for patients with moderate-to-severe psoriasis. Often these co-morbidities may go unrecognized or undertreated. While published data are available on the incidence and impact of some of them, practical guidance for dermatologists on detection and management of these co-morbidities is lacking.ObjectiveTo prepare expert recommendations to improve the detection and management of common co-morbidities in patients with moderate-to-severe psoriasis.MethodsA systematic literature review was conducted on some common co-morbidities of psoriasis–cardiovascular (CV) diseases (including obesity, hypertension, hyperglycaemia and dyslipidaemia), psychological co-morbidities (including depression, alcohol abuse and smoking) and PsA–to establish the incidence and impact of each. Data gaps were identified and a Delphi survey was carried out to obtain consensus on the detection and management of each co-morbidity. The expert panel members for the Delphi survey comprised 10 dermatologists with substantial clinical expertise in managing moderate-to-severe psoriasis patients, as well as a cardiologist and a psychologist (see appendix) with an interest in dermatology. Agreement was defined using a Likert scale of 1–7. Consensus regarding agreement for each statement was defined as ≥75% of respondents scoring either 1 (strongly agree) or 2 (agree).ResultsThe expert panel members addressed several topics including screening, intervention, monitoring frequency, and the effects of anti-psoriatic treatment on each co-morbidity. Consensus was achieved on 12 statements out of 22 (3 relating to PsA, 4 relating to psychological factors, 5 relating to CV factors). The panel members felt that dermatologists have an important role in screening their psoriasis patients for PsA and in assessing them for psychological and CV co-morbidities. In most cases, however, patients should be referred for specialist management if other co-morbidities are detected.ConclusionThis article provides useful and practical guidance for the detection and management of common co-morbidities in patients with moderate-to-severe psoriasis.

Childhood Psoriasis—An Analysis of German Health Insurance Data

This study explored the epidemiology, treatment, and comorbidities of juvenile psoriasis in Germany using health insurance data. Psoriasis is a chronic inflammatory skin condition that affects approximately 2% to 3% of the world's population. Data were obtained from a database of approximately 6.7 million individuals registered with health insurance organizations throughout Germany. The analysis considered all individuals age 18 years and younger with psoriasis who were registered in 2007. Comorbidities were identified using software based on a morbidity-based risk adjustment model. A total of 138,338 patients with a diagnosis of psoriasis were identified in the database, yielding a prevalence of 2.1%. Within this group there were 4,499 children and adolescents (≤ 18 years of age), a prevalence of 0.4%. The prevalence ranged from 0.1% at the age of 1 year to 0.8% at the age of 18 years. Most of the patients were treated with topical corticosteroids (72.2%) and antipsoriatics (e.g., tars, psoralen; 20.0%). Immunosuppressants were used in 3.3% of the cases. Juvenile psoriasis was associated with numerous significant comorbidities such as rheumatoid arthritis and inflammation (2.1%); delirium, psychosis, and psychotic and dissociative disorder (1.1%); and heart disease (0.6%). Our study demonstrated that psoriasis is more prevalent in children and adolescents than some older international investigations have documented. Analysis of the health insurance data showed that juvenile psoriasis is associated with a range of comorbidities. The data also may suggest an unrecognized burden of mental health problems in young persons with psoriasis.

Prevalence of Psoriasis and Rosacea Comorbidities in the Outpatient Setting

Prevalence of Psoriasis and Rosacea Comorbidities in the Outpatient Setting

Infectious, Oncologic, and Autoimmune Comorbidities of Psoriasis and Psoriatic Arthritis: A Report from the GRAPPA 2012 Annual Meeting

At the 2012 annual meeting of the Group for Research and Assessment of Psoriasis and PsA (GRAPPA) in Stockholm, Sweden, members addressed the infectious, oncologic, and autoimmune comorbidities of psoriasis and psoriatic arthritis (PsA). Members discussing infectious comorbidities asked whether patients with psoriasis or PsA are predisposed to particular types of infections, and whether the use of biologic agents is advisable in patients with certain preexisting infections. Regarding the oncologic comorbidities of psoriasis and PsA, members addressed cutaneous malignancy screening, lymphoproliferative malignancy risk and the need for screening, and treatment of patients with preexisting oncologic history requiring systemic therapy. Finally, GRAPPA members discussed autoimmune comorbidities associated with psoriasis and PsA; they agreed that research is nascent in this field and larger studies are necessary to determine the precise magnitude of these associations.

Cardiovascular Comorbidities of Psoriasis and Psoriatic Arthritis: A Report from the GRAPPA 2012 Annual Meeting

At the 2012 annual meeting of the Group for Research and Assessment of Psoriasis and Psoriatic Arthritis (GRAPPA) in Stockholm, Sweden, several GRAPPA members led a panel discussion on cardiovascular (CV) comorbidities of psoriasis and psoriatic arthritis (PsA). The panelists discussed the role of insulin resistance in the pathophysiology of psoriasis, the possible effect of tumor necrosis factor inhibitors on CV comorbidities, and the effect of 12/23 monoclonal antibodies on CV outcomes. The panelists also addressed how lessons from CV comorbidity research could be applied to other areas of comorbidity research in psoriasis and PsA and identified future research directions in this area.

Prologue: 2012 Annual Meeting of the Group for Research and Assessment of Psoriasis and Psoriatic Arthritis (GRAPPA)

The 2012 Annual Meeting of the Group for Research and Assessment of Psoriasis and Psoriatic Arthritis (GRAPPA) was held in June 2012 in Stockholm, Sweden, and attended by rheumatologists, dermatologists, and representatives of biopharmaceutical companies and patient groups from around the world. In this Prologue we introduce discussions that were held among meeting attendees. Prior to the 2012 meeting, 2 GRAPPA members organized a Fellows Symposium adjacent to the European Academy of Dermatology and Venerology meeting in Verona, where they discussed comorbidities and treatments of patients with psoriasis. The 2012 GRAPPA meeting began with a trainee symposium, where 30 rheumatology fellows and dermatology residents presented their research work. Other presentations and discussions included a review of arthritis mutilans; dermatology issues including screening tools for psoriatic arthritis (PsA) and the instruments to measure psoriasis severity; cardiovascular and other comorbidities of psoriasis and PsA; development of criteria to define inflammatory arthritis, enthesitis, dactylitis, and spondylitis; distinctions between peripheral spondyloarthritis and PsA; the status of an ultrasound outcome measure for dactylitis; and updates on several GRAPPA projects, including a study of biomarkers to predict structural damage in PsA, the ongoing video project, and several education initiatives.

Comorbidities of psoriasis

Psoriasis is a chronic, immune-mediated inflammatory skin disease that is associated with multiple comorbidities including psoriatic arthritis, cardiometabolic diseases, malignancies, nonalcoholic fatty liver disease, autoimmune diseases, inflammatory-bowel disease, obstructive sleep apnea and chronic obstructive pulmonary disease. Cardiovascular disease including myocardial infarction, stroke and subclinical atherosclerosis as well as obesity, metabolic syndrome, diabetes, hypertension and hyperlipidemia, are associated with psoriasis. Shared inflammatory pathways may be the basis for these disease associations, especially in the case of cardiovascular disease and its risk factors. Reduced quality of life, depression, anxiety, smoking and alcoholism are also seen in psoriasis patients. Awareness and understanding of the relationships between psoriasis and its comorbidities is important in managing patients with psoriasis. The multiple comorbidities associated with psoriasis will be discussed here, focusi...

AB1367 Persistency with subcutaneous anti-TNF therapy for treatment of rheumatoid arthritis, psoriatic arthritis, and ankylosing spondylitis patients

BackgroundRheumatoid arthritis (RA), psoriatic arthritis (PsA), and ankylosing spondylitis (AS) are chronic autoimmune diseases that result in destructive inflammation of the joints, as well as other organs. Golimumab, adalimumab, and...

Leptin induces secretion of pro‐inflammatory cytokines by human keratinocytes in vitro – a possible reason for increased severity of psoriasis in patients with a high body mass index

Investigations about prevalence of obesity in psoriasis patients are increased nowadays. Higher serum levels of leptin in patients with psoriasis who are overweight or obese suggest that leptin may serve as a molecular link between psoriasis and metabolic comorbidities. However, the pathological functions of leptin in psoriasis are not clearly understood. We investigated the influence of being overweight or obese on the risk of psoriasis, and the relationship between serum leptin levels and the severity of psoriasis in Chinese Han patients. We also investigated biological effects of leptin on the proliferation and secretion of pro-inflammatory cytokines by human keratinocytes in vitro. Obesity was a significant risk factor for psoriasis in the Chinese Han population; however, we did not observe a significant correlation between Psoriasis Area and Severity Index (PASI) and body mass index (BMI). We observed a positive correlation between the serum leptin level and PASI in overweight and obese male patients with psoriasis. Strong leptin immunoreactivity was detected in the epidermis of psoriatic lesions, particularly in keratinocytes. Leptin significantly increased the proliferation and secretion of pro-inflammatory cytokines by keratinocytes in vitro. In conclusion, this study suggests leptin as a novel molecular link between psoriasis and obesity, which may help to explain the more server conditions of psoriasis in patients with obesity.

Stress coping mechanisms in smoking psoriatics

The link between emotional stress and smoking has previously been investigated and results have suggested that smoking is used as a way of dealing with stress. There are many studies indicating the relationship between smoking and psoriasis or emotional stress and psoriasis. However, to our knowledge, the link between smoking associated with emotional stress and psoriasis has not been shown before. Our aim was to investigate psoriatic patients' abilities to cope with stress, the relationship between coping strategies and smoking habit. Ninety-nine individuals with psoriasis (57 females, and 42 males, mean age: 37.4 years) were included in this study. Sociodemographic information including age, sex, smoking habit, etc., was obtained; Psoriasis Area Severity Index (PASI) scores were recorded. The Fagerstrom Test for Nicotine Dependence was used on smoking patients to evaluate smoking habit or the degree of nicotine dependence. The Ways of Coping Questionnaire and Dermatology Life Quality Index were filled out by all patients. Data were assessed by comparing psoriatic smokers with nonsmokers and statistically analysis was carried out with the SPSS 11.5 program. Forty patients (40.4%) were smokers. When comparing the two groups' mechanisms of coping with stress, smokers and nonsmokers coped with stress in similar ways. The seeking social support scores from the Ways of Coping Questionnaire were significantly lower in smokers than nonsmokers ( p < 0.05), while the Fagerstrom Test for Nicotine Dependence scores were correlated with distrustful approach sub-scores, and PASI only correlated with smokers. The Dermatology Life Quality Index scores were correlated with the PASI and distrustful approach scores in all patients. Smoking and nonsmoking psoriatic patients had similar stress coping strategies, except the subgroup seeking social support, and usually used positive ways of coping with stress. Psoriatic patients who smoke might employ smoking to avoid stressful situations. They would benefit from education on adopting healthy stress management and, in turn, developing mature stress coping mechanisms. Future prospective studies are required to address the exact causal link between smoking, psoriasis and psychiatric comorbidity, including stress coping mechanisms.

Non‐segmental vitiligo and psoriasis comorbidity – a case‐control study in Italian patients

A recent systematic evaluation of vitiligo and psoriasis comorbidity has not yet been reported in a large series of patients with vitiligo. To investigate the practical/clinical implications in subjects with both vitiligo and psoriasis compared to those with vitiligo alone. This was a case-control study on 463 vitiligo patients in our clinic from March 2008 to April 2011. Medical assessment was performed by dermatologists using the modified Vitiligo European Task Force form. In an univariate analysis, inflammation/pruritus [odds ratio (OR) 2.42, P = 0.03], use of drugs that can induce psoriasis (OR 2.74, P = 0.01), a family history (FH) of psoriasis (OR 2.87, P = 0.02), cardiovascular disease (OR 5.70, P = 0.001), hypertension (OR 4.7, P = 0.006) and type 2 diabetes mellitus (OR 3.87, P = 0.004), were significantly correlated with patients exhibiting vitiligo and psoriasis comorbidity. A trend was found in personal history of cardiovascular disease in patients with both diseases (OR 2.99, P = 0.07). FH of vitiligo was significantly associated with patients having only vitiligo (OR 0.35, P = 0.05). Multivariate analysis demonstrated that inflammation/pruritus in vitiligo macules (OR 2.56, P = 0.047) and a FH of cardiovascular disease (OR 4.07, P = 0.02) were the most significant predictors of patients having both psoriasis and vitiligo, while the presence of organ-specific autoantibodies (OR 0.24, P = 0.007) was significantly associated with patients having only vitiligo. The presence of vitiligo and even mild psoriasis is significantly correlated with a family history of cardiovascular disease, a factor that requires greater attention and follow-up with respect to that necessary for vitiligo patients.

Prevalence of psoriasis and rosacea comorbidities in the outpatient setting

Prevalence of psoriasis and rosacea comorbidities in the outpatient setting

Dermatitis herpetiformis Duhring as a rare comorbidity of psoriasis in a patient on biologic therapy

Dermatitis herpetiformis Duhring as a rare comorbidity of psoriasis in a patient on biologic therapy