Komorbiditäten und Psoriasis

Psoriasis in obesity: comparison of serum levels of leptin and adiponectin in obese subjects - cases and controls

BACKGROUND

Psoriasis and obesity are somewhat related to a low-grade systemic inflammatory response.

OBJECTIVES

To determine leptin and adiponectin levels in psoriasis patients compared to control patients matched for weight.

METHODS

A case-control study was performed, evaluating 113 psoriasis patients and 41 controls with other dermatologic diseases.

RESULTS

The prevalence of obesity was 33% in cases and 21.9% in controls. All evaluated comorbidities were more prevalent among cases. When stratified by weight, the comorbidities were more frequent in overweight patients. We found no correlation between being overweight (p=0.25), leptin (p=0.18) or adiponectin (p=0.762) levels and psoriasis severity. When overweight cases and controls were compared, we found differences in the adiponectin values (p= 0.04). The overweight cases had lower adiponectin levels than the overweight controls. We found no differences in the leptin dosage between cases and controls. The overweight cases had higher leptin values than the normal weight cases (p<0.001).

STUDY LIMITATIONS

Several patients used systemic anti-inflammatory medication.

CONCLUSIONS

The prevalence of obesity among psoriasis cases (33%) was higher than in the general population (17.4%). We did not find any correlation between severity of psoriasis and inflammatory cytokines and the condition of being overweight. The overweight cases had lower values of adiponectin than the overweight controls. It seems, therefore, that there is a relationship between adiponectin and psoriasis, but this relationship depends on the presence of obesity.

Signaling Рathway Blockers: Action Mechanism, Efficacy, Safety of Therapy for Patients with Psoriasis and Psoriatic Arthritis

In the literature review, contemporary data on immune pathogenesis of psoriasis and the emergence of comorbid states against the background of systemic chronic inflammation among patients is discussed. On the example of the apremilast medical preparation, the information on a new class of therapeutic agents for the treatment of psoriasis and psoriatic arthritis – “small molecules” is given, including their physicochemical properties and action mechanism, as well as on the key differences from immune-suppressive and genetically engineered biological preparations. Data on large-scale international randomised clinical trials of the efficacy and safety of the PDE4 inhibitor of apremilast among patients with moderate to severe psoriasis and psoriatic arthritis is presented. The published international clinical recommendations on the use of apremilast among patients with psoriasis and psoriatic arthritis, the criteria for evaluating the response to therapy, as well as the potential profile of patients for the use of apremilast in real clinical practice are discussed.

Addiction: an underestimated problem in psoriasis health care

BACKGROUND

Psoriasis is a disease of enormous socio-economic impact. Despite approval of numerous highly efficient and costly therapies, a minor proportion of severely affected patients actually receives sufficient treatment.

OBJECTIVE

To investigate whether addictions are associated with psoriasis and to develop evidence-based recommendations for dermatologists in their daily clinical practice in order to improve medical assessment of psoriasis and patients' quality of life.

PATIENTS AND METHODS

Psoriasis patients at the University Department of Dermatology were asked to fill out a paper-based self-reported anonymous questionnaire with 92 questions of validated screening tests for the six most common addictions in Germany (alcohol, nicotine, drugs and illegal drugs, gambling, food). Body weight and height as well as current Psoriasis Area and Severity Index (PASI) were documented as well.

RESULTS

Between October 2015 and February 2016, 102 patients (65 males, 37 females; mean age 49.7 years (SD 13.4), range 18-83 years) participated in the study. Fifty-seven of the 102 patients showed addictive behaviour. Of these, 23.8% were high-risk drinkers, 41% regular smokers, 11% at risk of drug abuse, 4.1% at risk of food dependency and 19% compulsive gamblers. Compared with the general population, these results are significantly higher for alcohol abuse (P < 0.005), nicotine (P < 0.001) and gambling (P < 0.001). Body mass index was significantly higher in the study population (P < 0.001).

CONCLUSION

Addictions and gambling are more prevalent in patients with psoriasis compared with the general population. Respective screening measures are recommended in daily practice for doctors treating psoriasis patients, and PeakPASI is suggested as a score to document patients' lifetime highest PASI. Parallel to new drug approvals and even more detailed insights into the pathomechanism of psoriasis, public health strategies and interdisciplinary approaches are essential for a general sustained psoriasis treatment.

Systemic antipsoriatic combination therapy with fumaric acid esters for plaque-type psoriasis: report on 17 cases

BACKGROUND

In the literature as well as in existing psoriasis guidelines, only little evidence is available on combination regimens with systemic antipsoriatic agents. However, if systemic monotherapy is not efficacious enough to control the disease, a combination therapy might be necessary.

OBJECTIVE

To evaluate the use of fumaric acid esters (FAEs) in combination with other antipsoriatic agents in 6 specialized dermatological departments in Germany.

METHODS

A systematic retrospective chart review of patients receiving FAEs was performed.

RESULTS

A total of 17 cases of patients receiving FAEs combined with at least one other systemic therapy (methotrexate, acitretin, etanercept, cyclosporine, leflunomide and infliximab) to treat psoriasis or psoriatic arthritis were identified.

CONCLUSION

FAEs can be combined in an off-label setting with conventional as well as biological agents to treat recalcitrant psoriasis or psoriatic arthritis. Safety monitoring should be taken seriously as no controlled data for these combination regimens exist.

Psoriasis: to treat or to manage?

The recognition of psoriasis as a systemic disorder with characteristic skin symptoms and associated diseases has changed treatment concepts substantially. The complexity of psoriasis disease not only requires appropriate therapy but also weight-loss and smoking cessation programmes as well as trigger factor elimination. The term 'management' may better reflect the aim for a holistic approach of disease control. Comorbidity and the presence of psoriatic arthritis are important denominators for drug selection. However, there is a lack of prospective data substantiating a benefit of associated diseases by antipsoriatic therapy. Securing success using treatment goals helps to establish an efficacious therapy and to control inflammation. A regular scoring of disease severity, patients' quality of life and assessment of other clinically relevant conditions are mandatory to closely follow the disease course. There is debate whether an early treatment may modulate the future course of psoriasis. Concepts of minimal disease activity have not been implemented in psoriasis yet. There is a lack of evidence how long any treatment should be given and when and how to terminate. Finally, outcome tools should specifically be tailored for psoriasis to evaluate disease-related items as well as the benefit of management from the patient's perspective.

Psoriasis and psychiatric morbidity: a profile from a tertiary care centre of eastern India

Context:

Psoriasis has an impact on psychology of the patients. There is a dearth of studies regarding this field in eastern India.

Aims and Objectives:

The primary objective of this study is to evaluate the psychiatric morbidity in psoriasis and secondary objective is to assess the morbidity in all eight dimensions of psychosocial and physical aspects, i.e. cognitive, social, discomfort, limitations, depression, fear, embarrassment and anger.

Settings and Design:

Institutional based case control study.

Materials and Methods:

Forty-eight patients of psoriasis and equal number of healthy controls were included in the study. Self-reporting questionnaire-24 (SRQ-24) and skindex (A 61-item survey questionnaire) were used to assess the psychiatric morbidity in both groups.

Statistical Analysis Used:

“MedCalc version 10.2.0.0” (by Acacialaan 22, B-8400, Ostend, Belgium) was used as statistical software. Chi-square test was used as a test of significance.

Results:

The SRQ assessed psychiatric morbidity in the study group was 62.5%, compared with 18.5% in the control group. This difference was statistically significant (P < 0.001). Guttate psoriasis had maximum association with psychiatric morbidity (100%), followed by plaque type (63.6%) and palmoplantar type (42.8%). According to the skindex, the most common psychiatric morbidity in psoriasis patients was anger (58.3%), followed by discomfort (52.08%), social problem (52.08%), cognitive impairment (50%), embarrassment (50%), physical limitation (47.91%), fear (47.91%) and depression (43.75%). The skindex observed psychiatric morbidity among the case and control group was statistically significant for all the parameters (P < 0.0001).

Conclusion:

Psoriasis has a high degree of psychiatric morbidity and the extent of this co-morbidity is even greater than hitherto thought of.

Application of metabolomics on diagnosis and treatment of patients with psoriasis in traditional Chinese medicine

Traditional Chinese medicine (TCM) is one of the oldest forms of medical system. With syndrome as the core of diagnosis and therapy in TCM, it has the advantage of collecting macroscopic information of patients for diagnosis. To understand the in vivo mechanism of TCM, a metabolomics approach was used to investigate the global biological characterization of the urine of psoriasis patients with Blood Stasis Syndrome and the therapeutic metabolomics mechanism of the Optimized Yinxieling formula. A total of 41 cases of psoriasis patients with Blood Stasis Syndrome and 19 healthy volunteers were enrolled in this study. Fasting urine samples from patients with consecutive Optimized Yinxieling intake after 0, 4, 8 and 12 weeks and from healthy volunteers were analyzed by Orthogonal Projection on Latent Structures Discriminant Analysis (OPLS-DA), which was utilized for High Performance Liquid Chromatography (HPLC) analysis and temporal metabolic changes identification. For psoriasis group, the scores of PASI of patients decreased after 12 weeks of Optimized Yinxieling treating. The metabolic variations visualized not only in the healthy group and psoriasis group, but also in the psoriasis group before and after Optimized Yinxieling treatment, demonstrated that the metabolic characteristics of the two groups were significantly different. The optimized complex structure of the target proteins from Protein Data Bank was analyzed by software package Discovery Studio. With docking score of original inhibitor and the receptor as the threshold values, two compounds from Chinese medicinal chemical database were predicted to have good interactions with the target proteins. The Metabolomics technique combining molecular docking analysis enhanced our current understanding of the metabolic response to Blood Stasis Syndrome of Psoriasis and the action mechanism of Optimized Yinxieling. This article is part of a Special Issue entitled: Computational Proteomics, Systems Biology & Clinical Implications. Guest Editor: Yudong Cai.