Abstract
Psoriasis is one of the common complex disorders in Western world, affecting 2% to 3% of the population. Recent studies indicate that psoriasis is associated with an increased risk of comorbidity and mortality compared to the general population. It appears that patients with psoriasis have a higher prevalence of metabolic disorders such as diabetes, hypertension, obesity, and hyperlipidemia, as well as a higher frequency of cigarette smoking. These concomitant diseases can complicate the treatment of psoriasis. Even though the etiology of these associations is elusive, physicians should be aware of them and take active steps to reduce the risk profiles of patients with psoriasis and psoriatic arthritis, in order to lessen mortality and comorbidity.
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References and Recommended Reading
Raychaudhuri SP, Farber EM: The prevalence of psoriasis in the world. J Eur Acad Dermatol Venereol 2001, 15:16–17.
Gladman DD, Antoni C, Mease P, et al.: Psoriatic arthritis: epidemiology, clinical features, course, and outcome. Ann Rheum Dis 2005, 64(Suppl 2):ii14–17.
Capon F, Trembath RC, Barker JN: An update on the genetics of psoriasis. Dermatol Clin 2004, 22:339–347, vii.
Nair RP, Stuart PE, Nistor I, et al.: Sequence and haplotype analysis supports HLA-C as the psoriasis susceptibility 1 gene. Am J Hum Genet 2006, 78:827–851.
Mallon E, Bunce M, Savoie H, et al.: HLA-C and guttate psoriasis. Br J Dermatol 2000, 143:1177–1182.
Lindegard B: Diseases associated with psoriasis in a general population of 159,200 middle-aged, urban, native Swedes. Dermatologica 1986, 172:298–304.
Henseler T, Christophers E: Disease concomitance in psoriasis. J Am Acad Dermatol 1995, 32:982–986.
Lopez AD, Mathers CD, Ezzati M, et al.: Global and regional burden of disease and risk factors, 2001: systematic analysis of population health data. Lancet 2006, 367:1747–1757.
Arnett DK, McGovern PG, Jacobs JrDR, et al.: Fifteen-year trends in cardiovascular risk factors (1980-1982 through 1995–1997): the Minnesota Heart Survey. Am J Epidemiol 2002, 156:929–935.
Willerson JT, Ridker PM: Inflammation as a cardiovascular risk factor. Circulation 2004, 109:II2-II10.
Mitra B, Panja M: High sensitive C-reactive protein: a novel biochemical markers and its role in coronary artery disease. J Assoc Physicians India 2005, 53:25–32.
Sesso HD, Buring JE, Rifai N, et al.: C-reactive protein and the risk of developing hypertension. JAMA 2003, 290:2945–2951.
Li JJ, Fang CH: C-reactive protein is not only an inflammatory marker but also a direct cause of cardiovascular diseases. Med Hypotheses 2004, 62:499–506.
Vanizor Kural B, Orem A, Cimsit G, et al.: Evaluation of the atherogenic tendency of lipids and lipoprotein content and their relationships with oxidant-antioxidant system in patients with psoriasis. Clin Chim Acta 2003, 328:71–82.
Rocha-Pereira P, Santos-Silva A, Rebelo I, et al.: The inflammatory response in mild and in severe psoriasis Creactive protein and alpha2-macroglobulin plasma activity in medium-severe and severe psoriasis. Br J Dermatol 2004, 150:917–928.
Helliwell PS, Marchesoni A, Peters M, et al.: Cytidine deaminase activity, C reactive protein, histidine, and erythrocyte sedimentation rate as measures of disease activity in psoriatic arthritis. Ann Rheum Dis 1991, 50:362–365.
Spadaro A, Taccari E, Riccieri V, et al.: Interleukin-6 and soluble interleukin-2-receptor in psoriatic arthritis: correlations with clinical and laboratory parameters. Clin Exp Rheumatol 1996, 14:413–416.
Yasumoto S, Imayama A, Hori Y: Increased serum level of interleukin-6 in patients with psoriatic arthritis and thrombocytosis. J Dermatol 1995, 22:718–722.
Kane D, Roth J, Frosch M, et al.: Increased perivascular synovial membrane expression of myeloid-related proteins in psoriatic arthritis. Arthritis Rheum 2003, 48:1676–1685.
Tzoulaki I, Murray GD, Lee AJ, et al.: C-reactive protein, interleukin-6, and soluble adhesion molecules as predictors of progressive peripheral atherosclerosis in the general population: Edinburgh Artery Study. Circulation 2005, 112:976–983.
Manson JE, Bassuk SS: Obesity in the United States: a fresh look at its high toll. JAMA 2003, 289:229–230.
Herron MD, Hinckley M, Hoffman MS, et al.: Impact of obesity and smoking on psoriasis presentation and management. Arch Dermatol 2005, 141:1527–1534. This study is of great importance for investigators interested in clinical psoriasis research. It is a comprehensive study of the impact of obesity and smoking on psoriasis. The authors provide evidence indicating that smoking may have a role in the disease onset, while obesity seems to be a consequence of psoriasis. The.ndings encourage physicians to highlight the importance of diet, exercise, and smoking cessation to patients with psoriasis.
Naldi L, Chatenoud L, Linder D, et al.: Cigarette smoking, body mass index, and stressful life events as risk factors for psoriasis: results from an Italian case-control study. J Invest Dermatol 2005, 125:61–67. This work demonstrates that smoking and obesity are linked to psoriasis at disease onset. In contrast to Herron et al. [22], these authors suggest that obesity is a risk factor for the onset of psoriasis.
Hamminga EA, van der Lely AJ, Neumann HA, et al.: Chronic inflammation in psoriasis and obesity: Implications for therapy. Med Hypotheses 2006, 67:768–773. Here, authors hypothesize that losing weight may improve psoriasis by reducing concentrations of cytokine network, such as TNF-β, IL-6, and leptin, and by improving insulin sensitivity.
Mallbris L, Granath F, Hamsten A, et al.: Psoriasis is associated with lipid abnormalities at the onset of skin disease. J Am Acad Dermatol 2006, 54:614–621. This is the.rst study that provides a baseline characterization of lipid profile in psoriasis at disease onset. The authors demonstrate an atherogenic lipid profile at the onset of psoriasis. The study design allows a high specificity and reliable assessment of established confounding factors and eliminates factors such as obesity, hypertension, cigarette smoking, physical activity, and disease severity as possible explanations to the.ndings.
Reddy SM, Reed G, Anandarajah A, et al.: Comparative analysis of disease activity, radiographic features and bone density in psoriatic and rheumatoid arthritis. Arthritis Rheum 2005, 52:S641.
Ferretti G, Simonetti O, Offidani AM, et al.: Changes of plasma lipids and erythrocyte membrane.uidity in psoriatic children. Pediatr Res 1993, 33:506–509.
Lebwohl M, Ali S: Treatment of psoriasis. Part 2. Systemic therapies. J Am Acad Dermatol 2001, 45:649–661, quiz 662–664.
Jones SM, Harris CP, Lloyd J, et al.: Lipoproteins and their subfractions in psoriatic arthritis: identification of an atherogenic profile with active joint disease. Ann Rheum Dis 2000, 59:904–909.
Lazarevic MB, Vitic J, Mladenovic V, et al.: Dyslipoproteinemia in the course of active rheumatoid arthritis. Semin Arthritis Rheum 1992, 22:172–178.
Preece JF: Raised blood pressure and psoriasis. J R Coll Gen Pract 1977, 27:713–715.
Ena P, Madeddu P, Glorioso N, et al.: High prevalence of cardiovascular diseases and enhanced activity of the reninangiotensin system in psoriatic patients. Acta Cardiol 1985, 40:199–205.
Spadaro A, Taccari E, Mohtadi B, et al.: Life-table analysis of cyclosporin A treatment in psoriatic arthritis: comparison with other disease-modifying antirheumatic drugs. Clin Exp Rheumatol 1997, 15:609–614.
Cersosimo E, Defronzo RA: Insulin resistance and endothelial dysfunction: the road map to cardiovascular diseases. Diabetes Metab Res Rev 2006, Epub ahead of print.
Jucci A, Vignini M, Pelfini C, et al.: Psoriasis and insulin secretion. Preliminary results. Arch Dermatol Res 1977, 257:239–246.
Brenelli SL, Moraes AM, Monte-Alegre S, et al.: Insulin resistance in psoriasis. Braz J Med Biol Res 1995, 28:297–301.
Reynoso-von Drateln C, Martinez-Abundis E, Balcazar-Munoz BR, et al.: Lipid profile, insulin secretion, and insulin sensitivity in psoriasis. J Am Acad Dermatol 2003, 48:882–885.
Ucak S, Ekmekci TR, Basat O, et al.: Comparison of various insulin sensitivity indices in psoriatic patients and their relationship with type of psoriasis. J Eur Acad Dermatol Venereol 2006, 20:517–522.
Anan F, Takahashi N, Shinohara T, et al.: Smoking is associated with insulin resistance and cardiovascular autonomic dysfunction in type 2 diabetic patients. Eur J Clin Invest 2006, 36:459–465.
Yang RZ, Lee MJ, Hu H, et al.: Identification of omentin as a novel depot-specific adipokine in human adipose tissue: possible role in modulating insulin action. Am J Physiol Endocrinol Metab 2006, 290:E1253–1261.
Hagforsen E, Awder M, Lefvert AK, et al.: Palmoplantar pustulosis: an autoimmune disease precipitated by smoking? Acta Derm Venereol 2002, 82:341–346.
Smith JB, Fenske NA: Cutaneous manifestations and consequences of smoking. J Am Acad Dermatol 1996, 34:717–732, quiz 733–734.
Mills CM, Srivastava ED, Harvey IM, et al.: Smoking habits in psoriasis: a case control study. Br J Dermatol 1992, 127:18–21.
Poikolainen K, Reunala T, Karvonen J: Smoking, alcohol and life events related to psoriasis among women. Br J Dermatol 1994, 130:473–477.
Naldi L, Parazzini F, Brevi A, et al.: Family history, smoking habits, alcohol consumption and risk of psoriasis. Br J Dermatol 1992, 127:212–217.
Fortes C, Mastroeni S, Leffondre K, et al.: Relationship between smoking and the clinical severity of psoriasis. Arch Dermatol 2005, 141:1580–1584.
Peters MJ, van der Horst-Bruinsma IE, Dijkmans BA, et al.: Cardiovascular risk profile of patients with spondylarthropathies, particularly ankylosing spondylitis and psoriatic arthritis. Semin Arthritis Rheum 2004, 34:585–592.
Klareskog L, Stolt P, Lundberg K, et al.: A new model for an etiology of rheumatoid arthritis: smoking may trigger HLA-DR (shared epitope)-restricted immune reactions to autoantigens modified by citrullination. Arthritis Rheum 2006, 54:38–46, comment in 2006, 54:10–13.
Poikolainen K, Karvonen J, Pukkala E: Excess mortality related to alcohol and smoking among hospital-treated patients with psoriasis. Arch Dermatol 1999, 135:1490–1493.
Aicher A, Heeschen C, Mohaupt M, et al.: Nicotine strongly activates dendritic cell-mediated adaptive immunity: potential role for progression of atherosclerotic lesions. Circulation 2003, 107:604–611.
Sonnex TS, Carrington P, Norris P, et al.: Polymorphonuclear leukocyte random migration and chemotaxis in psoriatic and healthy adult smokers and non-smokers. Br J Dermatol 1988, 119:653–659.
Mallbris L, Akre O, Granath F, et al.: Increased risk for cardiovascular mortality in psoriasis inpatients but not in outpatients. Eur J Epidemiol 2004, 19:225–230.
Seishima M, Mori S, Noma A: Serum lipid and apolipoprotein levels in patients with psoriasis. Br J Dermatol 1994, 130:738–742.
Rocha-Pereira P, Santos-Silva A, Rebelo I, et al.: Dislipidemia and oxidative stress in mild and in severe psoriasis as a risk for cardiovascular disease. Clin Chim Acta 2001, 303:33–39.
Cheng SW, Ting AC, Wong J: Lipoprotein (a) and its relationship to risk factors and severity of atherosclerotic peripheral vascular disease. Eur J Vasc Endovasc Surg 1997, 14:17–23.
Alberti KG, Zimmet PZ: Definition, diagnosis and classification of diabetes mellitus and its complications. Part 1: diagnosis and classification of diabetes mellitus provisional report of a WHO consultation. Diabet Med 1998, 15:539–553.
Third Report of the National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel III).nal report. Circulation 2002, 106:3143/2-3421.
Balkau B, Charles MA: Comment on the provisional report from the WHO consultation. European Group for the Study of Insulin Resistance (EGIR). Diabet Med 1999, 16:442–443.
International Diabetes Federation: The IDF consensus worldwide definition of metabolic syndrome. http://www. idf.org/webdata/docs/IDF_Metasyndrome_definition.pdf. Accessed July 25, 2006.
Vahlquist C, Michaelsson G, Vessby B: Serum lipoproteins in middle-aged men with psoriasis. Acta Derm Venereol 1987, 67:12–15.
Uyanik BS, Ari Z, Onur E, et al.: Serum lipids and apolipoproteins in patients with psoriasis. Clin Chem Lab Med 2002, 40:65–68.
Piskin S, Gurkok F, Ekuklu G, et al.: Serum lipid levels in psoriasis. Yonsei Med J 2003, 44:24–26.
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Mallbris, L., Ritchlin, C.T. & Ståhle, M. Metabolic disorders in patients with psoriasis and psoriatic arthritis. Curr Rheumatol Rep 8, 355–363 (2006). https://doi.org/10.1007/s11926-006-0065-8
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DOI: https://doi.org/10.1007/s11926-006-0065-8