Psoriasis:Biologic treatment and liver disease

Patients with moderate or severe psoriasis have a high prevalence of chronic liver disease. Chronic liver disease in these patients is related to metabolic syndrome, alcohol abuse or viral infections. Therefore,treatment of these patients is challenging. Classic systemic treatments may be contraindicated because of their immunosuppressive and hepatotoxic potential.First-line therapy in this setting is generally ultraviolet B phototherapy combined with topical treatment, but its feasibility and efficacy are sometimes limited. The therapeutic options are further restricted by concomitant psoriatic arthritis. Biologic treatments have shown to be effective in psoriasis and psoriatic arthritis, and they are largely devoid of liver toxicity. Anti-tumor necrosis factor-alpha(TNF-α) treatments have proven to be effective and safe in patients with chronic hepatitis C virus(HCV) infections and other non-infectious chronic liver disorders, including alcoholic and non-alcoholic liver diseases. However, in chronic hepatitis B virus(HBV), anti-TNF-α treatments carry a high risk of HBV reactivation. Anti-interleukin-12/23 treatments are also effective in patients with psoriasis, but data regarding their safety in chronic hepatitis infections are still limited. Safety reports in patients with psoriasis and chronic HCV infection are contradictory, and in chronic HBVevidence indicate a potential risk of viral reactivation. Moreover, concerns remain about the long-term safety of both TNF-α antagonists and ustekinumab. Non-viral liver diseases such as alcoholic and non-alcoholic liver diseases are more prevalent in patients with psoriasis than in the general population. TNF-α antagonists have also been prescribed in these patients. Although data are still scarce in this setting, results suggest a favorable profile in patients with psoriasis and non-alcoholic liver diseases. We review the literature regarding all these aspects.     

Repeated Paradoxical Aggravation of Preexisting Psoriasis during Infliximab Treatment for Crohn's Disease

As more rheumatologists and dermatologists have begun to use biological agents such as TNF-α blocker, they have confronted an unexpected complication: psoriasis was paradoxically aggravated or induced by the TNF-α blocker. Although it is not a common complication of TNF-α blocker, this aggravation may be more common than previously thought. To our knowledge, most reports about TNF-α blocker-induced psoriasis have been limited to western countries while only a few cases have been reported in Korea and Japan. In addition, new onset of pustular psoriasis by TNF-α blocker has been reported more commonly than worsening of preexisting psoriasis. Now we report a patient whose preexisting psoriasis vulgaris was aggravated repeatedly after using the TNF-α blocker, infliximab, to control Crohn''s disease, which is a rare rheumatologic disease in Korea.     

银屑病患者非酒精性脂肪肝发生率和相关临床指标分析

目的 调查我院银屑病患者中非酒精性脂肪肝(NAFLD)的发生率.方法 纳入120例银屑病患者和年龄及性别相匹配的98例对照病例,应用腹部超声检测2组中NAFLD的发生率.同时,测定血清谷丙转氨酶(ALT)、天冬氨酸转氨酶(AST)、y-谷氨酰转移酶(GGT)、总胆固醇(TC)、高密度脂蛋白(HDL-L)、低密度脂蛋白(LDL-L)、甘油三酯(rG)及空腹血糖(FBS)水平.结果 银屑病组中NAFLD发病率升高(46.7％vs.30.6％,P=0.016).银屑病并发与无并发NAFLD者比较,2组血清AST、TC、HDL-L及LDL-L相比差异无统计学意义.银屑病并发NAFLD者血清ALT、GGT、TG和FBS明显高于无并发者(均P＜0.01).结论 银屑病易并发NAFLD,合并NAFLD银屑病患者常伴随肝酶、血脂及血糖代谢异常.     

Prevalence of inflammatory bowel disease in Japanese psoriatic patients

Psoriatic patients reportedly have a higher prevalence of inflammatory bowel disease (IBD); however, there have been few research studies of Japanese psoriatic patients. To elucidate the prevalence of IBD in Japanese psoriatic patients, a cross‐sectional study was performed. Information was collected regarding psoriatic patients with current or prior history of Crohn's disease (CD) or ulcerative colitis (UC) who were treated at Fukuoka University Hospital from 2010 to 2018. Among 681 psoriatic patients (449 men and 232 women), eight (1.2%, six men, two women) had UC and two (0.3%, one man, one woman) had CD. Diagnosis of IBD preceded psoriasis in five patients, while diagnosis of psoriasis preceded IBD in two; the remaining patients’ records did not have sufficient information. Seven of 10 UC‐positive patients had mild psoriasis, two had moderate psoriasis and one had severe psoriasis. When UC‐positive psoriatic patients were compared with IBD‐negative psoriatic patients, there were no differences in age at onset of psoriasis, age at first visit or complications (e.g. psoriatic arthritis, hypertension, hyperlipidemia, hyperuricemia and diabetes). However, UC‐positive patients had significantly higher body mass index (BMI) (26.7 vs 23.7; P = 0.021), compared with patients without IBD. The CD/UC ratio in this cohort was 0.25, while the prevalence of IBD was 1.2%; these values were both lower than those in previous reports involving Caucasian patients. Patients with psoriasis and UC may have higher BMI and milder skin symptoms than those with psoriasis alone. These observations must be further confirmed by controlled domestic studies with larger samples.     

Psoriasis associated with ulcerative colitis and Crohn's disease

Background  Numerous reports have demonstrated the epidemiological, pathogenic, and genetic association between psoriasis and Crohn's disease. Nevertheless, the association between psoriasis and ulcerative colitis was rarely described.
Objective  This study aims to investigate the association between psoriasis and inflammatory bowel disease.
Study design  Case-control study.
Setting  The study was performed utilizing the large medical dataset of Clalit Health Services.
Methods  Psoriasis patients were compared to controls regarding the prevalence of inflammatory bowel disease in a case–control study using logistic multivariate models.
Results  The study included 12 502 psoriasis patients aged 20 years and above and 24 287 age- and sex-matched controls. The prevalence of both Crohn's disease and ulcerative colitis was significantly higher in psoriasis patients compared with the control group. In multivariate analyses, psoriasis was associated with Crohn's disease [odds ratio (OR), 2.49; 95% confidence interval (95% CI), 1.71–3.62] as well as ulcerative colitis (OR, 1.64; 95% CI, 1.15–2.33). This association was independent of anti-tumour necrosis factor-α therapy.
Conclusion  Psoriasis is associated both with Crohn's disease and ulcerative colitis. Future studies on comorbidities in patients with psoriasis should focus on ulcerative colitis.

Conflicts of interest

None declared.     

Early oral presentation of Crohn's disease

Inflammatory changes of the oral mucosa in children can have a variety of infectious and non‐infectious etiologies. We report on a 10‐year‐old boy with progressive cobblestone‐like changes and erosions of oral mucosa over six months, which turned out to be early oral manifestations of Crohn disease.     

Psoriasis and non‐alcoholic fatty liver disease

Several recent studies have found an increased prevalence of non‐alcoholic fatty liver disease within psoriasis patients. The exact pathophysiological mechanisms behind these observations are unclear, but are likely related to the high prevalence of obesity and metabolic syndrome within this patient population. Chronic inflammation, mediated by either proinflammatory adipokines or skin‐derived cytokines, may contribute to fatty liver disease development by increasing insulin resistance which in turn promotes hepatic lipid accumulation. These same adipokines in addition to hepatic cytokines may act on the skin to influence psoriasis disease severity.     

Cutaneous Crohn's disease treated with infliximab and 4 years of follow up

Metastatic Crohn's disease (MCD) is a rare, non‐contiguous cutaneous manifestation of Crohn's disease. To date, there have been only four reports in the literature of an effective treatment of this condition with infliximab and there are no long‐term follow‐up studies on adult MCD patients treated with infliximab. We present a case of MCD treated with infliximab with 4.5 years of follow up.     

Psoriasis: classical and emerging comorbidities

Psoriasis is a chronic inflammatory systemic disease. Evidence shows an associationof psoriasis with arthritis, depression, inflammatory bowel disease andcardiovascular diseases. Recently, several other comorbid conditions have beenproposed as related to the chronic inflammatory status of psoriasis. Theunderstanding of these conditions and their treatments will certainly lead to bettermanagement of the disease. The present article aims to synthesize the knowledge inthe literature about the classical and emerging comorbidities related topsoriasis.     

银屑病伴发多发Bowen病及鳞状细胞癌1例

患者女,50岁。周身反复出现鳞屑性红斑伴瘙痒30年,右臀出现菜花状肿物1年。有银屑病病史30年,予UVA照射治疗70余次。手术切除右臀肿物,组织病理示鳞状细胞癌和Bowen病。诊断:银屑病;鳞状细胞癌;Bowen病(多发)。     

Cutaneous Crohn's disease with superimposed psoriasis: A unique case with overlapping histology

Crohn's disease (CD) is an idiopathic, chronic inflammatory disorder of the gastrointestinal tract. We recently encountered a unique case in which a patient with longstanding CD presented with skin lesions with histopathologic features of both psoriasis and granulomatous inflammation suggestive of cutaneous CD. To our knowledge, this has not been described concomitantly in the same patient, in the same lesions. Review of the literature suggests that the intersection of these 2 histopathological reaction patterns may not be pure coincidence. Clinical‐pathologic correlation of this case will be discussed, along with a review of the potential mechanisms of this unique disease presentation.