Psoriasis Comorbidities Research Articles

Impact of GLP-1 Receptor Agonists on Psoriasis and Cardiovascular Comorbidities: A Narrative Review.

Psoriasis is an immune-mediated skin disease known to be associated with a higher risk of cardiometabolic comorbidities such as hypertension, myocardial infarction, and stroke. GLP-1 receptor agonists (GLP-1RAs) are medications approved to treat type 2 diabetes mellitus and obesity and have been reported to improve psoriasis. As more psoriasis patients start GLP-1RAs for approved indications, it is of interest to understand the impact of GLP-1RAs on both psoriasis and associated cardiovascular risk. In this review, we examine the effect of GLP-1RAs on psoriasis and cardiovascular comorbidities-defined as hypertension, stroke, and myocardial infarction. The majority of case reports and prospective cohort studies found GLP-1RAs improved psoriasis, while two randomized controlled trials showed conflicting results. For cardiovascular disease, most studies found GLP-1RAs reduced systolic blood pressure, total stroke, and myocardial mortality. These results suggest that GLP-1RAs may be a particularly promising treatment for psoriasis patients with diabetes or obesity comorbidities, offering both cardioprotective benefits and potential improvement in psoriatic symptoms.

Elevated Serum Levels of Osteopontin in Patients with Psoriasis: Is It Associated with Ocular Comorbidities?

Introduction: Psoriasis is a chronic inflammatory disease affecting 2%-3% of the global population via immune-mediated mechanisms. Osteopontin plays a crucial role in T-helper 1 and T-helper 17-mediated illnesses, including psoriasis. Ocular complications in psoriasis have been reported and their assessment is of importance. Osteopontin is normally expressed constitutively in ocular structures and is linked to ocular homeostasis. Objective: This study aimed to clarify the role of osteopontin (OPN) in psoriasis (PS) and its correlation with disease severity and ocular manifestations. Methods: A case-control study involving 40 psoriatic patients and an equal number of age and sex-matched healthy subjects was conducted. We used the psoriasis area severity index (PASI) to assess disease severity and performed a comprehensive ophthalmological examination. Additionally, we measured serum osteopontin levels using Enzyme-Linked Immunosorbent Assay (ELISA) in both groups. Results: A significant elevation in serum OPN levels in psoriatic patients compared to controls was found (P=0.00). Furthermore, there was a highly significant positive correlation between serum OPN levels and patient age, disease duration, and PASI scores. Notably, a higher prevalence of ocular complications, including blepharitis, corneal affection, conjunctivitis, keratoconjunctivitis sicca, and cataract, in psoriatic patients compared to controls was observed. Importantly, significant associations between serum OPN levels and the presence of cataracts and intraocular pressure (IOP) were identified. Additionally, significant correlations between serum OPN levels and measures of visual acuity and ocular surface health were found. Conclusions: Osteopontin is considered a marker of psoriasis severity and is associated with ocular comorbidities in psoriasis.

Impact of Comorbidities and Skin Diseases on Post-Vaccination Reactions: A Study on COVID-19 Vaccinations in Poland.

Background: The COVID-19 pandemic necessitated rapid and widespread vaccination efforts, which proved critical in reducing the severity and mortality of the virus. However, the interplay between vaccinations, pre-existing skin conditions, and other comorbidities still needs to be explored. This study investigated the occurrence and severity of adverse events following immunization (AEFIs) with COVID-19 vaccines in individuals with chronic skin diseases and comorbidities within a Central European cohort. Methods: An anonymous online survey was conducted between May 2022 and February 2023, targeting students and employees of universities in Wrocław, Poland. A total of 513 respondents were analyzed, focusing on AEFIs following the first, second, and third doses of COVID-19 vaccines and the effects of COVID-19 on conditions such as atopic dermatitis, psoriasis, vitiligo, acne vulgaris, rosacea, and various comorbidities. Results: COVID-19 vaccination effectively protected against severe disease across all doses. The analysis revealed no significant impact of either COVID-19 infection or vaccination on the course of selected skin diseases and comorbidities. The reporting of AEFIs to the Sanitary Inspection was notably low. The Moderna and Pfizer mRNA-based vaccines were associated with a higher reported number of AEFIs, particularly after the second and third doses, compared to AstraZeneca, which exhibited fewer adverse events after subsequent doses. Conclusions: COVID-19 vaccination is both safe and effective, even in patients with pre-existing skin conditions and comorbidities. Vaccine selection may benefit from considering individual health profiles, and better reporting of AEFIs is needed to enhance vaccine safety monitoring.

Association Between Systemic Immune-Inflammation Index and Psoriasis, Psoriasis Comorbidities, and All-Cause Mortality: A Study Based on NHANES.

The relationship between systemic immune-inflammation index (SII) and psoriasis and its prognosis is not yet clear. In this study, the correlation between SII and psoriasis, psoriasis comorbidities, and all-cause mortality was investigated based on the National Health and Nutrition Examination Survey (NHANES). The study population was derived from five NHANES cycles: 2003-2006, 2009-2014, and survival follow-up was as of December 31, 2019. The association between SII and psoriasis and its comorbidities was analyzed using weighted multivariate logistic regression models. Weighted COX regression was used to calculate hazard ratios (HRs) and the corresponding 95% confidence intervals (CIs). Restricted cubic spline, subgroup and sensitivity analyses were also used. Logarithmic conversion was performed on SII(log2SII) to reduce the impact of outliers. A total of 21,431 participants were included in this study. As a continuous variable, log2SII was significantly associated with psoriasis in the fully adjusted model [OR = 1.20(1.04-1.39), p = .01]. log2SII remained positively associated with psoriasis after excluding participants with a history of cancer or cardiovascular disease (CVD), or non-Hispanic black participants. Among psoriasis patients, log2SII was significantly associated with metabolic syndrome (MetS) [OR = 1.68(1.19,2.38), p = .004] and all-cause mortality [HR = 1.48(1.09,1.99), p = .01]. Similar results were consistently observed when SII was analyzed as a categorical variable (in quartiles). This study suggested a positive association between SII and the prevalence of psoriasis. Among psoriasis patients, SII was positively correlated with MetS and all-cause mortality.

Synergistic Effect of Psoriasis and Metabolic Syndrome on Risk of All-Cause and Cardiovascular Mortality in US Adults: A Nationwide Cohort Study.

Metabolic syndrome (MetS) is a common comorbidity in psoriasis. However, the associations between MetS, psoriasis, and mortality remain largely unclear. To investigate the synergistic effect of MetS and psoriasis on total and cardiovascular disease (CVD) mortality in a representative sample of US adults. 14,930 participants from the 2003-2006 & 2009-2014 National Health and Nutrition Examination Survey were included in this prospective, nationwide cohort study. Participants were stratified into the psoriasis-/MetS- (reference) group, psoriasis-/MetS+ group, psoriasis+/MetS- group, and psoriasis+/MetS+ group. Overall, 14,930 participants, including 50.71% males and mean age of 43 years, were included in the final analysis. The weighted percentages of participants in the psoriasis-/MetS- group, psoriasis-/MetS+ group, psoriasis+/MetS- group and psoriasis+/MetS+ group were 72.77%, 24.36%, 1.94%, and 0.93%, respectively. A total of 874 deaths (246 CVD-related) occurred during a median follow-up of 110 months. Compared to the reference group, the hazard ratios (95% confidence intervals) in psoriasis-/MetS+, psoriasis+/MetS- and psoriasis+/MetS+ groups were 1.788 (1.486-2.152), 0.858 (0.431-1.707), and 2.050 (1.028-4.092), respectively, for all-cause mortality, and 1.856 (1.350-2.552), 1.229 (0.292-5.181) and 4.571 (1.724-12.119), respectively, for CVD mortality. Subgroup analysis showed that this association was not influenced by participants' age, sex, physical activity, smoking, estimated glomerular filtration rate, and urinary albumin/creatinine ratio. Similar results were obtained in the sensitivity analysis of the main results. Presence of comorbid MetS significantly increases all-cause and CVD mortality in psoriasis patients. Dermatologists can potentially aid in reducing mortality rate in psoriasis patients through targeted screening for MetS.

Evaluation of β2-microglobulin in the condition and prognosis of psoriasis patients

Background Numerous studies have linked the inflammatory pathway in psoriasis and metabolic disease, while no specific marker defined it. It is worth exploring the association of β2-microglobulin (β2M) in psoriasis severity and comorbidities. Objectives To investigate the correlation between blood β2M level and psoriasis severity, to explore the inflammatory factors influencing the occurrence of psoriasis comorbidities such as arthritis, diabetes, and hypertension. Methods Ninety-seven psoriasis patients were analyzed in the cohort retrospective study during 12 weeks. Results Significantly higher levels of blood β2M and ESR were observed in the group that patients’ PASI ≥10 than in the group that PASI <10. Blood β2M level had strong significantly positive correlations with the PASI in Pearson’s correlation analysis. In the model that systemic inflammatory factors to find psoriasis comorbidity risk factors, logistic regression analysis showed that blood β2M level was the significant risk factor associated with diabetes and hypertension. High-sensitivity C-reactive protein (hsCRP) was the significant risk factor associated with arthritis. Conclusions Patients with a severer psoriasis tended to have higher blood β2M levels and severer inflammatory state. In the systemic inflammation indexes, the level of blood β2M affected the risk of hypertension and diabetes, and hsCRP affected the risk of arthritis in patients with psoriasis.

Early Cerebral Microvasculature Impairment and Increased Body Mass Index in Patients with Psoriasis.

Psoriasis induces systemic atherosclerosis, but its impact on cerebrovascular function remains unclear. However, stroke prevention must be considered in psoriasis, as it is commonly comorbid with classic cardiovascular risk factors. Thus, the aim of the study is to assess cerebral microvasculature function and its confounders in patients with psoriasis. The study protocol included cerebral autoregulation assessment with measurements of vasomotor reactivity reserve (VMRr) on the middle cerebral arteries with the use of a Transcranial Doppler (TCD) in 50 patients with psoriasis without cerebrovascular events (46; 21-74 years) and 26 healthy controls (41; 29-58 years). Analyses of VMRr relationships with the psoriasis course, comorbidities, inflammatory markers and intima-media thickness (IMT) were performed. The study showed that VMRr was lower (64% vs. 76%, p = 0.001), and the IMT was higher (0.65 vs. 0.52 mm, p = 0.001) in patients compared to controls. The patients were also characterized by a higher body mass index (BMI) and a higher level of Il-6 than the controls (29.14 vs. 25.76 kg/m2, p = 0.004 and 585 vs. 204 pg/mL, p < 0.001, respectively), but only BMI was independently impacting VMRr reduction (p = 0.02). In conclusion, early cerebral microvasculature dysfunction may occur in patients with psoriasis, and its extent is associated with an increase in BMI. Thus, body mass reduction should be strongly recommended for stroke prophylaxis in patients with psoriasis.

Experience of living with psoriasis in Brazil: a Global Psoriasis Atlas online survey.

Psoriasis significantly burdens patients' lives, but there is limited data on this in Brazil. Between May 2022 and January 2023, we conducted a cross-sectional online survey of 563 Brazilian residents aged ≥18 years who had been diagnosed with psoriasis. Spearman's correlation (r) was used to test the correlation between self-assessed disease severity (Simplified Psoriasis Index [saSPI] extent score; range 0 [clear/minor] to 40 [widespread/severe]) and health-related quality of life (QoL, score of 1 means perfect health) and capability (ICECAP-A: score of 1 means full capability) measures. Multivariable linear regression was used to identify predictors of QoL and capability. A thematic analysis examined the free-text responses and identified common themes. The mean age of participants was 42.1 ± 12.4 years, and over half had at least one other long-term condition. The mean QoL score was 0.59 ± 0.25, and the mean capability score was 0.71 ± 0.21. At the time of survey completion, over 80% of respondents reported some level of pain and/or discomfort, and 86% reported feeling anxious and/or depressed. The mean self-assessed saSPI was 7.8 ± 8.6, which negatively correlated with health-related QoL (r = -0.49, P < 0.05) and capability (r = -0.44, P < 0.05). Significant predictors of poorer QoL and reduced capability included high saSPI, number of psoriasis flares and comorbidities, female gender, Black ethnicity, and employment status (unemployed, long-term sick). Frequently reported areas that impacted patients were social stigma/prejudice, powerlessness, lack of education and public awareness, and difficulty obtaining appropriate care/treatment. We found that the clinical manifestations, severity, and associated comorbidities of psoriasis negatively impacted health-related QoL and capability, along with feelings of stigmatization and barriers to specialist treatment. This highlights the need for better access to care and awareness of the disease to improve the lives of people living with psoriasis in Brazil.

Metabolic Comorbidities in Pediatric Psoriasis-A Comparative Cross-Sectional Study in South-Asian Children.

There is only limited data on the association between psoriasis and metabolic comorbidities in South-Asian children. To examine metabolic comorbidities among South-Asian children with and without psoriasis. A hospital-based, comparative, cross-sectional study was conducted in children with and without psoriasis over 19 months. Anthropometric, clinical, and metabolic comorbidity details (including disease extent and severity scores, obesity, systemic hypertension, diabetes mellitus, lipid abnormalities, and metabolic syndrome) were obtained in both groups according to standard criteria. Fifty-eight children with psoriasis (25 males/33 females, age 11.3 ± 3.0 years, range 4 to 17 years) and 62 children without psoriasis (37 males/25 females, age 11.0 ± 3.6 years, range 4 to 18 years) were recruited. The prevalence of obesity (31.0% versus 14.5%, P = 0.031, odds ratio 2.65) and metabolic syndrome (18.6% versus 4.6%, P = 0.044, odds ratio 4.68) were higher in children with psoriasis than without. The prevalence of other metabolic comorbidities (systemic hypertension, pre-diabetes, lipid abnormalities, elevated serum alanine aminotransferase, and non-alcoholic fatty liver disease) was not different between children with and without psoriasis and between obese and non-obese children with psoriasis. Among children with psoriasis, those with abdominal obesity had significantly lower disease severity and extent scores than those without. Psoriasis is associated with a significantly higher prevalence of obesity and close to significantly higher prevalence of metabolic syndrome in South-Asian children. Screening for metabolic comorbidities is essential even in non-obese children with psoriasis. Disease extent and severity are less in obese compared to non-obese South-Asian children with psoriasis.

Managing the Patient with Psoriasis and Metabolic Comorbidities.

Epidemiological data demonstrate strong associations between psoriasis and metabolic comorbidities, including obesity, hypertension, diabetes mellitus, dyslipidemia, and non-alcoholic fatty liver disease. The presence of metabolic comorbidities significantly influences the selection and effectiveness of pharmacological treatments. Some drugs should be prescribed with caution in patients with metabolic comorbidities because of an increased risk of adverse events, while others could have a reduced effectiveness. The aim of this narrative review is to highlight the challenges that healthcare professionals may face regarding the management of psoriasis in patients with metabolic comorbidities. In the first part of the article, the epidemiological association between psoriasis and metabolic comorbidities and their pathogenetic mechanisms is summarized. The second part describes the efficacy and safety profile of conventional and biologic drugs in patients with selected metabolic comorbidities including obesity, non-alcoholic fatty liver disease/hepatic steatosis, and diabetes. Finally, the role of pharmacological and non-pharmacological interventions, such as diet, alcohol abstinence, physical activity, and smoking avoidance is discussed. In conclusion, the choice of the best approach to manage patients with psoriasis with metabolic comorbidities should encompass both tailored pharmacological and individualized non-pharmacological interventions.

Deciphering the Genetic Links between Psychological Stress, Autophagy, and Dermatological Health: Insights from Bioinformatics, Single-Cell Analysis, and Machine Learning in Psoriasis and Anxiety Disorders.

The relationship between psychological stress, altered skin immunity, and autophagy-related genes (ATGs) is currently unclear. Psoriasis is a chronic skin inflammation of unclear etiology that is characterized by persistence and recurrence. Immune dysregulation and emotional disturbances are recognized as significant risk factors. Emerging clinical evidence suggests a possible connection between anxiety disorders, heightened immune system activation, and altered skin immunity, offering a fresh perspective on the initiation of psoriasis. The aim of this study was to explore the potential shared biological mechanisms underlying the comorbidity of psoriasis and anxiety disorders. Psoriasis and anxiety disorders data were obtained from the GEO database. A list of 3254 ATGs was obtained from the public database. Differentially expressed genes (DEGs) were obtained by taking the intersection of DEGs between psoriasis and anxiety disorder samples and the list of ATGs. Five machine learning algorithms used screening hub genes. The ROC curve was performed to evaluate diagnostic performance. Then, GSEA, immune infiltration analysis, and network analysis were carried out. The Seurat and Monocle algorithms were used to depict T-cell evolution. Cellchat was used to infer the signaling pathway between keratinocytes and immune cells. Four key hub genes were identified as diagnostic genes related to psoriasis autophagy. Enrichment analysis showed that these genes are indeed related to T cells, autophagy, and immune regulation, and have good diagnostic efficacy validated. Using single-cell RNA sequencing analysis, we expanded our understanding of key cellular participants, including inflammatory keratinocytes and their interactions with immune cells. We found that the CASP7 gene is involved in the T-cell development process, and correlated with γδ T cells, warranting further investigation. We found that anxiety disorders are related to increased autophagy regulation, immune dysregulation, and inflammatory response, and are reflected in the onset and exacerbation of skin inflammation. The hub gene is involved in the process of immune signaling and immune regulation. The CASP7 gene, which is related with the development and differentiation of T cells, deserves further study. Potential biomarkers between psoriasis and anxiety disorders were identified, which are expected to aid in the prediction of disease diagnosis and the development of personalized treatments.

Association between the severity of hard-to-treat psoriasis and the prevalence of metabolic syndrome: A hospital-based cross-sectional study in Jakarta, Indonesia.

Psoriatic lesions on the scalp, face, intertriginous, genitals, palms/soles, and nails are often delay diagnosed, hard-to-treat, and cause disability. Metabolic syndrome (MetS) is one of the most frequent and significant comorbidities in psoriasis. Many studies have discovered a link between psoriasis and MetS, but none have specifically assessed the hard-to-treat psoriasis in Indonesian population. This is a multicenter study involving four dermatology referral hospitals to investigate the association between psoriasis severity that has hard-to-treat lesions with the prevalence of MetS in Jakarta, Indonesia. Data was collected from April to October 2022. The severity of 84 hard-to-treat psoriasis patients was measured by Psoriasis Area Severity Index (PASI) scores. The participants divided into PASI score >10 (severe) and ≤ 10 (mild-moderate) groups. MetS was identified based on the modified National Cholesterol Education Program Adult Treatment Panel III. MetS was found in 64.3% of patients. Patients with a PASI score>10 had a significantly higher risk of metabolic syndrome compared to those with a score ≤ 10 (78.6% vs 50%, OR 3.667; 95% CI 1.413-9.514; p = 0.006). The prevalence of hypertension (p = 0.028), low levels of high-density lipoprotein (HDL) cholesterol (p = 0.01), mean fasting blood sugar (p = 0.018), and triglyceride levels (p = 0.044) between the two groups differed significantly. This study found most frequent components of MetS were abdominal obesity, decreased levels of HDL cholesterol, hypertension, hyperglycemia, and hypertriglyceridemia respectively. Individuals with severe hard-to-treat psoriasis had a 3.67 times more likely to have MetS rather than the mild-moderate group.

Positive association between insulin resistance and fatty liver disease in psoriasis: evidence from a cross-sectional study.

Fatty liver disease (FLD) is a common comorbidity of psoriasis and is often referred to as non-alcoholic fatty liver disease (NAFLD). However, the role of inflammation or insulin resistance (IR) in FLD is inconclusive. The study aims to explore whether FLD in psoriasis patients is more related to insulin resistance or systemic inflammation level. Data for this study were collected from the Shanghai Psoriasis Effectiveness Evaluation Cohort, a prospective cohort that examines psoriasis characteristics in the Chinese population. IR was assessed using the triglyceride glucose (TyG) and TyG-body mass index (TyG-BMI) indicators. Systemic non-specific inflammation was assessed using the neutrophil-to-lymphocyte ratio (NLR), derived neutrophil-to-lymphocyte ratio (dNLR), and systemic immune inflammation index (SII). The analysis included a total of 647 patients. Subsequent logistic regression analysis revealed that NLR, dNLR, and SII were not significantly associated with FLD in psoriasis patients, while TyG and TyG-BMI showed significant associations with FLD. Subgroup analysis indicated that in the majority of subgroups, TyG and TyG-BMI were significantly associated with FLD, particularly TyG-BMI. Excluding individuals with methotrexate and acitretin resulted in consistent findings with the main analysis. Further analysis revealed a significantly higher diagnosis rate of metabolic-associated fatty liver disease (MAFLD) compared to NAFLD. Metabolic factors play a crucial role in FLD in patients with psoriasis, and TyG and TyG-BMI are potential predictors of FLD. Therefore, MAFLD can be recommend as a term to describe FLD in psoriasis patients. https://www.chictr.org.cn/showproj.html?proj=58256, identifier ChiCTR2000036186. A multi-center clinical study of systemic treatment strategies for psoriasis in Chinese population. Registered 31 August 2020.

A retrospective analysis of comorbidities in patients with psoriasis at a single centre.

Psoriasis is a chronic inflammatory disease occurring worldwide. It is currently considered a multi-system disease, which is associated with several comorbidities. To deeply understand the clinical characteristics of psoriasis comorbidities and explore the relationship between psoriasis comorbidities, different subtypes and related influencing factors. This retrospective study analysed data from the electronic inpatient medical record system of dermatology and non-dermatology departments at a tertiary hospital in China. We collected relevant demographic data and clinical features of all patients diagnosed with psoriasis from January 2013 to September 2023. This study ultimately included a total of 1097 patients with psoriasis. Psoriasis vulgaris was the most common among the subtypes of psoriasis, with 957 (87.2%) cases. The sample consisted of 65.6% of males and 34.4% of females, with an average age of 53.5 ±15.2 years. Common comorbidities of psoriasis included hypertension (38.2%), hyperlipidaemia (29.4%), type 2 diabetes mellitus (24.6%), fatty liver disease (21.4%), coronary heart disease (21.0%), tumours (15.5%), gastroduodenal disease (14.4%), osteoarthropathy (11.8%), and cerebrovascular disease (10.8%). The incidence of hypertension (p = 0.015), hyperuricemia (p < 0.001), osteoarthropathy (p < 0.001), and autoimmune disease (p = 0.003) among different subtypes of psoriasis showed statistically significant differences. In addition, gender, smoking and alcohol consumption all have significant impacts on the distribution of comorbidities. The distribution of psoriasis comorbidities and complications varies among different subtypes of psoriasis. Lifestyles such as smoking and alcohol abuse, as well as gender, are also associated with the occurrence of psoriasis comorbidities.

Diagnosis and classification of axial spondyloarthritis (axSpA) - the current status

Axial spondyloarthritis (axSpA) is an inflammatory rheumatic disease typically characterized by inflammatory back pain (IBP). The term axSpA has largely replaced the long-used term ankylosing spondylitis (AS). IBP is caused by inflammation in the axial skeleton, with the sacroiliac joints (SIJ) being particularly frequently affected initially. The spine is usually added in later stages, which is then increasingly characterized structurally by the formation of new bone. The overall concept of spondyloarthritis includes other disease manifestations such as uveitis, psoriasis and colitis and comorbidities such as cardiovascular disease and osteoporosis.The ASAS classification criteria for axSpA, in place since 2009, have replaced the 1984 modified New York criteria. In the former, in addition to conventional X-rays, changes in the SIJ detected by magnetic resonance imaging (MRI) and also the detection of HLA B27 have, for the first time, played a role. It is important to note that these are not diagnostic criteria, as they do not exist. This paper outlines 10 points that should be considered when making a diagnosis.

Non-alcoholic fatty liver disease and psoriasis: mechanisms of comorbidity and approaches to therapy

Psoriasis is a chronic immune-mediated skin disease of a multifactorial nature, characterized by accelerated proliferation of keratinocytes and impaired differentiation, an imbalance between pro-inflammatory and anti-inflammatory cytokines, with frequent involvement of the musculoskeletal system in the pathological process. The etiology of psoriasis is unknown, but several risk factors have been identified, including family history, smoking and obesity. The high prevalence of obesity, diseases of the cardiovascular system and digestive organs in patients with psoriasis allows us to consider it as an indicator of the patient’s metabolic disorders. In the structure of comorbidity of patients with psoriasis, special attention is drawn to non-alcoholic fatty liver disease (NAFLD), which occupies a leading position in the structure of the incidence of chronic diffuse liver diseases among the adult population in many countries of the world, including Russia. Patients with psoriasis are more often diagnosed with NAFLD, regardless of the presence of metabolic syndrome and other traditional risk factors. The presence of NAFLD is associated with more severe psoriasis and worse outcomes. On the other hand, a negative effect of psoriasis on the course of liver pathology has been noted. In this regard, it seems particularly relevant to study the etiological factors and pathogenetic links underlying this comorbidity, as potential targets for targeted therapy, which can improve the effectiveness of treatment for this cohort of patients. The purpose of this review publication is to summarize and systematize the available data on the prevalence of comorbidity of psoriasis and NAFLD in the population, the mechanisms of its formation and approaches to patient management.

Resistin in patients with psoriasis vulgaris during PUVA therapy

BACKGROUND: Currently, psoriasis represents a serious medical and social problem, and it is one of the most common chronic skin diseases. Over the past decades, special attention has been paid to the association of psoriasis with various diseases, such as cardiovascular diseases, inflammatory bowel diseases, depression, etc. Common comorbidities of psoriasis include metabolic syndrome or obesity. Resistin is one of the hormones produced by adipose tissue, the concentration of which increases markedly in patients with psoriasis. Resistin expression is induced by proinflammatory cytokines such as IL-1, IL-6, IL-12 and TNF-a. In turn, an increase in resistin levels leads to increased production of pro-inflammatory cytokines involved in the development of psoriasis, thereby promoting the recruitment of leukocytes during the inflammatory process leading to chronic inflammation. Taken together, the above changes may contribute to the development of metabolic syndrome in psoriasis. Among the effective methods of treating the disease, phototherapy methods (PUVA and UVB 311 nm) remain relevant. Considering these data, it is of interest to study the level of resistin in the serum of patients with psoriasis and its change after a course of PUVA.&#x0D; AIM: The aim of our study was to evaluate the serum resistin level in patients with psoriasis vulgaris before and after PUVA.&#x0D; MATERIALS AND METHODS: The study was conducted at the department of Skin and Venereology diseases at the Sechenov University in the period from June 2022 to November 2023. The study included 30 patients with psoriasis vulgaris of moderate severity (PASI 20), of whom there were 16 men and 14 women. The healthy control group included 20 participants (11 men and 9 women). All patients had blood drawn from a vein during hospitalization and after a course of PUVA. Healthy participants underwent a single blood draw from a vein.&#x0D; RESULTS: A noticeable decrease in the level of resistin in the blood serum was revealed after a course of PUVA in all patients with psoriasis compared to baseline values. In addition, after treatment, resistin levels approached the values recorded in healthy participants.&#x0D; CONCLUSION: Thus, our study allows us to consider resistin as a biological marker of the effectiveness of PUVA in the treatment of patients with psoriasis vulgaris, as well as a predictor of the occurrence of concomitant diseases in patients with psoriasis.

Clinical profile, treatment and quality of life of patients with psoriatic arthritis in Malaysia: A population-based cross-sectional study.

Psoriatic arthritis (PsA) is a major comorbidity of psoriasis and may lead to irreversible joint damage and disability. This study aims to describe the clinical profile, treatment and quality of life (QoL) of patients with PsA in Malaysia. This is a multicentre retrospective cross-sectional study of psoriasis patients who were notified to the Malaysian Psoriasis Registry (MPR) from January 2007 to December 2018. Of 21 735 psoriasis patients, 2756 (12.7%) had PsA. The male to female ratio was 1:1. The mean age of psoriasis onset for PsA patients was 34.73 ± 14.44 years. They had a higher rate of family history of psoriasis (26% vs. 22.4%, p < 0.001), scalp (82.7% vs. 81.0%, p = 0.04) and nail involvement (73.3% vs. 53.3%, p < 0.001), obesity (62.6% vs. 54.4%, p < 0.001), dyslipidaemia (23.8% vs. 15.4%, p < 0.001), hypertension (31.1% vs. 22.7%, p < 0.001) and diabetes mellitus (20.9% vs. 15.2%, p < 0.001) compared to non-PsA patients. More than half (54.3%) had severe psoriasis [(body surface area >10% and/or Dermatology Life Quality Index (DLQI) >10)]. Most had oligo-/monoarthropathy (40.3%), followed by distal interphalangeal arthropathy (31.3%), symmetrical polyarthropathy (28.3%), spondylitis/sacroiliitis (8.2%) and arthritis mutilans (3.2%). Nearly 40% of PsA patients received systemic treatment, but only 1.6% received biologic agents. QoL was more significantly affected in PsA than in non-PsA patients (mean DLQI 10.12 ± 7.16 vs. 9.52 ± 6.67, p < 0.001). One in eight patients with psoriasis in Malaysia had PsA. They had a higher incidence of comorbidities, severe disease, impaired QoL and were more likely to receive systemic and biological treatment compared to non PsA patients.

Circulating Monocytes Are Predictive and Responsive in Moderate-to-Severe Plaque Psoriasis Subjects Treated with Apremilast

Monocytes play a critical role in the inflammation associated with psoriasis, and their abnormalities have been reported as biomarkers of cardiovascular event risk, a psoriasis comorbidity. Monocytic cells in chronic inflammatory disorders express elevated levels of cAMP phosphodiesterase. Restoring cAMP levels using the oral cAMP phosphodiesterase-4 inhibitor, apremilast, improves clinical outcomes for a subset of patients with psoriasis. We asked whether aberrant monocyte subsets or transcriptomic pathways can function as biomarkers of psoriasis endotypes that can predict enhanced clinical responses to cAMP phosphodiesterase inhibition. A 16-week open-label study of 22 patients with monocyte flow cytometric and transcriptomic analysis was performed. Subjects with elevated hyperadhesive monocyte doublets at baseline were more likely to be responders to apremilast (P < .0001); 82% of subjects with elevated hyperadhesive monocyte doublets achieved 50% reduction in PASI compared with 46% in those without elevated doublets. We observed a significant reduction in hyperadhesive monocyte-containing doublets and monocyte-platelet aggregates, suggesting an effect of apremilast on the adhesiveness of blood monocytes during chronic inflammation. Monocyte differentially expressed gene transcripts predictive of clinical response uncovered pharmacoendotypes with distinct patterns of nucleotide metabolism, energetics, and differentiation. Further study to understand the basis of drug responsiveness and to develop an apremilast psoriasis treatment algorithm using monocyte-refined gene expression is required to validate and become practical in clinical use, offering patients a test that personalizes their likelihood of clinical response.

Comparison of metabolic and neurological comorbidities in Asian patients with psoriasis and atopic dermatitis

Although various comorbidities have been noted to be associated with atopic dermatitis (AD) and psoriasis, few studies have compared comorbidities between the two diseases, and little is known about whether these comorbidities vary by the subtypes of psoriasis. In this study of 1:1 age- and sex-matched pair analysis between patients diagnosed with either psoriasis or AD at Asan Medical Center between 1991 and 2020, comorbidities, as determined by the International Classification of Diseases-10 codes, and likelihood ratios of metabolic and neurologic comorbidities in psoriasis compared with AD were studied using a logistic regression model. Among a total of 14,128 patients, the psoriasis group had higher odds of obesity (odds ratio [95% confidence interval]: 1.49 [1.34–1.66]), hypertension (1.14 [1.03–1.26]), diabetes mellitus (1.46 [1.29–1.66]), chronic kidney disease (1.59 [1.22–2.08]), and Parkinson's disease (2.1 [1.15–3.83]) than the AD group. Subgroup analysis revealed that patients with plaque psoriasis had higher odds of obesity (1.18 [1.05–1.33]), hypertension (1.18 [1.06–1.32]), diabetes mellitus (1.53 [1.34–1.75]), chronic kidney disease (1.66 [1.26–2.17]), and Parkinson’s disease (2.12 [1.16–3.88]) compared with AD. Meanwhile, guttate psoriasis was associated with higher odds of dementia (3.63 [1.06–12.40]) and patients with generalized pustular psoriasis showed higher odds of diabetes mellitus (5.42 [1.56–18.83]) compared with AD. In conclusion, Asian patients with all types of psoriasis should be closely monitored for the development of metabolic and neurologic diseases, especially men and those aged ≥ 40 years.