Body mass index, abdominal fatness, weight gain and the risk of psoriasis: a systematic review and dose-response meta-analysis of prospective studies

Association between lipid accumulation product and psoriasis among adults: a nationally representative cross-sectional study

BACKGROUND

Lipid accumulation product (LAP) is an accessible and relatively comprehensive assessment of obesity that represents both anatomical and physiological lipid accumulation. Obesity and psoriasis are potentially related, according to previous research. Investigating the relationship between adult psoriasis and the LAP index was the goal of this study.

METHODS

This is a cross-sectional study based on data from the National Health and Nutrition Examination Survey (NHANES) 2003-2006 and 2009-2014. The association between LAP and psoriasis was examined using multivariate logistic regression and smoothed curve fitting. To verify whether this relationship was stable across populations, subgroup analyses and interaction tests were performed.

RESULTS

The LAP index showed a positive correlation with psoriasis in 9,781 adult participants who were 20 years of age or older. A 27% elevated probability of psoriasis was linked to every unit increase in ln LAP in the fully adjusted model (Model 3: OR 1.27, 95% CI 1.06-1.52). In comparison with participants in the lowest ln LAP quartile, those in the highest quartile had an 83% greater likelihood of psoriasis (Model 3: OR 1.83, 95% CI 1.08-3.11). This positive correlation was more pronounced for young males, participants who had never smoked, non-drinkers, participants who exercised little, as well as non-hypertensive and non-diabetic participants.

CONCLUSIONS

This study found that the LAP index and adult psoriasis were positively correlated, especially in young males without comorbidities. Therefore, it is proposed that LAP may serve as a biomarker for early diagnosis of psoriasis and tracking the effectiveness of treatment.

The Effect of a Ketogenic Diet versus Mediterranean Diet on Clinical and Biochemical Markers of Inflammation in Patients with Obesity and Psoriatic Arthritis: A Randomized Crossover Trial

The effect of different diet patterns on psoriasis (PSO) and psoriatic arthritis (PSA) is unknown. Τhe aim of our study was to evaluate the effectiveness of a Mediterranean diet (MD) and Ketogenic diet (KD), in patients with PSO and PSA. Twenty-six patients were randomly assigned to start either with MD or KD for a period of 8 weeks. After a 6-week washout interval, the two groups were crossed over to the other type of diet for 8 weeks. At the end of this study, MD and KD resulted in significant reduction in weight (p = 0.002, p < 0.001, respectively), in BMI (p = 0.006, p < 0.001, respectively), in waist circumference (WC) (p = 0.001, p < 0.001, respectively), in total fat mass (p = 0.007, p < 0.001, respectively), and in visceral fat (p = 0.01, p < 0.001, respectively), in comparison with baseline. After KD, patients displayed a significant reduction in the Psoriasis Area and Severity Index (PASI) (p = 0.04), Disease Activity Index of Psoriatic Arthritis (DAPSA) (p = 0.004), interleukin (IL)-6 (p = 0.047), IL-17 (p = 0.042), and IL-23 (p = 0.037), whereas no significant differences were observed in these markers after MD (p > 0.05), compared to baseline. The 22-week MD-KD diet program in patients with PSO and PSA led to beneficial results in markers of inflammation and disease activity, which were mainly attributed to KD.

Relative fat mass and prediction of incident atrial fibrillation, heart failure and coronary artery disease in the general population

BACKGROUND

Relative fat mass (RFM) is an emerging marker of obesity that estimates body fat percentage using a sex-specific formula containing height and waist circumference (WC). We studied the association of RFM with incident atrial fibrillation (AF), heart failure (HF), and coronary artery disease (CAD) and explored RFM cutoffs for cardiovascular disease (CVD) prediction.

METHODS

We studied 95,003 participants (age 45 ± 13 years, 59% women) without prevalent AF, HF or CAD from the population-based Lifelines study. Outcomes were ascertained using electrocardiography and self-reported questionnaire data. We used logistic regression to study the association of RFM with individual outcomes and a composite outcome (incident AF, HF, and/or CAD). Multivariable models were adjusted for components of the SCORE risk model (age, sex, systolic blood pressure, cholesterol, and smoking). Optimal cutoffs were determined using the Youden index.

RESULTS

During a median follow-up of 3.8 (3.0-4.6) years, 224 (0.2%) participants developed AF, 1003 (1.1%) HF and 657 (0.7%) CAD. After multivariable adjustment, RFM was significantly associated with all outcomes (standardised OR 1.26, 95% CI 1.18-1.34 for the composite outcome). Optimal RFM cutoffs ( ≥26 for men, ≥38 for women) were lower than previously proposed RFM cutoffs ( ≥30 for men, ≥40 for women). In general, overall discriminative ability of RFM and its cutoffs was at least similar (in women) or better (in men) compared to BMI and WC. Since RFM was substantially correlated with age, we additionally determined age-specific cutoffs, which ranged from 23 to 27 in men and 33 to 43 in women.

CONCLUSIONS

RFM is associated with incident AF, HF, and CAD and may be used as a simple and intuitive marker of obesity and cardiovascular risk in the general population. This study provides potential RFM cutoffs for CVD prediction that may be used by future studies or preventive strategies targeting obesity and cardiovascular risk.

An Observational Study of 147 Psoriasis Patients: Overweightness and Obesity as a Significant Clinical Factors Correlated with Psoriasis

Background and Objectives: Psoriasis is a common, chronic, and immune-mediated inflammatory skin disease recognized to lead to a wide range of comorbid disorders, mainly obesity. The study aimed to evaluate the problem of overweightness and obesity among psoriasis patients in the context of their prevalence and influence on the disease course. Materials and Methods: The study group encompassed 147 adult patients with plaque psoriasis. Results: The prevalences of overweightness (39.46%) and obesity (37.41%) demonstrated in the study showed the strong predisposition of psoriatic patients for abnormal body mass. The vast majority (77%) of subjects with psoriatic arthritis were overweight or obese. The results of the correlation analysis revealed the significant impacts of overweightness and obesity, as defined by the BMI index, on modifying the severity of psoriasis (as assessed by the PASI with a correlation coefficient of R = 0.23, p = 0.016; and BSA values with a correlation coefficient of R = 0.21, p = 0.023), particularly in contrast to patients with a normal body mass. Conclusions: Overweightness and obesity constitute a major health burden among psoriatic patients, influencing the disease course and severity. Enhanced understanding of the phenomenon may directly translate into improving disease management and overall patient care.

No causal effect of genetically determined circulating homocysteine levels on psoriasis in the European population: evidence from a Mendelian randomization study

Background

Although numerous studies demonstrated a link between plasma homocysteine (Hcy) levels and psoriasis, there still exists a certain level of controversy. Therefore, we conducted a Mendelian randomization study to investigate whether homocysteine plays a causative role in the development or exacerbation of psoriasis.

Methods

A two-sample Mendelian randomization (MR) analysis was conducted. Summary-level data for psoriasis were acquired from the latest R9 release results from the FinnGen consortium (9,267 cases and 364,071 controls). Single nucleotide polymorphisms (SNPs) robustly linked with plasma Hcy levels at the genome-wide significance threshold (p < 5 × 10-8) (18 SNPs) were recognized from the genome-wide meta-analysis on total Hcy concentrations (n = 44,147 participants) in individuals of European ancestry. MR analyses were performed utilizing the random-effect inverse variance-weighted (IVW), weighted median, and MR-Egger regression methods to estimate the associations between the ultimately filtrated SNPs and psoriasis. Sensitivity analyses were conducted to evaluate heterogeneity and pleiotropy.

Results

MR analyses revealed no causal effects of plasma Hcy levels on psoriasis [IVW: odds ratio (OR) = 0.995 (0.863-1.146), p = 0.941; weighed median method: OR = 0.985 (0.834-1.164), p = 0.862; MR-Egger regression method: OR = 0.959 (0.704-1.305), p = 0.795]. The sensitivity analyses displayed no evidence of heterogeneity and directional pleiotropy, and the causal estimates of Hcy levels were not influenced by any individual SNP.

Conclusion

Our study findings did not demonstrate a causal effect of genetically determined circulating Hcy levels on psoriasis.

Update on Obesity in Psoriasis Patients

Psoriasis is a chronic inflammatory skin condition, with genetic, epigenetic, environmental, and lifestyle factors contributing to its onset and recurrence. Severe psoriasis has a great impact on quality of life, which is similar to that of insulin-dependent diabetes, depression, and ischemic heart disease, but with a lower mortality. There is an overlap between the rising incidences of autoimmune diseases and obesity. In recent years, research has shown that there is an association between psoriasis and obesity. Psoriasis is linked to obesity in a two-way manner, as each can precipitate the development of the other. Several adipose tissue-secreted adipokines were shown to be elevated in obese psoriasis patients, exhibiting similar mechanisms of action to those underlying the pathogenesis of psoriasis. Excess body weight can influence not only the treatment response in psoriasis, but also the adverse events, leading to decreased patient compliance. Specific human microbiome patterns have been identified for obesity and psoriasis and could represent a future therapeutic target in selected individuals.

Insulin Stimulates IL-23 Expression in Human Adipocytes: A Possible Explanation for the Higher Prevalence of Psoriasis in Obesity

Purpose

Psoriasis is a chronic systemic inflammatory disease involving the production of many pro-inflammatory cytokines derived from immune cells and interacting with different tissues leading to the typical skin lesions. Psoriasis shows a higher prevalence and a worse progression in obese than in lean subjects. The IL-23/IL-17 immune axis has a pivotal role in the pathogenesis of psoriasis and anti-IL-23 monoclonal antibodies are highly effective in its treatment. Since obesity in frequently associated with elevated insulin plasma levels, we have investigated the ability of in vitro differentiated human adipocytes to produce IL-23 at basal conditions and after insulin stimulation.

Material and Methods

In vitro differentiated human adipocytes were incubated in the absence and presence of different insulin concentrations and the expression of IL-23 was analyzed by real-time PCR and Western blotting.

Results

The results of this study show that in vitro differentiated human adipocytes spontaneously express IL-23 mRNA and protein being stimulated by insulin in a dose-dependent manner. The stimulatory effects of insulin on IL-23 expression were specific since it did not stimulate the expression of other well-known cytokines involved in psoriasis pathogenesis such as Il-22 nor LL-37. Furthermore, lipopolysaccharide did not stimulate IL-23 expression in human adipocytes, thus highlightening the specific effects of insulin in the stimulation of IL-23 expression in human adipocytes.

Conclusion

Here we show that human adipocytes spontaneously express IL-23 and that insulin stimulates IL-23 production by these cells in a specific manner as other stimuli, known to be involved in psoriasis pathophysiology, are ineffective. These observations could explain the association between psoriasis and obesity, a condition frequently characterized by a state of insulin hypersecretion.

Advanced Glycation End Products and Psoriasis

Advanced glycation end products (AGEs) are biologically active compounds formed physiologically throughout a sequence of chemical reactions, to generate highly oxidant-reactive aldehydes that combine covalently to proteins. They accumulate slowly in tissues during ageing but also in metabolic and selected inflammatory disorders. Accumulation of AGEs occurs more rapidly and intensely in the skin and serum of patients with type 2 diabetes, obesity, cardiovascular diseases, chronic renal insufficiency, and non-alcoholic fatty liver disease and also in the skin of patients with psoriasis. All of the above conditions are intimately associated with psoriasis. Interaction of AGEs with their receptors (RAGEs) stimulates cellular signaling with the formation of reactive oxygen species and activation of nuclear factor kappa light chain enhancer of activated B (NF-kB), which is a key regulator in the expression of inflammatory mediators and the production of oxidative stress. Thus, AGEs may play an interesting pathogenic role in the intersection of inflammatory and metabolic diseases, may represent a biomarker of inflammation and a potential target for novel therapeutic strategies. This is a narrative review with the objective to summarize current evidence on the role of AGEs in psoriasis.

Psoriatic Arthritis: Pathogenesis and Targeted Therapies

Psoriatic arthritis (PsA), a heterogeneous chronic inflammatory immune-mediated disease characterized by musculoskeletal inflammation (arthritis, enthesitis, spondylitis, and dactylitis), generally occurs in patients with psoriasis. PsA is also associated with uveitis and inflammatory bowel disease (Crohn's disease and ulcerative colitis). To capture these manifestations as well as the associated comorbidities, and to recognize their underlining common pathogenesis, the name of psoriatic disease was coined. The pathogenesis of PsA is complex and multifaceted, with an interplay of genetic predisposition, triggering environmental factors, and activation of the innate and adaptive immune system, although autoinflammation has also been implicated. Research has identified several immune-inflammatory pathways defined by cytokines (IL-23/IL-17, TNF), leading to the development of efficacious therapeutic targets. However, heterogeneous responses to these drugs occur in different patients and in the different tissues involved, resulting in a challenge to the global management of the disease. Therefore, more translational research is necessary in order to identify new targets and improve current disease outcomes. Hopefully, this may become a reality through the integration of different omics technologies that allow better understanding of the relevant cellular and molecular players of the different tissues and manifestations of the disease. In this narrative review, we aim to provide an updated overview of the pathophysiology, including the latest findings from multiomics studies, and to describe current targeted therapies.

Impact of Season and Other Factors on Initiation, Discontinuation, and Switching of Systemic Drug Therapy in Patients with Psoriasis: A Retrospective Study

This study investigated whether systemic drug prescribing for psoriasis varies by season and other exacerbating factors. Eligible patients with psoriasis were assessed for each season for initiation, discontinuation, and switching of systemic drugs. A total of 360,787 patients were at risk of initiating any systemic drugs in 2016‒2019; 39,572 patients and 35,388 patients were at risk of drug discontinuation or switching to a biologic and a nonbiologic systemic drug, respectively. The initiation of biologic therapy in 2016‒2019 peaked in spring (1.28%), followed by summer (1.11%), fall (1.08%), and winter (1.01%). Nonbiologic systemic drugs followed a similar pattern. Those aged 30‒39 years, male, those with psoriatic arthritis, those who live in the South region, those who live in areas with lower altitudes, and those who live in areas with lower humidity had higher initiation with the same seasonality pattern. Discontinuation of biologic drugs peaked in summer, and switching of biologics was highest in spring. Season is associated with initiation, discontinuation, and switching, although seasonality pattern is less clear for nonbiologic systemic drugs. Approximately 14,280 more patients with psoriasis in the United States are estimated to initiate a biologic in spring than in other seasons, and over 840 more biologic users switched in spring than in winter. The findings may provide evidence for healthcare resource planning in psoriasis management.

Approaches to nutrition intervention in plaque psoriasis, a multi-system inflammatory disease-The Diet and Psoriasis Project (DIEPP)

Psoriasis is an immune-mediated inflammatory skin disease affecting approximately 2% of the UK population. Its pathogenesis is suggested to be an outcome of genetic and environmental interplay. People with psoriasis have an increased likelihood of developing other conditions such as type 2 diabetes and cardiovascular disease. Systemic inflammation is hypothesised to be the common link between psoriasis and cardio-metabolic diseases. Emerging evidence shows diet as a potential therapeutic adjunct in the management of psoriasis. The Diet and Psoriasis Project (DIEPP) aims to investigate whether dietary factors are related to psoriasis severity by conducting an observational study followed by a dietary intervention trial, to assess the effect of the Mediterranean diet (MedD) and time-restricted eating (TRE) on psoriasis. This review article will explore the potential mechanisms by which the MedD and TRE may exert protective effects on psoriasis, evaluate the current evidence, and outline the design of the DIEPP. Given the early-stage evidence, we hope to be able to build knowledge to derive medically approved dietary recommendations and contribute to the research gaps exploring the role of diet and psoriasis.

Epidemiology of Psoriasis and Comorbid Diseases: A Narrative Review

Psoriasis is a chronic autoimmune inflammatory disease that remains active for a long period, even for life in most patients. The impact of psoriasis on health is not only limited to the skin, but also influences multiple systems of the body, even mental health. With the increasing of literature on the association between psoriasis and extracutaneous systems, a better understanding of psoriasis as an autoimmune disease with systemic inflammation is created. Except for cardiometabolic diseases, gastrointestinal diseases, chronic kidney diseases, malignancy, and infections that have received much attention, the association between psoriasis and more systemic diseases, including the skin system, reproductive system, and oral and ocular systems has also been revealed, and mental health diseases draw more attention not just because of the negative mental and mood influence caused by skin lesions, but a common immune-inflammatory mechanism identified of the two systemic diseases. This review summarizes the epidemiological evidence supporting the association between psoriasis and important and/or newly reported systemic diseases in the past 5 years, and may help to comprehensively recognize the comorbidity burden related to psoriasis, further to improve the management of people with psoriasis.

Current Insights Into the Role of Neuropeptide Y in Skin Physiology and Pathology

Neuropeptide Y is widely distributed within the body and has long been implicated as a contributor to skin disease based on the correlative clinical data. However, until recently, there have been few empirical investigations to determine whether NPY has a pathophysiological role in the skin. Due to appearance-altering phenotypes of atopic dermatitis, psoriasis, and vitiligo, those suffering from these diseases often face multiple forms of negative social attention. This often results in psychological stress, which has been shown to exacerbate inflammatory skin diseases - creating a vicious cycle that perpetuates disease. This has been shown to drive severe depression, which has resulted in suicidal ideation being a comorbidity of these diseases. Herein, we review what is currently known about the associations of NPY with skin diseases and stress. We also review and provide educated guessing what the effects NPY can have in the skin. Inflammatory skin diseases can affect physical appearance to have significant, negative impacts on quality of life. No cure exists for these conditions, highlighting the need for identification of novel proteins/neuropetides, like NPY, that can be targeted therapeutically. This review sets the stage for future investigations into the role of NPY in skin biology and pathology to stimulate research on therapeutic targeting NPY signaling in order to combat inflammatory skin diseases.

Emergencies in obese patients: a narrative review

Obesity is associated to an increased risk of morbidity and mortality due to respiratory, cardiovascular, metabolic, and neoplastic diseases. The aim of this narrative review is to assess the physio-pathological characteristics of obese patients and how they influence the clinical approach during different emergency settings, including cardiopulmonary resuscitation. A literature search for published manuscripts regarding emergency and obesity across MEDLINE, EMBASE, and Cochrane Central was performed including records till January 1, 2021. Increasing incidence of obesity causes growth in emergency maneuvers dealing with airway management, vascular accesses, and drug treatment due to both pharmacokinetic and pharmacodynamic alterations. Furthermore, instrumental diagnostics and in/out-hospital transport may represent further pitfalls. Therefore, people with severe obesity may be seriously disadvantaged in emergency health care settings, and this condition is enhanced during the COVID-19 pandemic, when obesity was stated as one of the most frequent comorbidity. Emergency in critical obese patients turns out to be an intellectual, procedural, and technical challenge. Organization and anticipation based on the understanding of the physiopathology related to obesity are very important for the physician to be mentally and physically ready to face the associated issues.

Cardiometabolic Comorbidities in Patients With Psoriasis: Focusing on Risk, Biological Therapy, and Pathogenesis

Psoriasis is a chronic inflammatory disease characterized by erythematous scaly plaques, accompanied by systemic damage that leads to the development of multiple comorbidities. In particular, the association between psoriasis and cardiometabolic comorbidities, including cardiovascular diseases (CVDs), obesity, diabetes mellitus, and metabolic syndrome, has been verified in a considerable number of clinical trials. Moreover, the increased risk of cardiometabolic comorbidities positively correlates with psoriasis severity. Biologic therapy targeting inflammatory pathways or cytokines substantially improves the life quality of psoriasis patients and may affect cardiometabolic comorbidities by reducing their incidences. In this review, we focus on exploring the association between cardiometabolic comorbidities and psoriasis, and emphasize the benefits and precautions of biologic therapy in the management of psoriasis with cardiometabolic comorbidities. The pathogenic mechanisms of cardiometabolic comorbidities in psoriasis patients involve common genetic factors, lipid metabolism, insulin resistance, and shared inflammatory pathways such as tumor necrosis factor-α and interleukin-23/Th-17 pathways.

Diabetes Detection and Prevention in Dermatology

We are currently in the midst of an international epidemic of diabetes mellitus (DM) and prediabetes. The prevalence of DM in the United States is estimated at 9.4% of the population across all ages, while an estimated 1 in 3 Americans (33.9%) has prediabetes. According to the WHO, about 60 million people suffer from diabetes in the European Region. Dermatologists may play an important role in tackling this epidemic via efforts to improve early detection of both diabetes and prediabetes. Dermatologists often treat patients with, or at risk of, diabetes. This includes patients who present with cutaneous manifestations such as acanthosis nigricans, as well as patient populations at increased risk, including those with psoriasis, hidradenitis suppurativa, and polycystic ovarian syndrome. Simple screening guidelines can be used to identify patients at risk, and screening can be performed via a single non-fasting blood test. The diagnosis of prediabetes is a key feature in diabetes prevention, as interventions in this group can markedly reduce progression towards diabetes. In addition to referral to a primary care physician, dermatologists may refer these patients directly to structured behavioral lifestyle intervention programs known as diabetes prevention programs. A significant portion of the population lacks routine care by a primary care physician, and current data indicates need for improvement in diabetes screening and prevention among patient groups such as those with psoriasis. These factors highlight the importance of the dermatologist's role in the detection and prevention of diabetes.

Late-onset development of psoriasis in Japan: a population-based cohort study

Background

Evidence of factors associated with psoriasis from large population-based cohort studies is scarce.

Objective

We aimed to explore the risk factors of late-onset psoriasis.

Methods

This study included 487,835 Japanese participants aged 40-107 years, who were followed prospectively from 2012 to 2018 using individually linked databases between annual health checkups and medical claims.

Results

During the study period, 2793 patients (0.57%) newly developed psoriasis; 13.8% had moderate-to-severe psoriasis. In the multivariate analysis, factors associated with psoriasis onset were age (hazard ratio [HR] 1.11 {95% confidence interval [CI]: 1.06-1.16}), male sex (HR: 1.11 [95% CI: 1.02-1.21]), body mass index (HR: 1.09 [95% CI: 1.05-1.14]), smoking (HR: 1.46 [95% CI: 1.31-1.63]), not exercising ≥1 hour per week (HR: 1.13 [95% CI: 1.05-1.22]), and gamma-glutamyl transpeptidase (HR: 1.04 [95% CI: 1.01-1.06]). When we used weight increment of ≥10 kg since the age of 20 years instead of body mass index in the multivariate model, this was also a risk factor (HR: 1.12 [95% CI: 1.04-1.21]).

Limitations

This study targeted people aged >40 years, thereby narrowing the search to the risk factors of late-onset psoriasis.

Conclusion

We showed that increasing age, male sex, body mass index, smoking, low physical activity, weight gain, and gamma-glutamyl transpeptidase are associated with late-onset development of psoriasis and revealed a relationship between liver dysfunction and psoriasis development.

Risk of retinal diseases in patients with psoriasis: A population-based cohort study in Taiwan

Psoriasis has been associated with the risk of several ocular complications; however, its relationship with retinal diseases remains unknown. This study aimed to investigate the risk of developing retinal diseases in patients with psoriasis. Study participants were recruited from the National Health Insurance Research Database in Taiwan. A total of 11 729 psoriasis patients and 117 290 matched controls were included, showing an incidence rate of 121.15 and 28.34 cases of retinal diseases per 100 000 person-years, respectively. Compared with controls, patients with psoriasis had an adjusted hazard ratio (aHR) of 3.40 (95% confidence interval [CI], 2.63-4.39) for retinal diseases after adjustment for potential confounders. Regarding the individual retinal disease, psoriasis patients had a significantly higher risk of developing retinal detachment (aHR, 5.07; 95% CI, 2.92-8.79), retinal vascular occlusion (aHR, 3.75; 95% CI 2.42-5.82), and retinopathy (aHR, 2.84; 95% CI, 1.99-4.05) than controls. In conclusion, patients with psoriasis had a significantly higher risk of retinal diseases than controls. Further studies are necessary to investigate the pathophysiology underlying the relationship between psoriasis and retinal diseases.

Comparison of Behavioral Risk Factors and Cardiometabolic Comorbidities of Psoriatic Arthritis and Psoriasis: A Case-Control Study in Chinese Patients

Purpose

Comparison of risk factors and comorbidities could help indicate the underlying mechanisms of diseases. This study aimed to compare behavioral factors and cardiometabolic comorbidities of PsA/psoriasis versus healthy controls to implicate the similarities and differences in potential pathogenic mechanisms for further research.

Patients and Methods

A case-control study in Chinese patients with PsA or psoriasis and healthy controls was conducted. Clinical information based on patient-reported and measured outcomes were collected. Multivariable logistic regression was used to investigate the associations, in terms of adjusted odds ratios (AORs).

Results

We randomly selected 171 patients with PsA, 342 with psoriasis, and 1026 healthy controls from our database, matching by age and sex. Dyslipidemia (AOR=4.62 for PsA and 2.97 for psoriasis) and alcohol drinking (AOR=3.20 for PsA and 3.62 for psoriasis) were significantly associated with both diseases. Overweight was inversely associated with both PsA (AOR=0.46, P=0.002) and psoriasis (AOR=0.56, P=0.001), while obesity was associated with PsA (AOR=2.02, P=0.025) but not psoriasis (AOR=0.87, P=0.621). Subgroup analysis by onset age of psoriatic lesions showed that former smoking was significantly associated with early-onset psoriasis (AOR=2.44, P=0.016) but not PsA (AOR=0.59, P=0.329). Laboratory test indicated that both PsA and psoriasis were associated with altered lipid profile.

Conclusion

PsA and psoriasis in Chinese patients share common behavioral and cardiometabolic risk factors including dyslipidemia and alcohol consumption. There is a U-shape association between BMI and PsA/psoriasis.

What Factors Influence on Dermatology-Related Life Quality of Psoriasis Patients in South Korea?

This descriptive study aimed to identify factors that can influence the quality of life of psoriasis patients. A total of 118 psoriasis outpatients completed a questionnaire consisting of the Dermatology Life Quality Index (DLQI), Psoriasis Life Stress Inventory (PLSI), Mishel Uncertainty in Illness Scale-Community form (MUIS-C), Center for Epidemiologic Studies-Depression scale (CES-D), and Self-Reported Severity Score (SRSS). The Psoriasis Area Severity Index (PASI) was calculated. The collected data were analyzed by descriptive statistics, t-test, one-way ANOVA, Scheffé test, Pearson’s correlation analysis, and stepwise multiple regression using SPSS/WIN 26.0. The average score of the DLQI was 14.19 ± 6.83 (range 0–30); the DLQI showed statistically significant differences according to age (F = 4.02, p = 0.021) and smoking type (F = 7.49, p = 0.001). The dermatology-related quality of life was significantly affected by psoriasis-related stress (β = 0.37, p < 0.001), depression (β = 0.35, p < 0.001), and subjective severity (β = 0.19, p = 0.005); these variables explained 60.7% of the variance in the dermatology-related quality of life (F = 61.34, p < 0.001). The results demonstrated that psoriasis-related stress, depression, and perceived severity of psoriasis should be considered when developing nursing interventions to improve patients’ quality of life.

Insights into interplay of immunopathophysiological events and molecular mechanistic cascades in psoriasis and its associated comorbidities

Psoriasis is an inflammatory skin disease with complex pathogenesis and multiple etiological factors. Besides the essential role of autoreactive T cells and constellation of cytokines, the discovery of IL-23/Th17 axis as a central signaling pathway has unraveled the mechanism of accelerated inflammation in psoriasis. This has provided insights into psoriasis pathogenesis and revolutionized the development of effective biological therapies. Moreover, genome-wide association studies have identified several candidate genes and susceptibility loci associated with this disease. Although involvement of cellular innate and adaptive immune responses and dysregulation of immune cells have been implicated in psoriasis initiation and maintenance, there is still a lack of unifying mechanism for understanding the pathogenesis of this disease. Emerging evidence suggests that psoriasis is a high-mortality disease with additional burden of comorbidities, which adversely affects the treatment response and overall quality of life of patients. Furthermore, changing trends of psoriasis-associated comorbidities and shared patterns of genetic susceptibility, risk factors and pathophysiological mechanisms manifest psoriasis as a multifactorial systemic disease. This review highlights the recent progress in understanding the crucial role of different immune cells, proinflammatory cytokines and microRNAs in psoriasis pathogenesis. In addition, we comprehensively discuss the involvement of various complex signaling pathways and their interplay with immune cell markers to comprehend the underlying pathophysiological mechanism, which may lead to exploration of new therapeutic targets and development of novel treatment strategies to reduce the disastrous nature of psoriasis and associated comorbidities.

First-Line Biologic Therapy and Obesity in Moderate-to-Severe Psoriasis: Results from the Prospective Multicenter Cohort Psobioteq

BACKGROUND

Obesity is associated with an increased risk of psoriasis.

OBJECTIVE

In this study, we examined whether body mass index (BMI) is taken into account when choosing first-line biologic therapy for psoriasis.

METHODS

In this cohort study, we compared obese (BMI ≥30 kg/m2) and non-obese patients for the first-line biologic therapy prescribed, its survival, reasons for discontinuation, therapy optimization, co-prescription of methotrexate and factors associated with long drug survival.

RESULTS

A total of 931 patients were included: 594 (64%) were male, median age was 46 years (interquartile range 36-56). The most-prescribed biologic agents as first-line treatment were adalimumab (ADA; 42.7%), ustekinumab (UST; 29.9%) and etanercept (ETA; 22.9%); only frequency of infliximab (IFX) prescription differed between groups. Drug survival was significantly shorter for obese than non-obese patients (p < 2.10-4) and was worse for obese than non-obese patients for UST (p = 0.009) and ETA (p = 0.02), with no difference for ADA (p = 0.11). The main reason for discontinuation was primary inefficacy (62%), which was more frequent in obese than non-obese patients. The cumulative incidence of optimization did not significantly differ between the groups, except for ADA (SHR 1.91, 95% CI [1.23-2.96], p = 0.005). On multivariate analysis, risk of discontinuation was associated with only ETA as first-line biologic therapy (HR 1.51, 95% CI 1.04-2.19).

CONCLUSION

This study highlighted the lack of difference in prescription of first-line biologic treatment, except for IFX, between obese and non-obese patients presenting moderate-to-severe psoriasis. Drug survival in obese patients is shorter, mainly because of inefficacy, than in non-obese patients. This highlights the need for targeted pharmacological studies in obese individuals to find optimal administration schemes.

Adiposity and Physical Activity as Risk Factors for Developing Psoriatic Arthritis: Longitudinal Data From a Population-Based Study in Norway

OBJECTIVE

Adiposity is prevalent among patients with psoriatic arthritis (PsA). However, the temporal relation is unclear. The present study was undertaken to investigate whether adiposity and body fat distribution are related to the risk of developing PsA, and whether physical activity could modify the possible risk.

METHODS

We included 36,626 women and men from the Norwegian Nord-Trøndelag Health Study without diagnosed PsA at baseline from 1995 to 1997. Cox regression analysis was used to estimate adjusted hazard ratios (HRs) with 95% confidence intervals (95% CIs) of incident PsA at follow-up from 2006 to 2008.

RESULTS

During follow-up, 185 new cases of PsA were reported. Increases of 1 SD in body mass index (BMI) (4.2 and 3.5 kg/m² for women and men, respectively) and waist circumference (10.8 and 8.6 cm, respectively) were associated with HRs of 1.40 (95% CI 1.24, 1.58) and 1.48 (95% CI 1.31, 1.68), respectively. Compared to individuals of normal weight, obese individuals had an HR of 2.46 (95% CI 1.65, 3.68), and overweight individuals had an HR of 1.41 (95% CI 1.00, 1.99). Comparing extreme quartiles of waist circumference yielded an HR of 2.63 (95% CI 1.73, 3.99). In analyses of combined effects using a BMI of <25 kg/m² and high physical activity as reference, a BMI of ≥25 kg/m² was associated with HRs of 2.06 (95% CI 1.18, 3.58) and 1.53 (95% CI 0.80, 2.91) among those with low and high physical activity levels, respectively. Corresponding HRs for high waist circumference and physical activity were 2.25 (95% CI 1.40, 1.63) and 1.85 (95% CI 0.95, 3.50).

CONCLUSION

The results suggest that adiposity, particularly central obesity, is associated with increased risk of incident PsA. Although there was no clear modifying effect of physical activity, high levels of physical activity reduced the risk of PsA, regardless of BMI.

The Effect of Antioxidant and Anti-Inflammatory Capacity of Diet on Psoriasis and Psoriatic Arthritis Phenotype: Nutrition as Therapeutic Tool?

Chronic inflammation and increased oxidative stress are contributing factors to many non-communicable diseases. A growing body of evidence indicates that dietary nutrients can activate the immune system and may lead to the overproduction of pro-inflammatory cytokines. Fatty acids as macronutrients are key players for immunomodulation, with n-3 polyunsaturated fatty acids having the most beneficial effect, while polyphenols and carotenoids seem to be the most promising antioxidants. Psoriasis is a chronic, immune-mediated inflammatory disease with multifactorial etiology. Obesity is a major risk factor for psoriasis, which leads to worse clinical outcomes. Weight loss interventions and, generally, dietary regimens such as gluten-free and Mediterranean diet or supplement use may potentially improve psoriasis’ natural course and response to therapy. However, data about more sophisticated nutritional patterns, such as ketogenic, very low-carb or specific macro- and micro-nutrient substitution, are scarce. This review aims to present the effect of strictly structured dietary nutrients, that are known to affect glucose/lipid metabolism and insulin responses, on chronic inflammation and immunity, and to discuss the utility of nutritional regimens as possible therapeutic tools for psoriasis and psoriatic arthritis.

Epidemiology of psoriasis in the Russian Federation according to the patient registry

Background. Psoriasis is a chronic skin disorder that impairs patients health-related quality of life. It is associated with patients need in specialized medical care and with essential medical costs. Psoriasis may be the reason for temporary or permanent disability. Patient registries are important sources of epidemiological and clinical data on patients with psoriasis and medical care provided. Aims. To describe demographic characteristics, characteristics of the disease, prevalence of concomitant and past diseases in adult (18 years and older) patients with moderate and severe psoriasis included in the patient registry of the Russian Society of Dermatovenereologists and Cosmetologists. Materials and methods. The data of 3,268 patients with psoriasis aged 18 years and older were analyzed as of inclusion in the registry. Data lock point was June 3, 2021. Descriptive statistics methods were applied in data analysis. Results. The mean ( SD) age of adult patients at inclusion in the registry was 46.1 14.4 years. Male patients accounted for 60.5%. The mean age of onset of psoriasis is 31.1 16.1 years. Most of the patients (89.5%) have psoriasis vulgaris. The mean body surface area at inclusion was 43.3% 24.7%. 28.9% of patients had psoriatic arthritis at inclusion in the registry. A high prevalence of cardiovascular diseases was revealed: arterial hypertension 28.5%, coronary heart disease 5.4%, myocardial infarction and acute cerebrovascular accident 0.9% each. More than half of patients are pre-obese or obese according to the WHO body mass index classification. 2.2% of patients have impaired glucose tolerance, 6.7% of patients have type 2 diabetes mellitus. 3.8% of patients have diseases or dysfunction of the thyroid gland. The prevalence of diseases of the digestive system is high: any disease of the esophagus, stomach and duodenum was noted in 10.2% of patients, any disease of the liver, gallbladder, biliary tract and pancreas in 11.8% of patients. The prevalence of viral hepatitis C among patients with psoriasis was 2.6%. Conclusions. The prevalence of comorbidities is high among Russian patients with moderate and severe psoriasis.

Bone Mineral Density, Osteoporosis, and Fracture Risk in Adult Patients with Psoriasis or Psoriatic Arthritis: A Systematic Review and Meta-Analysis of Observational Studies

INTRODUCTION

Awareness of psoriasis-related comorbidities has been established in the current guidelines; however, evidence regarding the association of bone density or bone fragility with psoriatic disease remains inconclusive.

METHODS

We conducted a systematic review and meta-analysis to assess bone mineral density and the risk of osteoporosis and fractures in patients with psoriatic disease, including those with cutaneous psoriasis and psoriatic arthritis. We searched electronic databases for published observational studies. A meta-analysis was performed using the random-effect model. Pooled estimates and their confidence intervals (CIs) were calculated. Small-study effects were examined using the Doi plot and Luis Furuya-Kanamori index.

RESULTS

The analysis of the standardized mean difference in the absolute value of bone mineral density at different measuring sites (lumbar spine, femoral neck, and total hip) revealed no significant difference between patients with psoriatic disease and non-psoriatic controls. The pooled results of the adjusted odds ratios (ORs) demonstrated no increased risk of osteoporosis in patients with psoriatic disease. Notably, patients with psoriatic disease had a higher OR of developing bone fractures (adjusted OR: 1.09; 95% CI: 1.06 to 1.12; I²: 0%).

CONCLUSION

Patients with psoriatic disease may be more likely to develop fractures compared with non-psoriatic controls. This higher risk for fracture may not necessarily be associated with lower bone mineral density nor a higher risk for osteoporosis.

Progress to Date in Advancing Stratified Medicine in Psoriasis

Stratified medicine is the tailoring of treatment to the individual characteristics of each patient. This is a challenging task in the context of psoriasis, a complex disease with a variety of phenotypic presentations and a comorbidity burden that extends beyond cutaneous manifestations. In recent years, considerable progress has been made in understanding the immunology of psoriasis, and this has informed the development of increasingly precise and efficacious therapies. However, not all patients respond to biologic therapy, and access is limited to patients with moderate to severe disease. However, subpopulations of patients are emerging with distinct patterns of response to therapy, largely determined by clinical and pharmacogenomic factors. Despite progress to date, the natural history of psoriasis remains poorly understood. It is likely that disease onset, progression, development of comorbidities and response to therapy are due to a combination of genetic, inflammatory and environmental factors. We envision that a greater understanding of the natural history of psoriasis will be a key factor in progressing a stratified medicine approach to patient care, as will earlier intervention in the course of the disease.

Endocrinological disorders and inflammatory skin diseases during COVID-19 outbreak: a review of the literature

INTRODUCTION

In the next future, dermatologists, endocrinologist and physicians may cope with the impact of extent SARS-CoV-2 (COVID-19) infection over chronic inflammatory skin diseases and their treatment. COVID-19 pandemic obliged many countries to impose social restrictions, resulting in the need to adapt daily lifestyle habits and working activities. These changes have drastically reduced physical activity and social interactions, with the possible increase of anxiety, eating disorders and weight gain.

EVIDENCE ACQUISITION

We searched for relevant studies (trials, real-life studies and case reports, meta-analysis, pooled data analysis, reviews) on endocrine disorders and inflammatory skin diseases. The database used was PubMed. The studies included were those published in the English language between January 1, 2018 and May 5, 2020.

EVIDENCE SYNTHESIS

Several studies have been previously showed the association of overweight and obesity, with the metabolic syndrome and insulin-resistance. It has been demonstrated how these conditions correlate with the worsening of such chronic inflammatory skin diseases, such as psoriasis, hidradenitis suppurativa and acne. Many evidences suggest an important role of adipose tissue in the production of pro-inflammatory cytokines (Leptin, adiponectin, TNFα, IL-6, MCP-1, PAI-1), involved in the pathogenesis and the exacerbations of these skin diseases. In addition, we should expect an increasing incidence rate of hypovitaminosis D in the next future due to reduced sun exposure caused by isolation at home and missed holidays. Scientific evidences already show the important immunomodulating role of vitamin D in inflammatory skin diseases.

CONCLUSIONS

Our study pays attention on medium-long term effects of COVID-19 outbreak on inflammatory skin disorders, due to the lifestyle changes. In such context this review considers how a multidisciplinary approach, involving dermatologists, nutritionists and endocrinologists, may lead to a better management of dermatologic patients.

Homocysteine and psoriasis

Psoriasis is caused by a complex interplay among the immune system, genetic background, autoantigens, and environmental factors. Recent studies have demonstrated that patients with psoriasis have a significantly higher serum homocysteine (Hcy) level and a higher prevalence of hyperhomocysteinaemia (HHcy). Insufficiency of folic acid and vitamin B₁₂ can be a cause of HHcy in psoriasis. Hcy may promote the immuno-inflammatory process in the pathogenesis of psoriasis by activating Th1 and Th17 cells and neutrophils, while suppressing regulatory T cells. Moreover, Hcy can drive the immuno-inflammatory process by enhancing the production of the pro-inflammatory cytokines in related to psoriasis. Hcy can induce nuclear factor kappa B activation, which is critical in the immunopathogenesis of psoriasis. There may be a link between the oxidative stress state in psoriasis and the effect of HHcy. Hydrogen sulfide (H₂S) may play a protective role in the pathogenesis of psoriasis and the deficiency of H₂S in psoriasis may be caused by HHcy. As the role of Hcy in the pathogenesis of psoriasis is most likely established, Hcy can be a potential therapeutic target for the treatment of psoriasis. Systemic folinate calcium, a folic acid derivative, and topical vitamin B12 have found to be effective in treating psoriasis.

Glucagon-like peptide-1 receptor agonist liraglutide therapy for psoriasis patients with type 2 diabetes: a randomized-controlled trial

OBJECTIVE

There were some clinical studies on GLP-1R agonist liraglutide therapy for psoriasis patients with type 2 diabetes, but there is a lack of randomized controlled trials and the mechanism of which remains unclear.

METHOD

A total of 25 psoriasis patients with type 2 diabetes were randomized 1: 1 divided into the control group (n = 13) or liraglutide group (n = 12) for 12 weeks. We determined the PASI, the DLQI, histopathology of psoriasis skin, and the expression of IL-17, IL-23, and TNF-α in the psoriasis skin.

RESULTS

After 12 weeks of treatment, the mean DLQI of the treatment group decreased from 22.00 ± 5.85 to 3.82 ± 3.60 (p < .05). Compared to week 12, the change in the baseline value of PASI and DLQI in the treatment group showed a significant difference compared with the control group (p < .05). The pathological changes of psoriasis skin and the expression of IL-17, IL-23, TNF-α in the psoriasis skin were improved in the treatment group. No serious adverse events occurred.

CONCLUSION

The skin lesions in psoriasis patients with type 2 diabetes were significantly improved after treatment with liraglutide, which may be related to the inhibition of the expression of inflammatory factors such as IL-23, IL-17, and TNF-α.

Adalimumab and methotrexate affect the concentrations of regulatory cytokines (interleukin-10, transforming growth factor-β1, and interleukin-35) in patients with plaque psoriasis

Dysfunctional regulatory T lymphocytes are important for the pathogenesis of psoriasis and atherosclerosis. We analyzed the severity of atherosclerosis and the concentration of regulatory cytokines in patients with psoriasis who were administered methotrexate or adalimumab for 12 weeks. We included 34 patients with psoriasis (17 each, administered methotrexate or adalimumab) and eight healthy volunteers. BMI, psoriasis area and severity index (PASI), body surface area (BSA), and at least 75% and 90% improvements in PASI were observed. The 10-year risk of fatal cardiovascular disease was estimated using Systematic Coronary Risk Evaluation charts. The plasma interleukin (IL)-10, IL-35, and transforming growth factor β1 (TGF-β1) levels were determined using enzyme-linked immunosorbent assay before and after the 12-week treatment regimen. PASI (P = .0006) and BSA (P = .0001) were positively correlated with the BMI, IL-35 (-0.38), and IL-10 (0.48) levels. Baseline IL-35 concentrations were the highest in healthy volunteers; the IL-10 and TGF-β1 level were the highest in the methotrexate group. IL-10 concentration decreased in both treatment groups (P = .02 for the methotrexate and P = .09 for adalimumab group), and IL-35 decreased in the adalimumab group (P = .019), consistent with skin lesion recovery. Thus, this study demonstrates the dysregulated secretion of regulatory cytokines in psoriatic patients under systemic treatment.

Deciphering the Association Between Psoriasis and Obesity: Current Evidence and Treatment Considerations

PURPOSE OF REVIEW

Obesity and psoriasis represent chronic inflammatory states that are interconnected in a vicious cycle, sharing also a degree of synergy. In this review, we aim to decipher the various lines of evidence supporting the bidirectional association between psoriasis and obesity highlighting their pathophysiologic connections as well as we attempt to strategize a therapeutic holistic approach for obese psoriatic patients.

RECENT FINDINGS

Recent meta-analyses have shown that (1) genetically higher BMI increased the odds of psoriasis occurrence; (2) obesity is associated with higher incidence and prevalence of psoriasis as well as psoriasis severity; (3) obesity is associated with lower efficacy to anti-TNF agents and may predict biologic treatment discontinuation; and (4) weight loss through diet and physical exercise may improve pre-existing psoriasis and prevent from de novo psoriasis. Methotrexate, acitretin, and cyclosporine could worsen hypertension, liver steatosis, and dyslipidemia. Since infliximab and ustekinumab are weight adjusted, they may be ideal drugs to treat obese psoriatic patients. IL-17 inhibitors are very effective independently from body weight; however, they tend to present better clearance rates in normal weight patients. There is a paucity on weight data regarding the efficacious IL-23 inhibitors. Apremilast may induce weight loss as an adverse effect presenting also some beneficial metabolic actions. Finally, simvastatin and some antidiabetic drugs could decrease psoriasis severity. More mechanistic, observational studies and well-conducted RCTs are necessary to decipher the enigmatic link between psoriasis and obesity, and to provide evidence-based specific guidelines for the screening and management of obese psoriatic patients.

Psoriasis Among Adolescents in Kuwait and the Role of Siblings, Breastfeeding, and Household Cat and Secondhand Smoke Exposure: A Cross-Sectional Study

INTRODUCTION

Globally, the epidemiology of psoriasis is poorly understood, and most countries lack essential epidemiologic data regarding disease burden and its determinants. This study sought to estimate the prevalence of psoriasis among adolescents in Kuwait and assess its association with different risk factors, including obesity, sibship size, breastfeeding, and exposure to household secondhand smoke (SHS) and pets.

METHODS

Schoolchildren aged 11-14 years (n = 3864) were enrolled in a cross-sectional study. Lifetime and current (past 12 months) prevalence of psoriasis were ascertained according to ever having a history of doctor-diagnosis plus current active lesion(s) and/or current use of treatment of psoriasis. Associations were assessed using Poisson regression with robust variance estimation, and adjusted prevalence ratios (aPR) and 95% confidence intervals (CI) were estimated.

RESULTS

The lifetime and current prevalence of psoriasis were estimated to be 3.6% (136/3806) and 1.1% (42/3806), respectively. Commonly reported anatomical sites affected by psoriasis included scalp (47.6%) and the extensor surface of the knees (50%) and elbows (38.1%). Household SHS exposure was associated with increased lifetime psoriasis (aPR = 1.41, 95% CI 1.07-1.98), and showed a trend for association with current psoriasis (1.77, 0.89-3.53). Similarly, cat-keeping during infancy was associated with lifetime psoriasis (1.96, 1.14-3.37), and demonstrated a trend for association with current psoriasis (1.49, 0.52-1.98). In contrast, breastfeeding was associated with a decreased lifetime psoriasis (0.62, 0.44-0.89), but was not associated with current psoriasis. Trend analyses showed that the prevalence of lifetime and current psoriasis increased with increasing numbers of total, older, and younger siblings.

CONCLUSIONS

Psoriasis affects a considerable proportion of schoolchildren in Kuwait. Interestingly, psoriasis prevalence was related to risk factors also found in allergic diseases, such as exposure to SHS, cat-keeping in infancy, breastfeeding, and sibship size, possibly suggesting a role of immune dysregulation.

Pathogenesis of psoriasis in the "omic" era. Part III. Metabolic disorders, metabolomics, nutrigenomics in psoriasis

Psoriasis is a systemic disease that is strictly connected with metabolic disorders (insulin resistance, atherogenic dyslipidemia, arterial hypertension, and cardiovascular diseases). It occurs more often in patients with a more severe course of the disease. Obesity is specially an independent risk factor and it is associated with a worse treatment outcome because of the high inflammatory activity of visceral fatty tissue and the production of inflammatory mediators involved in the development of both psoriasis and metabolic disorders. However, in psoriasis the activation of the Th17/IL-17 and the abnormalities in the Th17/Treg balance axis are observed, but this pathomechanism does not fully explain the frequent occurrence of metabolic disorders. Therefore, there is a need to look for better biomarkers in the diagnosis, prognosis and monitoring of concomitant disorders and therapeutic effects in psoriasis. In addition, the education on the use of a proper diet as a prophylaxis for the development of the above disorders is an important element of holistic care for a patient with psoriasis. Diet may affect gene expression due to epigenetic modification which encompasses interactions of environment, nutrition and diseases. Patients with psoriasis should be advised to adopt proper diet and dietician support.

Obesity, but Not Metabolic Diseases, Is Associated with Risk of Psoriasis: A Population-Based Cohort Study in Taiwan

<b><i>Background:</i></b> Obesity and metabolic diseases including diabetes, hyperlipidemia, and hypertension are reportedly associated with an increased risk of psoriasis. However, few prospective studies have investigated the association of obesity and metabolic diseases with the risk of psoriasis. <b><i>Objective:</i></b> To examine whether obesity or metabolic diseases increase the risk of psoriasis. <b><i>Methods:</i></b> Participants were collected from 4 rounds (2001, 2005, 2009, and 2013) of the Taiwan National Health Interview Survey. Incident cases of psoriasis were identified from the National Health Insurance database. Participants were followed from the time of the National Health Interview Survey interview until December 31, 2017, or until a diagnosis of psoriasis was made or the participant died. The Cox regression model was used for the analyses. <b><i>Results:</i></b> Of 60,136 participants, 406 developed psoriasis during 649,506 person-years of follow-up. Compared to participants with a BMI of 18.5–22.9, the adjusted hazard ratios (aHR) of psoriasis were 1.34 (95% CI 1.05–1.71) for a BMI of 25.0–29.9 and 2.70 (95% CI 1.95–3.72) for a BMI ≥30. Neither individual nor multiple metabolic diseases were associated with incident psoriasis. Participants with a BMI ≥30 were at significantly higher risk of both psoriasis without arthritis (aHR 2.60; 95% CI 1.85–3.67) and psoriatic arthritis (aHR 3.96; 95% CI 1.45–10.82). <b><i>Conclusion:</i></b> Obesity, but not metabolic diseases, significantly increased the risk of psoriasis.

Objectives, design and main findings until 2020 from the Rotterdam Study

The Rotterdam Study is an ongoing prospective cohort study that started in 1990 in the city of Rotterdam, The Netherlands. The study aims to unravel etiology, preclinical course, natural history and potential targets for intervention for chronic diseases in mid-life and late-life. The study focuses on cardiovascular, endocrine, hepatic, neurological, ophthalmic, psychiatric, dermatological, otolaryngological, locomotor, and respiratory diseases. As of 2008, 14,926 subjects aged 45 years or over comprise the Rotterdam Study cohort. Since 2016, the cohort is being expanded by persons aged 40 years and over. The findings of the Rotterdam Study have been presented in over 1700 research articles and reports. This article provides an update on the rationale and design of the study. It also presents a summary of the major findings from the preceding 3 years and outlines developments for the coming period.

Bodyweight variability and the risk of psoriasis: a nationwide population-based cohort study

BACKGROUND

Bodyweight variability has been suggested to exacerbate chronic inflammation and increase the risk of adverse cardiovascular events. Little is known whether high variability in bodyweight affects the development of psoriasis.

OBJECTIVE

To investigate the association between weight variability and the risk of psoriasis.

METHODS

Using a representative cohort enrolled in the national health examination programme conducted by the Korean National Health Insurance Service, 8 016 907 people who were free of psoriasis and who underwent at least three health examinations between 2010 and 2015 were followed until the end of 2017. We classified participants numerically according to the variability indices and defined high variability (Q4) as the highest quartile of variability. Cox proportional hazard regression models were used to evaluate the risk of psoriasis according to the quartile groups of bodyweight variability.

RESULTS

In total, 187 128 (2.33%) participants developed psoriasis during a median follow-up of 3.4 years. There was an association between baseline body mass index and the risk of psoriasis. In the multivariable model adjusting for confounding variables, an incrementally increased risk of psoriasis was observed for higher quartiles compared with the lowest quartile group (Q1). The hazard ratio (HR) and 95% confidence intervals comparing the highest (Q4) and lowest quartiles (Q1) of bodyweight variability were 1.06 (1.05-1.07) for psoriasis.

CONCLUSION

High bodyweight variability was significantly associated with an increased risk of psoriasis. These findings imply that clinicians should encourage patients to maintain proper bodyweight to help prevent psoriasis.

Plant Foods, Antioxidant Biomarkers, and the Risk of Cardiovascular Disease, Cancer, and Mortality: A Review of the Evidence

Although a high intake of plant foods such as fruits, vegetables, whole grains, nuts, and legumes has been recommended for chronic disease prevention, it has been unclear what is the optimal amount of intake of these foods and whether specific subtypes are particularly beneficial. The evidence from several recently published meta-analyses on plant foods and antioxidants and various health outcomes is reviewed as well as more recently published studies. In meta-analyses of prospective studies, inverse associations were observed between intake of fruits, vegetables, whole grains, and nuts and the risk of coronary artery disease, stroke, cardiovascular disease overall, total cancer, and all-cause mortality. The strongest reductions in risk were observed at an intake of 800 g/d for fruits and vegetables, 225 g/d for whole grains, and 15-20 g/d for nuts, respectively. Whole-grain and nut consumption was also inversely associated with mortality from respiratory disease, infections, and diabetes. Stronger and more linear inverse associations were observed between blood concentrations of antioxidants (vitamin C, carotenoids, vitamin E) and cardiovascular disease, cancer, and all-cause mortality than for dietary intake. Most studies that have since been published have been consistent with these results; however, further studies are needed on subtypes of plant foods and less common causes of death. These results strongly support dietary recommendations to increase intake of plant foods, and suggest optimal intakes for chronic disease prevention may be ∼800 g/d for intakes of fruits and vegetables, 225 g/d for whole grains, and 15-20 g/d for nuts. Diets high in plant foods could potentially prevent several million premature deaths each year if adopted globally.

Efficacy of Calcipotriol-Betamethasone Ointment in Patients with Mild to Moderate Plaque Psoriasis: Subgroup Analyses

Background: Several factors have been shown to affect psoriasis pathogenesis, clinical presentation and treatment response. Objectives: The aim of this study was to investigate the potential relationship between patients’ baseline characteristics and the efficacy of calcipotriol-betamethasone ointment in patients with mild to moderate plaque psoriasis and to evaluate whether the efficacy is consistent across subgroups. Method: Using data from the therapeutic equivalence study on patients with plaque psoriasis, post hoc analyses were performed to evaluate the impact of baseline demographic and disease characteristics, habits and comorbidities on the response to treatment with calcipotriol-betamethasone ointment. Results: Body mass index (BMI) and obesity were each independently associated (univariate analysis, p < 0.05) with reduction in modified Psoriasis Area and Severity Index (mPASI) and PASI75 (≥75% improvement in mPASI from baseline). Increased body weight is more common in patients with late-onset psoriasis. There was a significant trend for lower response rates with increasing BMI (p = 0.007) and obesity (p = 0.003). The odds of achieving PASI75 is 2.3 times lower for obese compared to normal-weight subjects.If patients with obesity or hypertension were treated with calcipotriol-betamethasone, they were still more likely to achieve PASI75 after 4-week treatment compared to vehicle (p < 0.001). Conclusion: Increased BMI and obesity present risk factors for reduced treatment effectiveness. Importantly, the efficacy of calcipotriol-betamethasone ointment was consistent in all subgroups.

Characterization of responder groups to secukinumab treatment in moderate to severe plaque psoriasis

Background: Secukinumab is a fully human monoclonal antibody that neutralizes interleukin-17A (IL-17A), a key cytokine involved in the development of psoriasis. Here, we characterized secukinumab treatment-responder profiles and identified baseline factors affecting response.Methods: Pooled phase 3 data from moderate to severe plaque psoriasis patients treated with secukinumab for 16 weeks (FIXTURE [NCT01358578], ERASURE [NCT01365455], and CLEAR [NCT02074982]) were analyzed to characterize responder groups, identifying factors associated with treatment response, and to evaluate early response kinetics as a biomarker for treatment response. Etanercept and ustekinumab were evaluated as comparators.Results: Patients treated with secukinumab 300 mg (n = 867), ustekinumab 45/90 mg (n = 318), and etanercept 50 mg (n = 298) were evaluated. For secukinumab 300 mg, more patients were in higher responder groups than etanercept and ustekinumab. In higher response groups, fewer patients had previous systemic or biologic treatment, metabolic syndrome, hypertension, diabetes, and fewer were current smokers. Mean body weight, waist circumference, and BMI decreased as response level increased. Early onset of response (PASI50 at Week 4 or 8) correlated with sustained efficacy at Week 16.Conclusions: Baseline factors, including weight and cardiometabolic status, were associated with response to secukinumab. Early onset of response may indicate treatment efficacy later on.

An Update on the Role of Adipose Tissues in Psoriasis

Psoriasis is a common chronic inflammatory skin disease that is increasingly being recognized as a disease that not only affects the skin but also has multi-systemic implications. The pathophysiological link between psoriasis and obesity is becoming increasingly elucidated by recent studies. The cross-talk between adipocytes and the immune system via various mediators such as adipokines could explain how obesity contributes to psoriasis. The effects of obesity on adipocytes include upregulation of pro-inflammatory adipokines such as leptin and resistin, downregulation of anti-inflammatory adipokine, and also the stimulation of pro-inflammatory cytokine production by macrophages. This article provides an update on the role of adipose tissues in psoriasis.

Peroxisome Proliferator-Activated Receptor-γ Gene Polymorphism in Psoriasis and Its Relation to Obesity, Metabolic Syndrome, and Narrowband Ultraviolet B Response: A Case-Control Study in Egyptian Patients

Background:

Psoriasis is a common dermatologic disease with multifactorial etiology in which genetic factors play a major role. Peroxisome proliferator-activated receptor (PPAR)-γ is expressed in keratinocytes and is known to affect cell maturation and differentiation in addition to its role in inflammation.

Aim:

To study the association between PPAR-γ gene polymorphism and psoriasis vulgaris in Egyptian patients to explore if this polymorphism influenced disease risk or clinical presentation.

Methods:

Forty-five patients with psoriasis vulgaris and 45 age, sex and body mass index matched healthy volunteers who have no present, past or family history of psoriasis as a control group were enrolled. Selected cases included obese and nonobese participants. Detection of PPAR-γ gene polymorphism was done with restriction fragment length polymorphism polymerase chain reaction. Narrow-band ultraviolet B (NBUVB) was given for every case three times/week for 12 weeks.

Results:

Homopolymorphism, heteropolymorphism, and Ala allele were significantly associated with cases (P = 0.01, P = 0.01, and P = 0.004, respectively) and increased risk of occurrence of psoriasis by 5.25, 3.65, and 3.37 folds, respectively. Heteropolymorphism was significantly associated with nonobese cases compared to obese ones (P = 0.01). Ala allele was significantly associated with obese cases (P = 0.001) and increased risk of occurrence of psoriasis in obese participants by 1.14 folds. Homopolymorphism, heteropolymorphism, and Ala allele were more prevalent among obese cases without metabolic syndrome (MS) than obese cases with MS but without statistical significance. Percentage of decrease of mean Psoriasis Area and Severity Index score before and after 3 months of treatment with NBUVB was higher in cases with heteropolymorphism with no significant difference between homo- and heteropolymorphism.

Conclusion:

PPAR-γ gene polymorphism is associated with and increased the risk of psoriasis and its associated obesity in Egyptian patients. It has no role in NBUVB response in those patients. Future large-scale studies on different populations are recommended.

Increased risk of psoriasis in subjects with abdominal obesity: A nationwide population-based study

Psoriasis is a chronic inflammatory skin disease known to be associated with a variety of systemic comorbidities, such as metabolic syndrome and obesity. Obesity represents a major comorbidity and has been suggested to be related to psoriasis. This nationwide population-based prospective cohort study was performed to investigate the impacts of body mass index (BMI) and waist circumference (WC) on psoriasis. We used the health check-up database and the study population consisted of subjects who had undergone health screening between January 2009 and December 2012. This study investigated patients newly diagnosed with psoriasis (International Classification of Disease, Tenth Revision, code L40) by dermatologists during the follow-up period (5.32 years), based on claims data. The total population consisted of 22 633 536 subjects, among whom 399 461 had newly developed psoriasis. Subjects with BMI of more than 30 had a higher risk of psoriasis (hazards ratio [HR], 1.118; 95% confidence interval [CI], 1.100-1.137) compared with the BMI 18.5-23 group. WC showed a dose-dependent association with psoriatic risk. Subjects with WC over 105 cm showed the highest risk of psoriasis (HR, 1.305; 95% CI, 1.261-1.349) compared with subjects with WC lower than 80/75 after adjusting for confounding factors, including BMI. The risk of psoriasis was highest in males with normal BMI and abdominal obesity (HR, 1.175; 95% CI, 1.150-1.200). Our study indicates that WC is a specific factor affecting psoriatic risk and highlights the association between abdominal obesity and psoriasis, thus increasing awareness of the role of abdominal obesity in the pathogenesis and comorbidities of psoriasis.

Methylenetetrahydrofolate Reductase C677T Gene Polymorphism as Risk Factor for Psoriasis in Saudis

Methylenetetrahydrofolate reductase (MTHFR) has been linked with the etiopathogenesis of psoriasis with inconsistent results. Methylenetetrahydrofolate reductase C677T polymorphism was evaluated in 106 Saudi psoriasis vulgaris patients and 280 matched healthy controls using PCR-RFLP (restriction fragment length plymorphism) technique. The cardiovascular risk factors were also compared in cases and controls. Allele T and genotypes CT and TT were found to be increased while allele C and genotype CC significantly decreased in psoriasis patients as compared with controls (P < .001). These results showed that the T-allele and T-containing genotypes (TT, CT) of MTHFR C677T are significantly linked with psoriasis susceptibility while C-allele and CC genotype are protective for it. Body mass index, fasting glucose, total cholesterol, low-density lipoprotein, triglycerides, and C-reactive protein, known markers for cardiovascular diseases, were found to be significantly elevated in the patient group as compared with the controls. It is concluded that the MTHFR C677T polymorphism increases psoriasis risk in Saudi patients.