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Psoriasis and Co-Morbid Disease: A Dose Response in Relation to Psoriasis Severity

Summary and Comment |
September 13, 2013

Psoriasis and Co-Morbid Disease: A Dose Response in Relation to Psoriasis Severity

  1. Jeffrey P. Callen, MD

Confirmation of an association between psoriasis and cardiovascular and peripheral vascular disease, validation of the link between psoriasis severity and risk for other disease, and reportage of some new associations

  1. Jeffrey P. Callen, MD

Gelfand and his colleagues were among the first to report an association between psoriasis and atherosclerotic vascular disease of the heart, central nervous system, and peripheral vascular system (see JW Dermatol Oct 27 2006). The data suggested that the association was strongest in more severe disease (this research used the need for phototherapy or for systemic therapy as a surrogate for severity). Other investigators have linked chronic pulmonary disease, diabetes, and metabolic syndrome to psoriasis and its severity (JW Dermatol May 15 2009).

Odds Ratios for Associated Systemic Disease in Patients with Psoriasis
Odds Ratios for Associated Systemic Disease in Patients with Psoriasis

This most recent study relies on data collected from medical records and responses to patient surveys in the U.K. In 9035 psoriasis patients and 90,350 controls without psoriasis, investigators found significant associations between psoriasis and systemic disease (see Table). Higher psoriasis severity increased this risk. Cerebrovascular disease, moderate-to-severe liver disease, and cancer were not more prevalent in the psoriasis patients in this study. Smoking status, the presence of obesity, and the effects of therapy were not reported. The authors state that their results “should be considered hypothesis generating and require confirmation in prospective studies.”

Comment

These results confirm an association between psoriasis and cardiovascular and peripheral vascular disease and validate the link between psoriasis severity and risk for other disease. Some relatively new associations are demonstrated, including with peptic ulcer disease, renal disease, and rheumatologic disease other than psoriatic arthritis. The prevalence of liver disease may be weight-related rather than an independent association. If these associations hold up in prospective studies, early intervention, including initiation of systemic therapy and recommendations promoting a healthful lifestyle, will become part of the regular dermatologic care of psoriatic patients.

  • Disclosures for Jeffrey P. Callen, MD at time of publication Consultant / Advisory board Amgen; Celgene; Xoma Equity Various trust accounts Editorial boards Archives of Dermatology; e-medicine.com; UpToDate Leadership positions in professional societies University of Louisville (Division Chief and Program Director)

Citation(s):

Reader Comments (1)

ABRAR KHOJAH Resident, Internal Medicine, king abdulaziz university hospital

i really like the topic of this study
its very smart important point
thank you

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