Epidemiology of comorbidities in psoriasis

Epidemiological studies have shown that, in patients with psoriasis, associated disorders may occur more frequently than expected. Such comorbidities include, among others, psoriatic arthritis, inflammatory bowel disease, obesity, diabetes, cardiovascular disease, several cancer types, and depression. Comorbidities often become clinically manifest years after onset of psoriasis and tend to be more frequently seen in severe disease.     

银屑病共患疾病的临床研究进展

早在1995年,银屑病和其他非皮肤科疾病的关系已经引起人们的关注,而在过去的10年中,越来越多的银屑病共患疾病,包括心血管系统疾病、代谢综合征、非酒精性脂肪肝、炎症性肠病、癌症、焦虑与抑郁的发现,证明银屑病是一种系统性疾病,改变了传统银屑病的治疗模式［1-2］。认识银屑病的共患疾病,早期筛查危险因素,并采取多学科合作的综合管理措施,对优化银屑病的治疗管理有重要意义。本文就目前对银屑病常见共患疾病的认识和临床综合治疗的进展做一综述……     

银屑病共患疾病的治疗

银屑病作为一种免疫机制参与介导的慢性炎症性皮肤病,与众多系统性疾病产生联系,包括代谢综合征、肿瘤等.银屑病与共患疾病在临床诊疗过程中常可相互影响,了解二者之间的相互作用有益于对患者进行综合治疗和疗效评估,同时也会带来对用药策略的思考.主要从常见的心血管疾病、糖尿病、高脂血症、肿瘤等方面介绍了这些系统性疾病的治疗如何影响银屑病及其治疗,并阐述银屑病及其治疗给共患疾病带来的影响.银屑病的主要治疗方法包括传统药物治疗、生物制剂、光疗以及生活方式的调整,治疗可能引起不良反应,诱发或加重系统性疾病,但也可能同时在皮肤外的其他系统发挥治疗作用,扩大治疗效应.     

Metabolic comorbidities and psoriasis

Psoriasis is a chronic inflammatory, immune-mediated skin disease, which affects 2%-3% of the population worldwide. Chronic plaque psoriasis is frequently associated with metabolic diseases including diabetes, obesity, dyslipidemia, metabolic syndrome and nonalcoholic fatty liver disease. Although the causal relationship between metabolic comorbidities and psoriasis has not yet been completely proven, it appears that shared genetic links, common environmental factors and/or common inflammatory pathways may underlie the development of psoriasis and comorbidities. The presence of comorbidities has important implications in the global approach to patients with psoriasis. Traditional systemic anti-psoriatic agents could negatively affect cardio-metabolic comorbidities, and may have important interactions with drugs commonly used by psoriatic patients. In contrast, the recent findings that the risk of myocardial infarction is reduced in patients with rheumatoid arthritis who respond to anti-TNF-α therapy compared to non-responders, supports the hypothesis that the anti-inflammatory effect of TNF-α blockers might reduce the cardiovascular risk potentially also in psoriasis patients. Finally, patients with moderate to severe psoriasis should be treated promptly and effectively, and should be encouraged to drastically correct their modifiable cardiovascular risk factors, in particular obesity and smoking habit.     

Cardiovascular comorbiditiy in psoriasis

The chronic inflammatory nature of psoriasis is also thought to predispose patients to other diseases with an inflammatory component, the most notable being cardiovascular and metabolic (cardiometabolite) disorders. This concept is supported by studies showing that psoriasis is associated with cardiovascular risk factors like diabetes, obesity, hypertension, dyslipidemia, smoking and diseases including MI. Given the increased prevalence of cardiovascular co morbidities in patients, dermatologists treating psoriasis need to approach the disease as a potentially multisystem disorder and must alert these patients to the potentially negative effects of their disease.     

Associated comorbidities in psoriasis and inflammatory bowel disease

Background The association between psoriasis and inflammatory bowel disease (IBD) has been previously reported although a great deal remains unknown about associated comorbidities. Objectives The aim of this study was to examine comorbidities in individuals diagnosed with both psoriasis and IBD, and to compare those with individuals diagnosed with psoriasis‐only. We also looked at differences within the IBD group by clearly defining that cohort. Methods We included 146 patients diagnosed with both psoriasis and IBD and 146 controls diagnosed of psoriasis‐only without previous records of IBD, matched by gender, ethnicity and age (±5 years). Patients were obtained from the research patient data repository of Brigham and Women’s Hospital (BWH) and Massachusetts General Hospital. Controls were obtained from the psoriatic arthritis and psoriasis follow‐up study (PAFS) at BWH. The comparison between the two groups included socio‐demographics, comorbidities and laboratory inflammation parameters. Results Compared to individuals with psoriasis‐only, patients with both psoriasis and IBD had significantly higher rates of autoimmune thyroiditis (2.1% vs. 6.8%), hepatitis (0.7 vs. 6.2%) and diabetes (11.0% vs. 26.7%). In addition, of the 146 patients with psoriasis and IBD, 60 (41.1%) were diagnosed with seronegative arthritis. The average C‐reactive protein (CRP) and erythrocyte sedimentation rate (ESR) of the last visits in our clinics were significantly elevated compared to the individuals with psoriasis‐only (ESR, 33.5 vs. 4.0 mm/h; CRP, 9.1 vs. 2.3 mg/L; both P‐values <0.0001). Conclusions We found that patients with both, psoriasis and IBD have a number of further associated comorbidities, some at significantly higher levels than individuals with psoriasis‐only. Common inflammatory pathways and genetic predispositions for specific patterns in the immune response may play an important role in the evolution of associated conditions.     

白细胞介素17A介导银屑病及心血管合并症的研究进展

白细胞介素（IL）-23/IL-17轴是寻常型斑块状银屑病发病的主要通路,IL-17A是相关免疫通路中的关键节点,介导了动脉粥样硬化和银屑病的重叠炎症通路,促进炎症、凝血和血栓形成,在银屑病心血管合并症的发生发展中起重要作用。抑制IL-17A的炎症作用能减少重度银屑病患者心血管合并症的发生率及病死率。本文综述近年来IL...     

Pustular psoriasis in childhood

Recurrent annular pustular psoriasis over the trunk of an 11-year-old boy followed infantile psoriasis in the napkin area. Etretinate therapy induced a partial remission. The difficulty in distinguishing between annular pustular psoriasis and subcorneal pustular dermatosis of Sneddon and Wilkinson is discussed.     

Cyclosporin in childhood psoriasis

BACKGROUND: Cyclosporin is known to be highly effective in the treatment of psoriasis in adults. It has also proved effective and well tolerated in the treatment of severe childhood atopic dermatitis. Psoriasis in childhood is relatively unusual but by no means rare and on occasions the disease can be very difficult to control in this age group. The use of cyclosporin for psoriasis in childhood has received scarcely any attention and in the few cases that have been reported the results have been inconsistent. Three children aged from 7 to 11 years with severe psoriasis resistant to topical agents were treated with cyclosporin. The highest dose required was 3.5 mg/kg per day. The duration of treatment ranged from 6 weeks to 4 months. Cyclosporin was effective and generally well tolerated. Treatment was interrupted in one case due to nausea and diarrhoea. None of the patients developed hypertension or renal impairment. The potential role of cyclosporin in severe childhood psoriasis is discussed.     

生物制剂治疗对银屑病相关心血管疾病的影响

银屑病易伴发心血管疾病, 与动脉粥样硬化存在相似的致病机制, 都涉及固有免疫的激活和自身反应性T细胞的活化。近年来, 越来越多的生物制剂被运用于银屑病的系统治疗中, 包括肿瘤坏死因子α、白细胞介素12/23和白细胞介素17A抑制剂, 不同生物制剂的疗效、安全性及其对心血管疾病的影响也引起了皮肤科医生的重视。本文对银屑病和动脉粥样硬化共同的免疫机制, 以及不同生物制剂对心血管疾病与相关代谢变化的影响进行了概述。     

Cardiovascular biomarkers in patients with psoriasis

Psoriasis is a systemic inflammatory disease of the skin with associated comorbidity. Severe forms of psoriasis are associated with increased mortality, which might be due to cardiovascular (CV) comorbidity. In this study, we investigated in 79 patients with psoriasis compared to 80 healthy volunteers different biomarkers that play a role in vascular disease and inflammation, such as C‐reactive protein (CRP), human soluble CD40 ligand (sCD40L), oxidized low‐density lipoprotein (ox‐LDL), human matrix Gla protein (MGP) and fetuin‐A. Our results showed that CRP (P < 0.0001), sCD40L (P < 0.0001) and MGP (P < 0.0001) were increased in the patient cohort. Fetuin‐A showed decreased serum levels in patients with psoriasis (P < 0.0001), whereas ox‐LDL did not show any significant difference. In multivariate analyses controlling for sex, age and BMI, these findings were confirmed. Thus, CV biomarkers are altered in patients with psoriasis. If the decrease in fetuin‐A as well as the increase in sCD40L can be proven in further studies, these biomarkers may help to characterize a subgroup of patients who are at risk to develop CVD and/or monitor the effect of therapeutic antipsoriatic strategies on concomitant diseases. This knowledge may be useful in the management of high‐need patients with psoriasis.     

Management of psoriasis in childhood

It is not unusual for psoriasis to start in childhood although a mild or atypical presentation sometimes makes it difficult to establish a confident diagnosis at this age. All adult forms occur but flexural psoriasis and guttate psoriasis are particularly common. Management involves education of the child and parents concerning the nature of psoriasis and the effects of treatment. Genetic counselling may be provided if needed based on population data. Environmental triggers of psoriasis should be sought particularly infection. Psoriasis can usually be treated effectively in children with topical agents including emollients, coal tar, corticosteroids, dithranol and calcipotriol according to age and the sites affected. In those who do not respond, consideration should be given first to day care or in-patient treatment which may be combined with UVB phototherapy. Systemic therapy should be used only under extreme circumstances such as resistant erythrodermic, pustular or arthropathic psoriasis. There are no controlled trials in this age group but the most experience has been with retinoids which are probably the second-line drug of choice for children. Methotrexate and cyclosporin appear to be effective in children but more efficacy and safety data are required.     

Economic burden of comorbidities in patients with psoriasis is substantial

Background Psoriasis is frequently associated with comorbidities. Objective To estimate the incremental economic burden associated with comorbidities in patients with psoriasis, accounting for psoriasis severity. Methods Patients continuously enrolled ≥ 6 months after a randomly selected psoriasis diagnosis date were selected from the Ingenix Impact National Managed Care Database (1999–2004). Comorbidities identified during the 6‐month study included: psoriatic arthritis, cardiovascular disease, depression, diabetes, hyperlipidemia, hypertension, obesity, cerebrovascular diseases and peripheral vascular disease. Resource utilization and costs during the 6‐month follow‐up period were compared for patients with ≥ 1 comorbidity vs. those without and for patients with a specific comorbidity vs. those without. Adjusted incidence rate ratios (IRRs) and odds ratios (ORs) were estimated for resource utilization using negative binomial and logistic regression models, respectively. Adjusted incremental costs associated with comorbidities were reported using general linear models with log‐link and gamma distributions or two‐part models. Models controlled for age, sex and psoriasis severity. Results A total of 114 512 patients were included; 51% had ≥ 1 comorbidity. Hyperlipidemia (27%) and hypertension (25%) were most prevalent. Patients with comorbidities were more likely to experience urgent care [OR (95% confidence interval (CI)) = 1.58 (1.51–1.65)] than patients without comorbidities. They also had significantly greater hospitalization rates [IRR (95% CI) = 2.27 (2.13–2.42)] and outpatient visits [IRR (95% CI) = 1.53 (1.52–1.55)]. Compared with patients who did not have comorbidities, patients with comorbidities incurred $2184 (P < 0.001) greater total costs. Conclusion Comorbidities present a significant economic burden in patients with psoriasis.     

生物制剂治疗银屑病共病研究进展

银屑病是一种常见的免疫介导的慢性炎症性疾病,与之相关的共病包括银屑病关节炎、心血管疾病、代谢综合征、炎症性肠病和心理疾病等。由于银屑病及其共病之间可能存在共同的致病途径,抑制相应免疫反应靶点的生物制剂可以通过改变全身炎症状态而对其共病产生影响。本文就生物制剂对银屑病共病治疗的应用进展进行综述。