A clinical study of psoriasis and its association with co-morbid conditions
Keywords:
Psoriasis, metabolic syndrome, comorbiditiesAbstract
Objectives The study aimed (1) to compare incidence of co-morbidities among psoriatic patients (cases) and nonpsoriatic patients (controls), (2) to determine the association between psoriasis and various co-morbidities and (3) to determine the relationship between the severity of psoriasis and co-morbidities. Methods We performed a hospital-based case-control study involving 100 psoriatic patients (cases) and 100 age- and sex-matched nonpsoriatic patients (controls) from the dermatology outpatient department in a government teaching institute. Detailed history and examination was followed by relevant investigations. The severity of psoriasis was assessed according to Psoriasis Area and Severity Index (PASI), and body surface area (BSA) measurement. Cardiovascular risk factors were assessed by using the definition for metabolic syndrome, which includes the presence of three or more of the National Cholesterol Education Program’s Adult Panel III (ATP III) criteria. Results The study revealed statistically significant association of psoriasis with metabolic syndrome (27% vs 8%, p = 0.0004) and psoriatic arthritis. Psoriatic patients had significantly higher levels of triglycerides (24% vs 8%, p = 0.002) and fasting blood sugar (23 % vs 8%, p = 0.003) along with significantly lower HDL levels (29 % vs 7%, p = 0.000, in males and 7% vs 2%, p = 0.043 in females). Abdominal obesity was more prevalent in psoriatic patients (24 % vs 9%, p = 0.02 in male and 9 % vs 3%, p = 0.033 in females). Neither metabolic syndrome nor psoriatic arthritis correlated with the severity of psoriasis. Conclusion There was higher prevalence of metabolic syndrome in patients with psoriasis. However, its presence did not correlate with either severity or duration of the psoriasis. Hence, we suggest that all patients need to be evaluated for metabolic syndrome irrespective of severity of psoriasis which is the risk factor for systemic diseases.References
Griffiths C, Barker J. Psoriasis. In: Burns T, Breathnach S, Cox N, Griffiths C, editors. Rook’s Textbook of Dermatology. 8th ed. Oxford: Blackwell Science; 2010. p. 20.1-20.19
Godjonsson J, Elder J. Psoriasis. In: Goldsmith L, Katz S, Gilchrest B, Paller A, Leffell D, Wolff K, editors. Fitzpatrick’s dermatology in General Medicine. 8th ed. New York: McGraw-Hill: 2012. p. 197-231.
Azfar RS, Gelfand JM. Psoriasis and metabolic diseases: epidemiology and pathophysiology. Curr Opin Rheumatol. 2008;20:416-22.
Menter A, Griffiths C, Tebbey P, Horn E, Sterry W; on behalf of the international Psoriasis Council. Exploring the association between cardiovascular and other disease-related risk factors in the psoriasis population: The need for increased understanding across the medical community. J Eur Acad Dermatol Venereol. 2010;24:1371-7.
Sommer DM, Jenisch S, Suchan M, Christophers E, Weichenthal M. Increased prevalence of the metabolic syndrome in patients with moderate to severe psoriasis. Arch Dermatol Res. 2006;298; 321-8.
Gisondi P, Tessari G, Conti A, Piaserico S, Schianchi S, Peserico A et al. Prevalence of metabolic syndrome in patients with psoriasis: a hospital-based case-control study. Br J Dermatol. 2007;157:68-73
Ena P, Madeddu P, Glorioso N, Cerimele D, Rappelli A. High prevalence of cardiovascular diseases and enhanced activity of the renin-angiotensin system in psoriatic patients. Acta Cardiol. 1985;40:199-205.
Onumah N, Kircik LH. Psoriasis and its comorbidities. J Drugs Dermatol. 2012;11:s5-10
Lal S. Clinical pattern of psoriasis in Punjab. Indian J Dermatol Venereol Leprol. 1996;35:5-12.
Bedi TR. Psoriasis in north India. Geographical variations. Dermatological 1977;155:310-4.
Grover C. Psoriasis. In: Sacchidanand S, Editor. IADVL Textbook of Dermatology. Mumbai: Bhalani; 2015. p.1042.
Bedi TR. Clinical profile of psoriasis in North India. Indian J Dermatol Venereol Leprol. 1995;61:202-5.
Pavithran K, Karunakaran M, Aparna P, Raghunatha S. Disorders of keratinization. In: Sacchidanand S, Editor. IADVL Textbook of Dermatology. Mumbai: Bhalani; 2013. p.1037.
Prasad PVS, Babu B, Kaviarasan PK, Senthilnathan A. A clinical study of psoriatic arthropathy. Indian J Dermatol Venereol Leprol. 2007;73:166-70.
Reich K, Kruger K, Mossner R, Augustin M. Epidemiology and clinical pattern of psoriatic arthritis in Germany: A prospective interdisciplinary epidemiological study of 1511 patients with plaque-type psoriasis. Br J Dermatol. 2009;160:1040-7.
Henseler T, Christophers E. Disease concomitance in psoriasis. J Am Acad Dermatol. 1995;32:982-6.
Christophers E. Comorbidities in psoriasis. Clin Dermatol. 2007;25:529-34.
Naldi L, Mercury SR. Epidemiology of comorbidities in psoriasis. Dermatol Ther. 2010;23:114-8.
Sanjeev JA. Comorbidities in psoriasis. Indian J Dermatol Venereal Leprol. 2013;79:s10-s17.
Neimann AL, Shin DB, Wang X, Margolis DJ, Troxel AB, Gelfand JM. Prevalence of cardiovascular risk factors in patients with psoriasis. J Am Acad Dermatol. 2006;55:829-35.
Yang YW, Keller JJ, Lin HC. Medical comorbidity associated with psoriasis in adults: A population-based study. Br J Dermatol. 2011;165:1037-43.
Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol Education Program (NCEP) Expert Panel On Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel III). JAMA. 2001;285:2486-97.
The IDF consensus worldwide definition of the metabolic syndrome. Internal Diabetes Federation, 2006.
Alberti KG, Zimmet P, Shaw J, IDF Epidemiology Task Force Consensus Group. The metabolic syndrome – A new worldwide definition. Lancet 2005;366:1059-62.
Liu J, Grundy SM, Wang W, Smith SC Jr, Vega GL, Wu Z et al. Ethnic-specific criteria for the metabolic syndrome: Evidence from China. Diabetes Care 2006;29:1414-6.
Love TJ, Qureshi AA, Karlson EW, Gelfand JM, Choi HK. Prevalence of the metabolic syndrome in psoriasis: Results from the National Health and Nutrition Examination Survey, 2003-2006. Arch Dermatol. 2011;147:419-24.
Sterry W, Strober BE, Menter A, International Psoriasis Council. Obesity in psoriasis: The metabolic, clinical and therapeutic implications. Report of an interdisciplinary conference and review. Br J Dermatol 2007;157:649-55.
Pietrzak A, Chodorowska G, Szepietowski J, Zalewska-Janowska A, Krasowska D, Hercogová J. Psoriasis and serum lipid abnormalities. Dermatol Ther. 2010;23:160-73.
Cohen AD, Gilutz H, Henkin Y, Zahger D, Shapiro J, Bonneh DY et al. Psoriasis and the metabolic syndrome. Acta Derm Venereol. 2007;87:506-9.
Qureshi AA, Choi HK, Setty AR, Curhan GC. Psoriasis and the risk of diabetes and hypertension: a prospective study of US female nurses. Arch Dermatol. 2009;145:379-82
Nisa N, Qazi MA. Prevalence of metabolic syndrome in patients with psoriasis. Indian J Dermatol Venereol Leprol. 2010;76:662-5.
Ghiasi M, Nouri M, Abbasi A, Hatami P, Abbasi MA, Nourijelyani K. Psoriasis and increased prevalence of hypertension and diabetes mellitus. Indian J Dermatol. 2011;56:533-6.
Pereira RR, Amladi ST, Varthakavi PK. A study of the prevalence of diabetes, insulin resistance, lipid abnormalities, and cardiovascular risk factors in patients with chronic plaque psoriasis. Indian J Dermatol. 2011;56:520-6.
Kutlu S, Ekmekci TR, Ucak S, Koslu A, Altuntas Y. Prevalence of metabolic syndrome in patients with psoriasis. Indian J Dermatol Venereol Leprol. 2011;77;193-4.
Akcali C, Buyukcelik B, Kirtak N, Inaloz S. Clinical and laboratory parameters associated with metabolic syndrome in Turkish patients with psoriasis. J Int Med Res. 2014;
Ali NM, Kuruvila M, Unnikrishnan B. Psoriasis and metabolic syndrome: A case control study. Indian J Dermatol Venereol Leprol. 2014;80:255-6
Masmoudi J, Maalej I, Masmoudi A, Rached H, Rebai A, Turki H et al. Alexithymia and psoriasis: a case control study of 53 patients. Encephale. 2009;35:10-7.
Krueger G, Koo J, Lebwohl M, Menter A, Stern RS, Rolstad T. The impact of psoriasis on quality of life: results of a 1998 National Psoriasis Foundation patient membership survey. Arch Dermatol. 2001;137:280-4.
Esposito M, Saraceno R, Giunta A, Maccarone M, Chimenti S. An Italian study on psoriasis and depression. Dermatology. 2006;212:123-7.
Gupta MA, Gupta AK. Depression and suicidal ideation in dermatology patients with acne, alopecia areata, atopic dermatitis and psoriasis. Br J Dermatol. 1998;139:846-50.
Campolmi E, Zanieri F, Santosuosso U, D'Erme AM, Betti S, Lotti T et al. The importance of stressful family events in psoriatic patients: a retrospective study. J Eur Acad Dermatol Venereol. 2012;26:1236-9.
Devrimici-Ozguven H, Kundakci N, Kumbaser H, Boyvat A. The depression, anxiety, life satisfaction and affective expression levels in psoriasis patients. J Eur Acad Dermatol Venereol. 2000;14:267-71.
