Increased prevalence of the metabolic syndrome in patients with moderate to severe psoriasis

The role of chronic inflammation causing metabolic and vascular disorders is increasingly recognized. It is hypothesized that proinflammatory cytokines contribute to atherogenesis, peripheral insulin resistance, and the development of hypertension and type II diabetes. Psoriasis as a chronic inflammatory skin disorder is characterized by a variety of immunologic and inflammatory changes and may similarly predispose for those disorders. The objective of this study was to elucidate the association of psoriasis with chronic vascular and metabolic disorders. We investigated a total of 581 adult patients hospitalised for plaque type psoriasis as compared to 1,044 hospital-based controls. A distinct pattern of chronic disorders was found to be significantly associated with psoriasis, including diabetes mellitus type II [odds ratio (OR)=2.48], arterial hypertension (OR = 3.27), hyperlipidemia (OR = 2.09), and coronary heart disease (OR = 1.95). The combined presence of these conditions together with obesity, known as the metabolic syndrome, was clearly more prevalent in psoriasis patients (OR = 5.29). In addition, psoriasis patients were significantly more likely to be smokers (OR = 2.96) and to have a regular or heavy consumption of alcohol (OR = 3.33 and 3.61, respectively). In conclusion, psoriasis patients appear to be at higher risk for diabetes mellitus and cardiovascular disease. This could likely be due to the effects of chronic inflammatory changes, in particular the secretion of proinflammatory cytokines. The risk of late term cardiovascular complications might support the use of systemic treatment in psoriasis.     

Increased prevalence of the metabolic syndrome in patients with moderate to severe psoriasis

The role of chronic inflammation causing metabolic and vascular disorders is increasingly recognized. It is hypothesized that proinflammatory cytokines contribute to atherogenesis, peripheral insulin resistance, and the development of hypertension and type II diabetes. Psoriasis as a chronic inflammatory skin disorder is characterized by a variety of immunologic and inflammatory changes and may similarly predispose for those disorders. The objective of this study was to elucidate the association of psoriasis with chronic vascular and metabolic disorders. We investigated a total of 581 adult patients hospitalised for plaque type psoriasis as compared to 1,044 hospital-based controls. A distinct pattern of chronic disorders was found to be significantly associated with psoriasis, including diabetes mellitus type II [odds ratio (OR)=2.48], arterial hypertension (OR = 3.27), hyperlipedemia (OR = 2.09), and coronary heart disease (OR = 1.95). The combined presence of these conditions together with obesity, known as the metabolic syndrome, was clearly more prevalent in psoriasis patients (OR = 5.29). In addition, psoriasis patients were significantly more likely to be smokers (OR = 2.96) and to have a regular or heavy consumption of alcohol (OR = 3.33 and 3.61, respectively). In conclusion, psoriasis patients appear to be at higher risk for diabetes mellitus and cardiovascular disease. This could likely be due to the effects of chronic inflammatory changes, in particular the secretion of proinflammatory cytokines. The risk of late term cardiovascular complications might support the use of systemic treatment in psoriasis.     

甲氨蝶呤治疗中、重度银屑病的疗效观察

目的:观察甲氨蝶呤(methotrexate,MTX)治疗中、重度银屑病的临床疗效和安全性。方法:41例银屑病患者每周接受MTX5～15mg静脉滴注治疗1次,共20次。结果:41例患者经过10～20周治疗后,痊愈16例(39.0%),显效17例(41.5%),好转7例(17.1%),无效1例(2.4%),有效率为80.5%,不良反应为纳差、恶心、呕吐、头痛、荨麻疹、月经过多、丙氨酸转氨酶轻度升高。结论:MTX5～15mg每周1次静脉滴注治疗中、重度银屑病安全有效。     

High prevalence of cardiovascular risk factors in patients with moderate or severe psoriasis in northern China

Recent studies suggest that psoriasis is a systemic disorder associated with cardiovascular disease (CVD) risk factors, such as obesity, hypertension and dyslipidemia. However, these risk factors have not been widely recognized across different populations. This cross-sectional study aimed to examine the association of risk factors for CVD with psoriasis by comparing patients with psoriasis and matched controls in northern China. This study identified 291 patients with diagnosed moderate or severe psoriasis as cases and 445 age- and gender-matched subjects as controls. A significant association (P < 0.01) was observed between overall psoriasis incidence and smoking [odds ratio (OR), 2.96; 95 % confidence interval (CI) 2.09–4.09], alcohol consumption (OR, 3.77; 95 % CI 2.381–5.955), diabetes (OR, 2.79; 95 % CI 1.70–4.59), hypertension (OR, 2.19; 95 % CI 1.56–3.06) and hyperlipidemia (OR, 1.76; 95 % CI 1.29–2.40). Furthermore, hypertension correlated with the duration of psoriasis after adjustment for age and sex. Hyperlipidemia, smoking and alcohol consumption were related to the severity of the disease. Moreover, patients with psoriasis had lower levels of apolipoprotein B (ApoB) and lipoprotein (Lip) than did controls (P < 0.05). These data suggest that multiple risk factors for CVD are associated with psoriasis. CVD risk factor screening should be performed, and appropriate measures should be taken accordingly for psoriasis patients.     

The efficacy of multiple courses of alefacept in patients with moderate to severe chronic plaque psoriasis

Among patients with psoriasis who did not achieve Psoriasis Area and Severity Index 50 during the first course of alefacept therapy, 53% achieved Psoriasis Area and Severity Index 50 during the second course (odds ratio [95% confidence interval] vs placebo 2.30 [1.26-4.19]). Alefacept provided incremental efficacy over 5 successive 12-week treatment courses.     

中度和重度银屑病患者经济负担及其影响因素研究

目的 探讨中国中、重度银屑病患者的直接经济负担及其影响因素。 方法 对中国7个城市、29家三级甲等医院皮肤科就诊的150例中度与重度银屑病患者（男女各75例）进行问卷调查,收集患者的社会人口学特征、临床特征和直接经济负担数据。对中重度患者的直接经济负担进行描述统计分析,并采用逐步多元回归进行影响因素分析。 结果 150例中、重度银屑病患者年龄（43.87 ± 13.42）岁,平均病程3年（2 ~ 6年）。中度82例,重度68例。患者年均直接经济负担为（6 452 ± 6 392）元,中度患者（4 163 ± 4 605）元,重度患者（9 212 ± 7 146）元,中度与重度比较,差异有统计学意义（z = 5.70,P < 0.001）。对患者直接经济负担的影响因素主要包括疾病严重程度、疾病类型、是否住院、是否患有并发症以及患者所在城市。 结论 重度银屑病患者的经济负担是中度银屑病患者的2倍。医生在对患者进行治疗时应加强对并发症及疾病严重程度的控制,并对非寻常性银屑病患者予以更多关注。     

中重度银屑病的维持治疗

银屑病目前尚是一种不可治愈的疾病,大部分患者不能实现长期的临床缓解,因此需要维持治疗以达到长期缓解的目的。然而,国外研究指出,接受传统治疗及光疗的中重度银屑病患者中约20%不能坚持为期1年的治疗［１］,接受生物制剂治疗的银屑病患者中10% ~ 15%在第1年就中断治疗［2-3］,而中重度银屑病患者中断治疗后多数在2 ~ 6个月内复发,影响疗效且增加经济负担,因此强调中重度银屑病的维持治疗很有必要。银屑病维持治疗的定义尚未明确,Mrowietz等［4］提到,中重度斑块型银屑病的治疗分为两个阶段,即诱导阶段和维持阶段。诱导阶段定义为16周,可根据情况适当延长到24周,维持阶段即为诱导阶段之后的时间段。本文提出的维持治疗概念指的是皮损基本消退之后的治疗……     

阿维A治疗斑块状银屑病临床疗效观察

目的:观察阿维A治疗中、重度斑块状银屑病的疗效.方法:将中、重度斑块状银屑病患者随机分成两组,分别给予阿维A和海棠合剂治疗,疗程均为8周,以银屑病面积和严重度指数(PASI)和皮肤病生活质量指数(DLQI)作为观察指标,比较两种药物的疗效.结果:治疗后,两组患者的PASI评分和DLQI评分与治疗前比较均显著下降(P＜0.01),但PASI改善率和DLQI改善率两组间比较差异无统计学意义,PASI50和PASI75有效率亦无统计学意义(P＞0.05).结论:阿维A治疗中、重度斑块状银屑病有效.     

Recommendations for the treatment of nail psoriasis in patients with moderate to severe psoriasis: a dermatology expert group consensus

Background Nail involvement is common in psoriasis patients and is often associated with severe disease. Patients with nail psoriasis experience pain, functional impairment and social stigma, with significant restriction of daily activities and quality of life. However, nail psoriasis often goes untreated, as many physicians believe it is difficult to treat, despite the availability of effective treatment options. Clinical data and guidelines for managing and treating psoriasis patients with both skin and nail symptoms are limited. Objective To prepare recommendations for the management and treatment of patients with moderate to severe psoriasis with nail involvement. Methods A collaborative Delphi survey was used to obtain consensus on current practice in the management of nail disease in patients with moderate to severe psoriasis from an expert panel of 11 dermatologists from Europe and Canada with substantial clinical expertise in managing these patients. Agreement was defined utilizing a Likert scale of 1–9. Consensus regarding agreement was an interquartile range (IQR) ≥7; consensus regarding disagreement was an IQR ≤3. Results The expert panel addressed several topics including burden of disease, nail assessment, treatment goals and treatment options. The panel agreed that: it is extremely important to assess nail involvement in patients with psoriasis; nail assessments are rarely performed in routine clinical practice; full skin and nail clearance is an achievable goal with appropriate systemic therapy in patients with moderate to severe psoriasis with nail involvement. Conclusion This article provides useful and practical considerations for the management and treatment of patients with moderate to severe skin and nail psoriasis.     

Combination therapy to treat moderate to severe psoriasis

In patients with moderate-to-severe psoriasis, remission can be difficult to achieve and sustain. Both acutely acting and long-term maintenance agents are needed. Speed and efficiency of available monotherapies tend to be inversely proportional to safety. Combination, rotational, and sequential approaches are often more effective and safer than single-agent therapy. Combining agents with complementary adverse effect profiles is preferable. Apparent synergistic enhancement is seen with most paired combinations of the four major therapies: acitretin, phototherapy (ultraviolet B/psoralen plus ultraviolet A), cyclosporine, and methotrexate. Of those, only cyclosporine in combination with psoralen plus ultraviolet A is contraindicated because of increased cancer risk. Combinations of each of those major therapies with topical agents (retinoids, steroids, vitamin D derivatives, and others) have been used with varying efficacy and safety. The immunomodulators, hydroxyurea and thioguanine, have also shown some success in combination therapy. The new biologic agents with their novel modes of action and adverse effect profiles may prove to be important adjuncts in combination/rotational/sequential approaches. In some cases, monotherapy (with either systemic agents or phototherapy) adequately controls moderate to severe disease. A regimen using a single agent has the advantages of lower cost and greater adherence by the patient. For any number of reasons, however, including loss of efficacy, adverse effects, or cumulative or acute toxicity-and especially the inability to clear resistant lesions-a single modality will not be adequate. Using two or more therapies is thus the rule rather than the exception for most patients with moderate-to-severe psoriasis, but picking a combination that serves to balance safety and efficacy needs careful consideration, especially since no evidence-based treatment guidelines exist.     

Use of biological agents in patients with moderate to severe psoriasis: a cohort-based perspective

OBJECTIVE: To compare characteristics of patients enrolled in a long-term multicenter cohort trial who had used biological therapies for treatment of psoriasis with those who had not used these agents. DESIGN: Retrospective analysis of users vs nonusers of biological therapies. SETTING: Database from the PUVA Follow-up Study, a multicenter, 30-year study of patients originally treated with psoralen UV-A (PUVA) for moderate to severe psoriasis. Patients A total of 521 patients who completed the last cycle of follow-up of the PUVA Follow-up Study. MAIN OUTCOME MEASURES: Demographic data, severity data (physician global assessment), type of biological therapy used, patients' opinions about their therapy, and their best treatment. RESULTS: Seventy-four of 521 patients (14%) used biological therapies: 65% etanercept (n = 48), 22% infliximab (n = 16), 11% efalizumab (n = 8), and 8% alefacept (n = 6). Users of biological therapies were younger, had more formal education, and were more likely to have had a greater extent of psoriasis at entry than the other cohort members. In 1998, those who used biological treatments were more likely than other cohort members to have been assessed as having severe psoriasis. In 2004, no significant difference was noted. Users of etanercept considered this agent to be as effective as methotrexate and more effective in clearing their skin and having fewer adverse effects than PUVA or UV-B. The proportion of patients originally enrolled in the 16 centers who had used biological agents varied greatly (0%-33%). CONCLUSION: After short durations of therapy, patients' opinions about biological agents tended to be positive.     

司库奇尤单抗治疗中重度斑块型银屑病患者中NLR与PASI值相关性分析

目的：分析司库奇尤单抗治疗中重度斑块型银屑病时中性粒细胞和淋巴细胞比值(NLR)与PASI值的相关性。方法：2017年4月1日至7月31日中重度斑块型银屑病患者每周皮下注射司库奇尤单抗,治疗4次,随后每4周1次,治疗11次。结果：司库奇尤单抗共治疗中重度斑块型患者22例,PASI评分由治疗前的22.28分下降至2.31分,NLR下降值同PASI下降值具有相关性（r12周=0.504,r24周=0.604,r36周=0.470,r48周=0.454;均P<0.05）。结论：司库奇尤单抗治疗银屑病有效,NLR下降值与PASI下降值呈正相关。     

Strategies for optimizing treatment with efalizumab in moderate to severe psoriasis

With the advent of biological therapies for the treatment of plaque psoriasis, guidance on the usage of these new agents has become necessary. One such agent, efalizumab, a humanized recombinant monoclonal IgG₁ antibody developed to target T-cell-mediated inflammation, provides rapid and sustained efficacy for many psoriasis patients. This article explores the pretreatment, initiation, and treatment phases with efalizumab therapy. In the pretreatment phase, physicians need to assess patients’ disease state and educate them about the course of efalizumab treatment. Prior to initiation, physicians need to establish stable disease, ensure an adequate transition or washout of any prior psoriasis therapeutics, and obtain baseline platelet counts. After initiating treatment, both physician and patient must participate in disease monitoring. Patients responding favourably may receive continuous treatment. Those who do not respond to the drug or who experience adverse events should be managed appropriately in order to continue therapy or be transitioned onto another agent. A growing body of clinical evidence, as well as experience from clinical investigators, has provided much insight into the management strategies for patients undergoing treatment with efalizumab.