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Krajina I, Stupin A, Šola M, Mihalj M. Oxidative Stress Induced by High Salt Diet—Possible Implications for Development and Clinical Manifestation of Cutaneous Inflammation and Endothelial Dysfunction in Psoriasis vulgaris. Antioxidants (Basel) 2022; 11:antiox11071269. [PMID: 35883760 PMCID: PMC9311978 DOI: 10.3390/antiox11071269] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2022] [Revised: 06/19/2022] [Accepted: 06/23/2022] [Indexed: 02/07/2023] Open
Abstract
Although oxidative stress is recognized as an important effector mechanism of the immune system, uncontrolled formation of reactive oxygen and nitrogen species promotes excessive tissue damage and leads to disease development. In view of this, increased dietary salt intake has been found to damage redox systems in the vessel wall, resulting in endothelial dysfunction associated with NO uncoupling, inflammation, vascular wall remodeling and, eventually, atherosclerosis. Several studies have reported increased systemic oxidative stress accompanied by reduced antioxidant capacity following a high salt diet. In addition, vigorous ionic effects on the immune mechanisms, such as (trans)differentiation of T lymphocytes are emerging, which together with the evidence of NaCl accumulation in certain tissues warrants a re-examination of the data derived from in vitro research, in which the ionic influence was excluded. Psoriasis vulgaris (PV), as a primarily Th17-driven inflammatory skin disease with proven inflammation-induced accumulation of sodium chloride in the skin, merits our interest in the role of oxidative stress in the pathogenesis of PV, as well as in the possible beneficial effects that could be achieved through modulation of dietary salt intake and antioxidant supplementation.
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Affiliation(s)
- Ivana Krajina
- Department of Dermatology and Venereology, Osijek University Hospital, J. Huttlera 4, HR-31000 Osijek, Croatia;
- Faculty of Medicine, Josip Juraj Strossmayer University of Osijek, J. Huttlera 4, HR-31000 Osijek, Croatia
| | - Ana Stupin
- Scientific Center of Excellence for Personalized Health Care, Josip Juraj Strossmayer University of Osijek, Trg Svetog Trojstva 3, HR-31000 Osijek, Croatia;
- Institute and Department of Physiology and Immunology, Faculty of Medicine, Josip Juraj Strossmayer University of Osijek, J. Huttlera 4, HR-31000 Osijek, Croatia
| | - Marija Šola
- Department of Dermatology and Venereology, Osijek University Hospital, J. Huttlera 4, HR-31000 Osijek, Croatia;
- Faculty of Medicine, Josip Juraj Strossmayer University of Osijek, J. Huttlera 4, HR-31000 Osijek, Croatia
- Correspondence: (M.Š.); (M.M.); Tel.: +385-31-512-800 (M.M.)
| | - Martina Mihalj
- Department of Dermatology and Venereology, Osijek University Hospital, J. Huttlera 4, HR-31000 Osijek, Croatia;
- Scientific Center of Excellence for Personalized Health Care, Josip Juraj Strossmayer University of Osijek, Trg Svetog Trojstva 3, HR-31000 Osijek, Croatia;
- Institute and Department of Physiology and Immunology, Faculty of Medicine, Josip Juraj Strossmayer University of Osijek, J. Huttlera 4, HR-31000 Osijek, Croatia
- Correspondence: (M.Š.); (M.M.); Tel.: +385-31-512-800 (M.M.)
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Ellis CN, Neville SJ, Sayyouh M, Elder JT, Nair RP, Gudjonsson JE, Ma T, Kazerooni EA, Rubenfire M, Agarwal PP. Epicardial adipose tissue volume is greater in men with severe psoriasis, implying an increased cardiovascular disease risk: A cross-sectional study. J Am Acad Dermatol 2021; 86:535-543. [PMID: 34678237 DOI: 10.1016/j.jaad.2021.09.069] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2021] [Revised: 09/03/2021] [Accepted: 09/12/2021] [Indexed: 12/22/2022]
Abstract
BACKGROUND Patients with psoriasis have elevated risk of coronary artery disease. OBJECTIVE Do patients with severe psoriasis have larger epicardial adipose tissue volumes (EAT-V) that are associated with cardiovascular risk? METHODS For this cross-sectional study, we recruited dermatology patients with severe psoriasis and control patients without psoriasis or rheumatologic disease themselves or in a first-degree relative. Participants aged 34 to 55 years without known coronary artery disease or diabetes mellitus underwent computed tomography (CT); EAT-V was obtained from noncontrast CT heart images. RESULTS Twenty-five patients with psoriasis (14 men, 11 women) and 16 controls (5 men, 11 women) participated. Groups had no statistical difference in age, body mass index, various cardiovascular risk factors (except high-sensitivity C-reactive protein in men), CT-determined coronary artery calcium scores or plaque, or family history of premature cardiovascular disease. Mean EAT-V was greater in the psoriasis group compared to controls (P = .04). There was no statistically significant difference among women; however, male patients with psoriasis had significantly higher EAT-V than controls (P = .03), even when corrected for elevated high-sensitivity C-reactive protein (P = .05). LIMITATIONS A single-center convenience sample may not be representative. CONCLUSION Males with psoriasis without known coronary disease or diabetes had greater EAT-V than controls. EAT-V may be an early identifier of those at increased risk for cardiovascular events.
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Affiliation(s)
- Charles N Ellis
- Department of Dermatology, University of Michigan Medical School, Ann Arbor, Michigan
| | - Stephen J Neville
- Department of Radiology, University of Michigan Medical School, Ann Arbor, Michigan
| | - Mohamed Sayyouh
- Department of Radiology, University of Michigan Medical School, Ann Arbor, Michigan
| | - James T Elder
- Department of Dermatology, University of Michigan Medical School, Ann Arbor, Michigan
| | - Rajan P Nair
- Department of Dermatology, University of Michigan Medical School, Ann Arbor, Michigan
| | - Johann E Gudjonsson
- Department of Dermatology, University of Michigan Medical School, Ann Arbor, Michigan
| | - Tianwen Ma
- Department of Biostatistics, University of Michigan School of Public Health, Ann Arbor, Michigan
| | - Ella A Kazerooni
- Department of Radiology, University of Michigan Medical School, Ann Arbor, Michigan; Division of Pulmonary & Critical Care Medicine, Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, Michigan
| | - Melvyn Rubenfire
- Division of Cardiovascular Medicine, Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, Michigan
| | - Prachi P Agarwal
- Department of Radiology, University of Michigan Medical School, Ann Arbor, Michigan.
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Martinez-Moreno A, Ocampo-Candiani J, Garza-Rodriguez V. Psoriasis and Cardiovascular Disease: A Narrative Review. Korean J Fam Med 2021; 42:345-355. [PMID: 32512983 PMCID: PMC8490176 DOI: 10.4082/kjfm.20.0053] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2020] [Revised: 04/29/2020] [Accepted: 05/07/2020] [Indexed: 12/19/2022] Open
Abstract
Psoriasis is a chronic, autoimmune, and inflammatory disease that affects 2% of the world's population. In recent years, it has been demonstrated that psoriasis confers a 25% increase in relative risk of cardiovascular disease, independent of factors such as hyperlipidemia, smoking, and obesity. The objective of this review was to analyze and describe the association between psoriasis and cardiovascular disease. In this review, we describe the epidemiological association of psoriasis and cardiovascular disease, pathophysiology, mechanisms, and its association with the well-known cardiovascular risk calculators. In addition, we describe diagnostic tools, such as imaging techniques and novel biomarkers, that are useful in the evaluation of atherosclerotic cardiovascular disease. Finally, we present different systemic therapies that are used in patients with psoriasis and their effect on atherosclerotic cardiovascular disease. This article provides an overview of the current literature on psoriasis and cardiovascular risk, which can be useful for primary care physicians in their daily clinical practice.
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Affiliation(s)
- Adrian Martinez-Moreno
- Servicio de Dermatología, Hospital Universitario “Dr. José E. González”, Universidad Autónoma de Nuevo León, Monterrey, Mexico
| | - Jorge Ocampo-Candiani
- Servicio de Dermatología, Hospital Universitario “Dr. José E. González”, Universidad Autónoma de Nuevo León, Monterrey, Mexico
| | - Veronica Garza-Rodriguez
- Servicio de Dermatología, Hospital Universitario “Dr. José E. González”, Universidad Autónoma de Nuevo León, Monterrey, Mexico
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Kim D, Chung H, Lee JE, Kim J, Hwang J, Chung Y. Immunologic Aspects of Dyslipidemia: a Critical Regulator of Adaptive Immunity and Immune Disorders. J Lipid Atheroscler 2021; 10:184-201. [PMID: 34095011 PMCID: PMC8159760 DOI: 10.12997/jla.2021.10.2.184] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2021] [Revised: 04/23/2021] [Accepted: 05/02/2021] [Indexed: 11/09/2022] Open
Abstract
Dyslipidemia is a major cause of cardiovascular diseases which represent a leading cause of death in humans. Diverse immune cells are known to be involved in the pathogenesis of cardiovascular diseases such as atherosclerosis. Conversely, dyslipidemia is known to be tightly associated with immune disorders in humans, as evidenced by a higher incidence of atherosclerosis in patients with autoimmune diseases including psoriasis, rheumatoid arthritis, and systemic lupus erythematosus. Given that the dyslipidemia-related autoimmune diseases are caused by autoreactive T cells and B cells, dyslipidemia seems to directly or indirectly regulate the adaptive immunity. Indeed, accumulating evidence has unveiled that proatherogenic factors can impact the differentiation and function of CD4+ T cells, CD8+ T cells, and B cells. This review discusses an updated overview on the regulation of adaptive immunity by dyslipidemia and proposes a potential therapeutic strategy for immune disorders by targeting lipid metabolism.
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Affiliation(s)
- Daehong Kim
- Laboratory of Immune Regulation, Institute of Pharmaceutical Sciences, College of Pharmacy, Seoul National University, Seoul, Korea
| | - Hayeon Chung
- Laboratory of Immune Regulation, Institute of Pharmaceutical Sciences, College of Pharmacy, Seoul National University, Seoul, Korea
| | - Jeong-Eun Lee
- Laboratory of Immune Regulation, Institute of Pharmaceutical Sciences, College of Pharmacy, Seoul National University, Seoul, Korea
| | - Jiyeon Kim
- Laboratory of Immune Regulation, Institute of Pharmaceutical Sciences, College of Pharmacy, Seoul National University, Seoul, Korea
| | - Junseok Hwang
- Laboratory of Immune Regulation, Institute of Pharmaceutical Sciences, College of Pharmacy, Seoul National University, Seoul, Korea
| | - Yeonseok Chung
- Laboratory of Immune Regulation, Institute of Pharmaceutical Sciences, College of Pharmacy, Seoul National University, Seoul, Korea
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Sbidian E, Chaimani A, Garcia-Doval I, Doney L, Dressler C, Hua C, Hughes C, Naldi L, Afach S, Le Cleach L. Systemic pharmacological treatments for chronic plaque psoriasis: a network meta-analysis. Cochrane Database Syst Rev 2021; 4:CD011535. [PMID: 33871055 PMCID: PMC8408312 DOI: 10.1002/14651858.cd011535.pub4] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
BACKGROUND Psoriasis is an immune-mediated disease for which some people have a genetic predisposition. The condition manifests in inflammatory effects on either the skin or joints, or both, and it has a major impact on quality of life. Although there is currently no cure for psoriasis, various treatment strategies allow sustained control of disease signs and symptoms. Several randomised controlled trials (RCTs) have compared the efficacy of the different systemic treatments in psoriasis against placebo. However, the relative benefit of these treatments remains unclear due to the limited number of trials comparing them directly head-to-head, which is why we chose to conduct a network meta-analysis. OBJECTIVES To compare the efficacy and safety of non-biological systemic agents, small molecules, and biologics for people with moderate-to-severe psoriasis using a network meta-analysis, and to provide a ranking of these treatments according to their efficacy and safety. SEARCH METHODS For this living systematic review we updated our searches of the following databases monthly to September 2020: the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, and Embase. We searched two trials registers to the same date. We checked the reference lists of included studies and relevant systematic reviews for further references to eligible RCTs. SELECTION CRITERIA Randomised controlled trials (RCTs) of systemic treatments in adults (over 18 years of age) with moderate-to-severe plaque psoriasis or psoriatic arthritis whose skin had been clinically diagnosed with moderate-to-severe psoriasis, at any stage of treatment, in comparison to placebo or another active agent. The primary outcomes of this review were: the proportion of participants who achieved clear or almost clear skin, that is, at least Psoriasis Area and Severity Index (PASI) 90 at induction phase (from 8 to 24 weeks after the randomisation), and the proportion of participants with serious adverse events (SAEs) at induction phase. We did not evaluate differences in specific adverse events. DATA COLLECTION AND ANALYSIS Several groups of two review authors independently undertook study selection, data extraction, 'Risk of bias' assessment, and analyses. We synthesised the data using pair-wise and network meta-analysis (NMA) to compare the treatments of interest and rank them according to their effectiveness (as measured by the PASI 90 score) and acceptability (the inverse of serious adverse events). We assessed the certainty of the body of evidence from the NMA for the two primary outcomes and all comparisons, according to CINeMA, as either very low, low, moderate, or high. We contacted study authors when data were unclear or missing. We used the surface under the cumulative ranking curve (SUCRA) to infer on treatment hierarchy: 0% (treatment is the worst for effectiveness or safety) to 100% (treatment is the best for effectiveness or safety). MAIN RESULTS We included 158 studies (18 new studies for the update) in our review (57,831 randomised participants, 67.2% men, mainly recruited from hospitals). The overall average age was 45 years; the overall mean PASI score at baseline was 20 (range: 9.5 to 39). Most of these studies were placebo-controlled (58%), 30% were head-to-head studies, and 11% were multi-armed studies with both an active comparator and a placebo. We have assessed a total of 20 treatments. In all, 133 trials were multicentric (two to 231 centres). All but two of the outcomes included in this review were limited to the induction phase (assessment from 8 to 24 weeks after randomisation). We assessed many studies (53/158) as being at high risk of bias; 25 were at an unclear risk, and 80 at low risk. Most studies (123/158) declared funding by a pharmaceutical company, and 22 studies did not report their source of funding. Network meta-analysis at class level showed that all of the interventions (non-biological systemic agents, small molecules, and biological treatments) were significantly more effective than placebo in reaching PASI 90. At class level, in reaching PASI 90, the biologic treatments anti-IL17, anti-IL12/23, anti-IL23, and anti-TNF alpha were significantly more effective than the small molecules and the non-biological systemic agents. At drug level, infliximab, ixekizumab, secukinumab, brodalumab, risankizumab and guselkumab were significantly more effective in reaching PASI 90 than ustekinumab and three anti-TNF alpha agents: adalimumab, certolizumab, and etanercept. Ustekinumab and adalimumab were significantly more effective in reaching PASI 90 than etanercept; ustekinumab was more effective than certolizumab, and the clinical effectiveness of ustekinumab and adalimumab was similar. There was no significant difference between tofacitinib or apremilast and three non-biological drugs: fumaric acid esters (FAEs), ciclosporin and methotrexate. Network meta-analysis also showed that infliximab, ixekizumab, risankizumab, bimekizumab, secukinumab, guselkumab, and brodalumab outperformed other drugs when compared to placebo in reaching PASI 90. The clinical effectiveness of these drugs was similar, except for ixekizumab which had a better chance of reaching PASI 90 compared with secukinumab, guselkumab and brodalumab. The clinical effectiveness of these seven drugs was: infliximab (versus placebo): risk ratio (RR) 50.29, 95% confidence interval (CI) 20.96 to 120.67, SUCRA = 93.6; high-certainty evidence; ixekizumab (versus placebo): RR 32.48, 95% CI 27.13 to 38.87; SUCRA = 90.5; high-certainty evidence; risankizumab (versus placebo): RR 28.76, 95% CI 23.96 to 34.54; SUCRA = 84.6; high-certainty evidence; bimekizumab (versus placebo): RR 58.64, 95% CI 3.72 to 923.86; SUCRA = 81.4; high-certainty evidence; secukinumab (versus placebo): RR 25.79, 95% CI 21.61 to 30.78; SUCRA = 76.2; high-certainty evidence; guselkumab (versus placebo): RR 25.52, 95% CI 21.25 to 30.64; SUCRA = 75; high-certainty evidence; and brodalumab (versus placebo): RR 23.55, 95% CI 19.48 to 28.48; SUCRA = 68.4; moderate-certainty evidence. Conservative interpretation is warranted for the results for bimekizumab (as well as mirikizumab, tyrosine kinase 2 inhibitor, acitretin, ciclosporin, fumaric acid esters, and methotrexate), as these drugs, in the NMA, have been evaluated in few trials. We found no significant difference between any of the interventions and the placebo for the risk of SAEs. Nevertheless, the SAE analyses were based on a very low number of events with low to moderate certainty for all the comparisons. Thus, the results have to be viewed with caution and we cannot be sure of the ranking. For other efficacy outcomes (PASI 75 and Physician Global Assessment (PGA) 0/1) the results were similar to the results for PASI 90. Information on quality of life was often poorly reported and was absent for several of the interventions. AUTHORS' CONCLUSIONS Our review shows that compared to placebo, the biologics infliximab, ixekizumab, risankizumab, bimekizumab, secukinumab, guselkumab and brodalumab were the most effective treatments for achieving PASI 90 in people with moderate-to-severe psoriasis on the basis of moderate- to high-certainty evidence. This NMA evidence is limited to induction therapy (outcomes were measured from 8 to 24 weeks after randomisation) and is not sufficient for evaluation of longer-term outcomes in this chronic disease. Moreover, we found low numbers of studies for some of the interventions, and the young age (mean age of 45 years) and high level of disease severity (PASI 20 at baseline) may not be typical of patients seen in daily clinical practice. Another major concern is that short-term trials provide scanty and sometimes poorly-reported safety data and thus do not provide useful evidence to create a reliable risk profile of treatments. We found no significant difference in the assessed interventions and placebo in terms of SAEs, and the evidence for all the interventions was of low to moderate quality. In order to provide long-term information on the safety of the treatments included in this review, it will also be necessary to evaluate non-randomised studies and postmarketing reports released from regulatory agencies. In terms of future research, randomised trials directly comparing active agents are necessary once high-quality evidence of benefit against placebo is established, including head-to-head trials amongst and between non-biological systemic agents and small molecules, and between biological agents (anti-IL17 versus anti-IL23, anti-IL23 versus anti-IL12/23, anti-TNF alpha versus anti-IL12/23). Future trials should also undertake systematic subgroup analyses (e.g. assessing biological-naïve participants, baseline psoriasis severity, presence of psoriatic arthritis, etc.). Finally, outcome measure harmonisation is needed in psoriasis trials, and researchers should look at the medium- and long-term benefit and safety of the interventions and the comparative safety of different agents. Editorial note: This is a living systematic review. Living systematic reviews offer a new approach to review updating, in which the review is continually updated, incorporating relevant new evidence as it becomes available. Please refer to the Cochrane Database of Systematic Reviews for the current status of this review.
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Affiliation(s)
- Emilie Sbidian
- Department of Dermatology, Hôpital Henri Mondor, Créteil, France
- Clinical Investigation Centre, Hôpital Henri Mondor, Créteil, France
- Epidemiology in Dermatology and Evaluation of Therapeutics (EpiDermE) - EA 7379, Université Paris Est Créteil (UPEC), Créteil, France
| | - Anna Chaimani
- Université de Paris, Centre of Research in Epidemiology and Statistics (CRESS), INSERM, F-75004, Paris, France
- Cochrane France, Paris, France
| | - Ignacio Garcia-Doval
- Department of Dermatology, Complexo Hospitalario Universitario de Vigo, Vigo, Spain
| | - Liz Doney
- Centre of Evidence Based Dermatology, Cochrane Skin Group, The University of Nottingham, Nottingham, UK
| | - Corinna Dressler
- Division of Evidence Based Medicine, Department of Dermatology, Venerology and Allergology, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Camille Hua
- Department of Dermatology, Hôpital Henri Mondor, Créteil, France
- Epidemiology in Dermatology and Evaluation of Therapeutics (EpiDermE) - EA 7379, Université Paris Est Créteil (UPEC), Créteil, France
| | - Carolyn Hughes
- c/o Cochrane Skin Group, The University of Nottingham, Nottingham, UK
| | - Luigi Naldi
- Centro Studi GISED (Italian Group for Epidemiologic Research in Dermatology) - FROM (Research Foundation of Ospedale Maggiore Bergamo), Padiglione Mazzoleni - Presidio Ospedaliero Matteo Rota, Bergamo, Italy
| | - Sivem Afach
- Epidemiology in Dermatology and Evaluation of Therapeutics (EpiDermE) - EA 7379, Université Paris Est Créteil (UPEC), Créteil, France
| | - Laurence Le Cleach
- Department of Dermatology, Hôpital Henri Mondor, Créteil, France
- Epidemiology in Dermatology and Evaluation of Therapeutics (EpiDermE) - EA 7379, Université Paris Est Créteil (UPEC), Créteil, France
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Aksoy M, Toptan M, An I. Retinal nerve fibre layer thickness and choroidal thickness: An evaluation in psoriasis patients. Int J Clin Pract 2021; 75:e13904. [PMID: 33290620 DOI: 10.1111/ijcp.13904] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2020] [Accepted: 11/30/2020] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND/OBJECTIVES To conduct a comparative study of retinal nerve fibre layer (RNFL) thickness and choroidal thickness of psoriasis patients and healthy volunteers. METHODS This study included 35 severe psoriasis patients, 35 mild psoriasis patients and 35 healthy individuals. RNFL and choroidal thickness analysis were performed by spectral field optical coherence tomography (SD-OCT). Only patients with psoriasis vulgaris who have not used systemic therapy for the last 3 months were included in the study. RESULTS In the severe psoriasis group, the RSLT thickness was found to be statistically significantly thinner and the choroid thickness was thicker than the mild psoriasis and control group (P < .001). There was no significant difference in terms of RNLF and choroid thickness compared to mild psoriasis and the control group (P > .05). The correlation between length of the disease duration, RNFL and choroidal thickness was not significant (P > 0,05). CONCLUSION The increase in choroidal thickness was found to be significant, while with respect to RNFL thickness, a decrease was evident, a possible indicator of damage to microvascular structures in the choroid and ganglion cells, especially in patients with severe psoriasis. Therefore, choroidal and RSLT thickness measurement with OCT device can assist in the detection of damage to psoriasis.
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Affiliation(s)
- Mustafa Aksoy
- Department of Dermatolog, Harran University Medical Faculty, Sanlıurfa, Turkey
| | - Muslum Toptan
- Department of Ophthalmotology, Harran University Medical Faculty, Sanlıurfa, Turkey
| | - Isa An
- Department of Dermatolog, Sanlıurfa Training and Research Hospital, Sanlıurfa, Turkey
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Rana A, Mahajan VK, Mehta KS, Chauhan PS, Kumar M, Sharma A, Sharma R, Dhattarwal N, Sondhi M. Cardiomyopathy and echocardiographic abnormalities in Indian patients with psoriasis: Results of a pilot study. Int J Clin Pract 2021; 75:e13756. [PMID: 33064900 DOI: 10.1111/ijcp.13756] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2020] [Accepted: 10/04/2020] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND The relationship between psoriasis and cardiomyopathy is understudied in Indian patients. OBJECTIVE We evaluated psoriasis patients for cardiomyopathy and other echocardiographic abnormalities. METHODS About 98 (M:F = 67:31) patients with mild to moderate psoriasis aged 18-75 years (mean ± SD = 42.12 ± 12.79 years) having no pre-existing metabolic syndrome and cardiovascular disorders were studied. X-ray chest, electrocardiogram and echocardiography were performed and interpreted by cardiologist for size of the left and right ventricles, left ventricle ejection fraction, diastolic function, pulmonary artery pressure and valve abnormality/regurgitation and their severity as per current guidelines/recommendations. The cardiomyopathies were defined according to standard diagnostic guidelines. RESULTS Echocardiographic abnormalities were noted in 13 (13.3%) patients aged 19-75 years (mean ± SD = 43.30 ± 15.71 years). The left ventricular diastolic dysfunction (grade 1) was observed in nine patients (moderate severe psoriasis in four patients) and one of them also had concentric left ventricular hypertrophy; a precursor of restrictive cardiomyopathy. Mild tricuspid valve regurgitation was present in other four patients. There was no statistically significant difference in age, gender, duration and the severity of psoriasis when compared with patients having normal echocardiography. The mitral or aortic valves, pulmonary artery pressure, mid-right-ventricular diameter and the left atrial volume showed no abnormality. CONCLUSIONS Psoriasis perhaps plays a role in left ventricular dysfunction and possibly cardiomyopathy even with moderately severe disease and in the absence of clinical symptoms. However, these observations need to be interpreted with caution in the absence of any statistically significant difference between age, gender, duration and severity of psoriasis in the patients having normal and abnormal echocardiography.
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Affiliation(s)
- Ashwani Rana
- Department of Dermatology, Venereology & Leprosy, Dr Rajendra Prasad Government Medical College, Himachal Pradesh, Kangra (Tanda), India
| | - Vikram K Mahajan
- Department of Dermatology, Venereology & Leprosy, Dr Rajendra Prasad Government Medical College, Himachal Pradesh, Kangra (Tanda), India
| | - Karaninder S Mehta
- Department of Dermatology, Venereology & Leprosy, Dr Rajendra Prasad Government Medical College, Himachal Pradesh, Kangra (Tanda), India
| | - Pushpinder S Chauhan
- Department of Dermatology, Venereology & Leprosy, Dr Rajendra Prasad Government Medical College, Himachal Pradesh, Kangra (Tanda), India
| | - Mukul Kumar
- Department of Cardiology, Dr Rajendra Prasad Government Medical College, Himachal Pradesh, Kangra (Tanda), India
| | - Anuj Sharma
- Department of Dermatology, Venereology & Leprosy, Dr Rajendra Prasad Government Medical College, Himachal Pradesh, Kangra (Tanda), India
| | - Reena Sharma
- Department of Dermatology, Venereology & Leprosy, Dr Rajendra Prasad Government Medical College, Himachal Pradesh, Kangra (Tanda), India
| | - Niharika Dhattarwal
- Department of Dermatology, Venereology & Leprosy, Dr Rajendra Prasad Government Medical College, Himachal Pradesh, Kangra (Tanda), India
| | - Megha Sondhi
- Department of Dermatology, Venereology & Leprosy, Dr Rajendra Prasad Government Medical College, Himachal Pradesh, Kangra (Tanda), India
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Wacewicz-Muczyńska M, Socha K, Soroczyńska J, Niczyporuk M, Borawska MH. Cadmium, lead and mercury in the blood of psoriatic and vitiligo patients and their possible associations with dietary habits. THE SCIENCE OF THE TOTAL ENVIRONMENT 2021; 757:143967. [PMID: 33302005 DOI: 10.1016/j.scitotenv.2020.143967] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/26/2020] [Revised: 11/01/2020] [Accepted: 11/13/2020] [Indexed: 06/12/2023]
Abstract
BACKGROUND Psoriasis and vitiligo are common, autoimmune skin diseases, their etiology is still unclear. The relationship between environmental factors including diet and various skin diseases has been studied. The general mechanism of cadmium (Cd), lead (Pb) and mercury (Hg) toxicity is through the production of reactive oxygen species which are known to play a role in etiopathogenesis of skin disorders. OBJECTIVE The aim of this study was to estimate the influence of dietary habits on the concentration of Cd, Pb and Hg in the peripheral blood samples of patients with psoriasis and vitiligo. METHODS In this case-control study, sixty patients with psoriasis, fifty patients with vitiligo and fifty eight healthy people were examined. Blood levels of Cd, Pb and Hg were determined by atomic absorption spectrometry. Food-frequency questionnaires were implemented to collect the dietary data. RESULTS Significant differences (p < 0.05) of Cd levels were found between women and men with psoriasis and women and men in the control group. The concentration of Pb was significantly higher among vitiligo patients (50.04 ± 26.54 μg/L) than in healthy controls (36.04 ± 27.35 μg/L). Significantly lower ratio of Se/Pb, Zn/Pb and Cu/Pb was found among psoriatic men. Significantly (p < 0.05) lower values of Se/Hg ratio were observed among vitiligo patients compared to controls. CONCLUSIONS The elevated levels of toxic elements could increase oxidative stress which may partly contribute to inflammation in the pathogenesis of psoriasis and vitiligo, which requires further research. Analysis of the influence of frequent consumption of food products on toxic metals concentration showed that the dietary habits have impact on the content of examined toxic metals in the blood of patients. The obtained results may be useful for composing the diet and could be helpful in prevention of psoriasis and vitiligo.
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Affiliation(s)
- Marta Wacewicz-Muczyńska
- Department of Specialist Cosmetology, Medical University of Bialystok, Akademicka 3 St., 15-267 Bialystok, Poland.
| | - Katarzyna Socha
- Department of Bromatology, Medical University of Bialystok, Mickiewicza 2D St., 15-222 Bialystok, Poland
| | - Jolanta Soroczyńska
- Department of Bromatology, Medical University of Bialystok, Mickiewicza 2D St., 15-222 Bialystok, Poland
| | - Marek Niczyporuk
- Department of Esthetic Medicine, Medical University of Bialystok, Akademicka 3 St., 15-267 Bialystok, Poland; Outdoor-Patients Dermatological Department, Medical University of Bialystok Clinical Hospital, Żurawia 14 St., 15-540 Bialystok, Poland
| | - Maria H Borawska
- Department of Bromatology, Medical University of Bialystok, Mickiewicza 2D St., 15-222 Bialystok, Poland
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9
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Eisa M, Sandhu A, Prakash R, Ganocy SJ, Fass R. The Risk of Acute Myocardial Infarction in Patients With Gastroesophageal Reflux Disease. J Neurogastroenterol Motil 2020; 26:471-476. [PMID: 32989184 PMCID: PMC7547190 DOI: 10.5056/jnm19192] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2019] [Revised: 06/01/2020] [Accepted: 06/09/2020] [Indexed: 12/13/2022] Open
Abstract
Background/Aims A number of inflammatory mediators have been documented to be elevated in gastroesophageal reflux disease (GERD). Similar inflammatory mediators are involved in coronary artery disease. Thus, the aim of the study is to determine if GERD is a risk factor for developing acute myocardial infarction (AMI). Methods We used Explorys, a private cloud-based data store to which a number of health care systems feed information. We identified a cohort of GERD patients who have undergone an esophagogastroduodenoscopy compared to those without GERD. Incidence of AMI was studied after statistically controlling for known AMI risk factors. Results Total of 200 400 patients were included in the GERD group and 386 800 patients in non-GERD group. The primary event of AMI occurred in 17 200 patients in the GERD group (8.6%) vs 24 300 in non-GERD group (6.3%). Using logistic regression analysis and controlling for 6 major risk factors which included male gender (OR, 1.09; 95% CI, 1.07-1.11; P < 0.001), hypertension (OR, 6.53; 95% CI, 6.21-6.88; P < 0.001), hyperlipidemia (OR, 3.08; 95% CI, 2.96-3.20; P < 0.001), diabetes mellitus (OR, 1.72; 95% CI, 1.69-1.76; P < 0.001), obesity (OR, 1.02; 95% CI, 1.00-1.04; P = 0.044), and smoking (OR, 1.38; 95% CI, 1.35-1.41; P < 0.001). The odds of developing AMI in the GERD population was 1.11 (95% CI, 1.08-1.13; P < 0.001). GERD had higher odds of developing AMI than male gender or obesity in our study. Conclusions This study demonstrated that GERD is a risk factor for AMI, higher than male gender and obesity. However, the increased risk may be clinically insignificant.
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Affiliation(s)
- Mohamed Eisa
- Department of Internal Medicine, The Esophageal and Swallowing Center, Division of Gastroenterology and Hepatology, MetroHealth Medical Center, Case Western Reserve University, Cleveland, OH, USA
| | - Annumeet Sandhu
- Department of Internal Medicine, The Esophageal and Swallowing Center, Division of Gastroenterology and Hepatology, MetroHealth Medical Center, Case Western Reserve University, Cleveland, OH, USA
| | - Ravi Prakash
- Department of Internal Medicine, The Esophageal and Swallowing Center, Division of Gastroenterology and Hepatology, MetroHealth Medical Center, Case Western Reserve University, Cleveland, OH, USA
| | - Stephen J Ganocy
- Center for Health Care Research and Policy, Case Western Reserve University, Cleveland, OH, USA
| | - Ronnie Fass
- Department of Internal Medicine, The Esophageal and Swallowing Center, Division of Gastroenterology and Hepatology, MetroHealth Medical Center, Case Western Reserve University, Cleveland, OH, USA
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Kamath P, Benesh G, Romanelli P, Iacobellis G. Epicardial Fat: A New Therapeutic Target in Psoriasis. Curr Pharm Des 2020; 25:4914-4918. [PMID: 31808384 DOI: 10.2174/1381612825666191206091105] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2019] [Accepted: 12/05/2019] [Indexed: 12/21/2022]
Abstract
Psoriasis is a chronic inflammatory disease affecting over 8 million Americans. Importantly, patients with psoriasis are at an increased risk of developing atherosclerosis, coronary artery disease, and myocardial infarctions. Several studies have suggested that psoriasis may be an independent risk factor for cardiovascular disease given their shared inflammatory properties and pathogenic similarities. Epicardial fat is also linked to cardiovascular disease and may be an independent risk factor for atherosclerosis. It has been proposed that measuring epicardial fat tissue may serve as a useful subclinical measure of cardiovascular disease in psoriasis patients. Echocardiography has been increasingly adopted as an accurate, minimally invasive, and cost-effective measure of determining the volume and thickness of epicardial fat. Using echocardiographic measures of epicardial fat thickness as a marker of cardiovascular disease and therapeutic target in psoriasis patients may provide clinicians with a means to better manage and hopefully prevent deleterious downstream effects.
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Affiliation(s)
- Preetha Kamath
- University of Miami Miller School of Medicine, Miami, Florida, FL, 33136, United States
| | - Gabrielle Benesh
- University of Miami Miller School of Medicine, Miami, Florida, FL, 33136, United States
| | - Paolo Romanelli
- Department of Dermatology and Cutaneous Surgery, University of Miami Miller School of Medicine, Miami, Florida, FL, 33136, United States
| | - Gianluca Iacobellis
- Division of Endocrinology, Diabetes, Metabolism, Department of Medicine, University of Miami Miller School of Medicine, Miami, Florida, FL, 33136, United States
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11
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Choudhary S, Pradhan D, Pandey A, Khan MK, Lall R, Ramesh V, Puri P, Jain AK, Thomas G. The Association of Metabolic Syndrome and Psoriasis: A Systematic Review and Meta-Analysis of Observational Study. Endocr Metab Immune Disord Drug Targets 2020; 20:703-717. [DOI: 10.2174/1871530319666191008170409] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2019] [Revised: 09/14/2019] [Accepted: 09/16/2019] [Indexed: 02/06/2023]
Abstract
Background:
Metabolic syndrome worsens complications in psoriasis patients by predisposing
them to cardiovascular diseases. Psoriasis has been widely associated with metabolic syndrome;
however, it has still not been proven owing to a limited number of studies and some of those reporting
conflicting results.
Objective:
Psoriasis has reportedly been associated with metabolic syndrome; however, it has yet not
been established beyond doubt owing to conflicting literature. The present meta-analysis of observational
studies aims to evaluate the prevalence of metabolic syndrome in psoriasis patients and establish
an inferring point that psoriasis patients are certainly susceptible to metabolic syndrome. The study
will benefit clinicians to assess and monitor psoriasis patients for several associated comorbid conditions
and in its treatment.
Methods:
A systematic web search for ‘Psoriasis’, ‘Metabolic Syndrome’, ‘Hypertension’, ‘Plasma
Glucose’, ‘Dyslipidaemia’, ‘Waist Circumference’ was performed, collecting all original observational
studies on humans up to April 30, 2018. Depending on the inclusion and exclusion criteria, articles
were screened for eligibility. Due to the presence of significant heterogeneity, the Odds Ratio (OR)
was calculated using a random-effect model with Der-Simonian and Laird method. The statistical heterogeneity
was determined using I2 statistics. Comprehensive Meta-Analysis Software, Version 3 was
used to perform all the analysis.
Results:
Sixty-three studies encompassing 15,939 psoriasis patients and 103,984 controls were included
in this meta-analysis. Among them, 30.29 % of psoriasis patients were reported with metabolic
syndrome in comparison to 21.70 % of subjects in the control group. The present study clearly indicates
an increased prevalence of metabolic syndrome among psoriasis patients (OR: 2.077 [95% CI,
1.84 - 2.34]).
Conclusions:
The findings support the fact that psoriasis patients have a higher incidence of metabolic
syndrome. Our study also recommends that psoriasis patients should be regularly monitored for metabolic
syndrome complications and its associated risk factors such as hypertension, raised triglyceride,
lowered HDL Cholesterol, increased fasting plasma glucose, and waist circumference.
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Affiliation(s)
- Saumya Choudhary
- Department of Molecular and Cellular Engineering, Sam Higginbottom University of Agriculture, Technology and Sciences, Allahabad, India
| | - Dibyabhaba Pradhan
- Computational Genomics Centre, Informatics, Systems and Research Management (ISRM) Division- Indian Council of Medical Research, New Delhi, India
| | - Anamika Pandey
- Department of Soil Science and Plant Nutrition, Selcuk University, Turkey
| | - Mohd. Kamran Khan
- Department of Soil Science and Plant Nutrition, Selcuk University, Turkey
| | - Rohit Lall
- Department of Molecular and Cellular Engineering, Sam Higginbottom University of Agriculture, Technology and Sciences, Allahabad, India
| | - V. Ramesh
- Department of Skin and STD, Vardhman Mahavir Medical College, Safdarjung Hospital, New Delhi, India
| | - Poonam Puri
- Department of Skin and STD, Vardhman Mahavir Medical College, Safdarjung Hospital, New Delhi, India
| | - Arun K. Jain
- Biomedical Informatics Centre, National Institute of Pathology - Indian Council of Medical Research, New Delhi, India
| | - George Thomas
- Department of Molecular and Cellular Engineering, Sam Higginbottom University of Agriculture, Technology and Sciences, Allahabad, India
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12
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Early diagnosis of psoriatic arthritis among psoriasis patients: clinical experience sharing. Clin Rheumatol 2020; 39:3677-3684. [PMID: 32468320 PMCID: PMC7648743 DOI: 10.1007/s10067-020-05132-1] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2020] [Revised: 04/18/2020] [Accepted: 04/23/2020] [Indexed: 12/15/2022]
Abstract
Background The early detection of psoriatic arthritis (PSA) poses a challenge to rheumatologists, even when their diagnosis is aided by sonography. In order to facilitate early detection of PSA among patients with psoriasis (PSO), we retrospectively analyzed of the relationships between serological markers and comorbidities in 629 psoriatic patients, 102 of which had PSA, while the other 527 had PSO. Results Serological markers were found not to be useful in distinguishing between PSA and PSO (p > 0.05 for all comparisons). The prevalence rate of PSA among PSO patients was around 19.4%. Two components of metabolic syndrome—hyperlipidemia (2.94%) and gout (4.9%)—were significantly more prevalent in PSA patients than in PSO patients (p < 0.05). The odds ratio for PSA is 15.94 in patients with hyperlipidemia with a 95% confidence interval (CI) of 1.64–154.80; meanwhile, the odds ratio for PSA is 3.83 in patients with gout with a 95% CI of 1.19–12.31. Allergic rhinitis (5.88%) was more prevalent in PSA patients than in PSO patients (p < 0.01). The odds ratio was 8.17 in patients with allergic rhinitis with a 95% CI of 2.26–29.50. Plasma hs-miR-210-3p distinguishes PSA from PSO, and its levels can also be distinguished from PSA after treated with anti-TNFα biologics agents (both p < 0.05). Conclusions No clinical available serology markers, but hyperlipidemia, gout, axial spondylopathy (inflammatory back pain), or allergic rhinitis, could differentiate between psoriatic arthritis from psoriasis. Plasma hs-miR-210-3p and comorbidities may differentiate psoriatic arthritis from psoriasis.Key Points • Clinical manifestations and comorbidities are different between psoriatic arthritis and psoriasis only patients. • Traditional serology markers are similar between psoriatic arthritis and psoriasis-only patients. • Plasma hs-miR-210-3p distinguishes PSA from PSO, and its levels can also be distinguished from PSA after treated with anti-TNFα biologics agents in our study. |
Electronic supplementary material The online version of this article (10.1007/s10067-020-05132-1) contains supplementary material, which is available to authorized users.
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Angiotensin-converting enzyme and subclinical atherosclerosis in psoriasis: Is there any association? A case-control study. J Am Acad Dermatol 2020; 82:980-981.e1. [DOI: 10.1016/j.jaad.2018.08.003] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2018] [Revised: 07/25/2018] [Accepted: 08/04/2018] [Indexed: 11/19/2022]
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Sbidian E, Chaimani A, Afach S, Doney L, Dressler C, Hua C, Mazaud C, Phan C, Hughes C, Riddle D, Naldi L, Garcia-Doval I, Le Cleach L. Systemic pharmacological treatments for chronic plaque psoriasis: a network meta-analysis. Cochrane Database Syst Rev 2020; 1:CD011535. [PMID: 31917873 PMCID: PMC6956468 DOI: 10.1002/14651858.cd011535.pub3] [Citation(s) in RCA: 62] [Impact Index Per Article: 15.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
BACKGROUND Psoriasis is an immune-mediated disease for which some people have a genetic predisposition. The condition manifests in inflammatory effects on either the skin or joints, or both, and it has a major impact on quality of life. Although there is currently no cure for psoriasis, various treatment strategies allow sustained control of disease signs and symptoms. Several randomised controlled trials (RCTs) have compared the efficacy of the different systemic treatments in psoriasis against placebo. However, the relative benefit of these treatments remains unclear due to the limited number of trials comparing them directly head-to-head, which is why we chose to conduct a network meta-analysis. This is the baseline update of a Cochrane Review first published in 2017, in preparation for this Cochrane Review becoming a living systematic review. OBJECTIVES To compare the efficacy and safety of conventional systemic agents, small molecules, and biologics for people with moderate-to-severe psoriasis, and to provide a ranking of these treatments according to their efficacy and safety. SEARCH METHODS We updated our research using the following databases to January 2019: the Cochrane Skin Specialised Register, the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, Embase, LILACS and the conference proceedings of a number of dermatology meetings. We also searched five trials registers and the US Food and Drug Administration (FDA) and European Medicines Agency (EMA) reports (until June 2019). We checked the reference lists of included and excluded studies for further references to relevant RCTs. SELECTION CRITERIA Randomised controlled trials (RCTs) of systemic treatments in adults (over 18 years of age) with moderate-to-severe plaque psoriasis or psoriatic arthritis whose skin had been clinically diagnosed with moderate-to-severe psoriasis, at any stage of treatment, in comparison to placebo or another active agent. The primary outcomes of this review were: the proportion of participants who achieved clear or almost clear skin, that is, at least Psoriasis Area and Severity Index (PASI) 90 at induction phase (from 8 to 24 weeks after the randomisation), and the proportion of participants with serious adverse effects (SAEs) at induction phase. We did not evaluate differences in specific adverse effects. DATA COLLECTION AND ANALYSIS Several groups of two review authors independently undertook study selection, data extraction, 'Risk of bias' assessment, and analyses. We synthesised the data using pair-wise and network meta-analysis (NMA) to compare the treatments of interest and rank them according to their effectiveness (as measured by the PASI 90 score) and acceptability (the inverse of serious adverse effects). We assessed the certainty of the body of evidence from the NMA for the two primary outcomes, according to GRADE, as either very low, low, moderate, or high. We contacted study authors when data were unclear or missing. MAIN RESULTS We included 140 studies (31 new studies for the update) in our review (51,749 randomised participants, 68% men, mainly recruited from hospitals). The overall average age was 45 years; the overall mean PASI score at baseline was 20 (range: 9.5 to 39). Most of these studies were placebo-controlled (59%), 30% were head-to-head studies, and 11% were multi-armed studies with both an active comparator and a placebo. We have assessed a total of 19 treatments. In all, 117 trials were multicentric (two to 231 centres). All but two of the outcomes included in this review were limited to the induction phase (assessment from 8 to 24 weeks after randomisation). We assessed many studies (57/140) as being at high risk of bias; 42 were at an unclear risk, and 41 at low risk. Most studies (107/140) declared funding by a pharmaceutical company, and 22 studies did not report the source of funding. Network meta-analysis at class level showed that all of the interventions (conventional systemic agents, small molecules, and biological treatments) were significantly more effective than placebo in terms of reaching PASI 90. At class level, in terms of reaching PASI 90, the biologic treatments anti-IL17, anti-IL12/23, anti-IL23, and anti-TNF alpha were significantly more effective than the small molecules and the conventional systemic agents. At drug level, in terms of reaching PASI 90, infliximab, all of the anti-IL17 drugs (ixekizumab, secukinumab, bimekizumab and brodalumab) and the anti-IL23 drugs (risankizumab and guselkumab, but not tildrakizumab) were significantly more effective in reaching PASI 90 than ustekinumab and 3 anti-TNF alpha agents: adalimumab, certolizumab and etanercept. Adalimumab and ustekinumab were significantly more effective in reaching PASI 90 than certolizumab and etanercept. There was no significant difference between tofacitinib or apremilast and between two conventional drugs: ciclosporin and methotrexate. Network meta-analysis also showed that infliximab, ixekizumab, risankizumab, bimekizumab, guselkumab, secukinumab and brodalumab outperformed other drugs when compared to placebo in reaching PASI 90. The clinical effectiveness for these seven drugs was similar: infliximab (versus placebo): risk ratio (RR) 29.52, 95% confidence interval (CI) 19.94 to 43.70, Surface Under the Cumulative Ranking (SUCRA) = 88.5; moderate-certainty evidence; ixekizumab (versus placebo): RR 28.12, 95% CI 23.17 to 34.12, SUCRA = 88.3, moderate-certainty evidence; risankizumab (versus placebo): RR 27.67, 95% CI 22.86 to 33.49, SUCRA = 87.5, high-certainty evidence; bimekizumab (versus placebo): RR 58.64, 95% CI 3.72 to 923.86, SUCRA = 83.5, low-certainty evidence; guselkumab (versus placebo): RR 25.84, 95% CI 20.90 to 31.95; SUCRA = 81; moderate-certainty evidence; secukinumab (versus placebo): RR 23.97, 95% CI 20.03 to 28.70, SUCRA = 75.4; high-certainty evidence; and brodalumab (versus placebo): RR 21.96, 95% CI 18.17 to 26.53, SUCRA = 68.7; moderate-certainty evidence. Conservative interpretation is warranted for the results for bimekizumab (as well as tyrosine kinase 2 inhibitor, acitretin, ciclosporin, fumaric acid esters, and methotrexate), as these drugs, in the NMA, have been evaluated in few trials. We found no significant difference between any of the interventions and the placebo for the risk of SAEs. Nevertheless, the SAE analyses were based on a very low number of events with low to very low certainty for just under half of the treatment estimates in total, and moderate for the others. Thus, the results have to be viewed with caution and we cannot be sure of the ranking. For other efficacy outcomes (PASI 75 and Physician Global Assessment (PGA) 0/1) the results were very similar to the results for PASI 90. Information on quality of life was often poorly reported and was absent for several of the interventions. AUTHORS' CONCLUSIONS Our review shows that compared to placebo, the biologics infliximab, ixekizumab, risankizumab, bimekizumab, guselkumab, secukinumab and brodalumab were the best choices for achieving PASI 90 in people with moderate-to-severe psoriasis on the basis of moderate- to high-certainty evidence (low-certainty evidence for bimekizumab). This NMA evidence is limited to induction therapy (outcomes were measured from 8 to 24 weeks after randomisation) and is not sufficient for evaluation of longer-term outcomes in this chronic disease. Moreover, we found low numbers of studies for some of the interventions, and the young age (mean age of 45 years) and high level of disease severity (PASI 20 at baseline) may not be typical of patients seen in daily clinical practice. Another major concern is that short-term trials provide scanty and sometimes poorly-reported safety data and thus do not provide useful evidence to create a reliable risk profile of treatments. Indeed, we found no significant difference in the assessed interventions and placebo in terms of SAEs, but the evidence for all the interventions was of very low to moderate quality. In order to provide long-term information on the safety of the treatments included in this review, it will also be necessary to evaluate non-randomised studies and postmarketing reports released from regulatory agencies. In terms of future research, randomised trials comparing directly active agents are necessary once high-quality evidence of benefit against placebo is established, including head-to-head trials amongst and between conventional systemic and small molecules, and between biological agents (anti-IL17 versus anti-IL23, anti-IL23 versus anti-IL12/23, anti-TNF alpha versus anti-IL12/23). Future trials should also undertake systematic subgroup analyses (e.g. assessing biological-naïve participants, baseline psoriasis severity, presence of psoriatic arthritis, etc.). Finally, outcome measure harmonisation is needed in psoriasis trials, and researchers should look at the medium- and long-term benefit and safety of the interventions and the comparative safety of different agents. Editorial note: This is a living systematic review. Living systematic reviews offer a new approach to review updating, in which the review is continually updated, incorporating relevant new evidence as it becomes available. Please refer to the Cochrane Database of Systematic Reviews for the current status of this review.
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Affiliation(s)
- Emilie Sbidian
- Hôpital Henri Mondor, Department of Dermatology, 51 Avenue du Maréchal de Lattre de Tassigny, Créteil, France, 94000
- Hôpital Henri Mondor, Clinical Investigation Centre, Créteil, France, 94010
- Université Paris Est Créteil (UPEC), Epidemiology in Dermatology and Evaluation of Therapeutics (EpiDermE) - EA 7379, Créteil, France
| | - Anna Chaimani
- Université de Paris, Research Center in Epidemiology and Statistics Sorbonne Paris Cité (CRESS-UMR1153), Inserm, Inra, F-75004, Paris, France
- Cochrane France, Paris, France
| | - Sivem Afach
- Université Paris Est Créteil (UPEC), Epidemiology in dermatology and evaluation of therapeutics (EpiDermE) - EA 7379, Créteil, France
| | - Liz Doney
- Cochrane Skin Group, The University of Nottingham, Centre of Evidence Based Dermatology, A103, King's Meadow Campus, Lenton Lane, Nottingham, UK, NG7 2NR
| | - Corinna Dressler
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Division of Evidence Based Medicine, Department of Dermatology, Venerology and Allergology, Charitéplatz 1, Berlin, Germany, 10117
| | - Camille Hua
- Hôpital Henri Mondor, Department of Dermatology, 51 Avenue du Maréchal de Lattre de Tassigny, Créteil, France, 94000
| | - Canelle Mazaud
- Hôpital Henri Mondor, Department of Dermatology, 51 Avenue du Maréchal de Lattre de Tassigny, Créteil, France, 94000
| | - Céline Phan
- Centre Hospitalier Victor Dupouy, Department of Dermatology, Argenteuil, France
| | - Carolyn Hughes
- The University of Nottingham, c/o Cochrane Skin Group, A103, King's Meadow Campus, Lenton Lane, Nottingham, UK, NG7 2NR
| | - Dru Riddle
- Texas Christian University (TCU), School of Nurse Anesthesia, Fort Worth, Texas, USA
| | - Luigi Naldi
- Padiglione Mazzoleni - Presidio Ospedaliero Matteo Rota, Centro Studi GISED (Italian Group for Epidemiologic Research in Dermatology) - FROM (Research Foundation of Ospedale Maggiore Bergamo), Via Garibaldi 13/15, Bergamo, Italy, 24122
| | - Ignacio Garcia-Doval
- Complexo Hospitalario Universitario de Vigo, Department of Dermatology, Meixoeiro sn, Vigo, Spain, 36214
| | - Laurence Le Cleach
- Hôpital Henri Mondor, Department of Dermatology, 51 Avenue du Maréchal de Lattre de Tassigny, Créteil, France, 94000
- Université Paris Est Créteil (UPEC), Epidemiology in Dermatology and Evaluation of Therapeutics (EpiDermE) - EA 7379, Créteil, France
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Samejo S, Kazi AG, Afridi HI, Kazi TG. Evaluate the effect of cadmium on levels of zinc in scalp hair and blood samples of smoker and nonsmoker psoriatic patients at different stage. ENVIRONMENTAL SCIENCE AND POLLUTION RESEARCH INTERNATIONAL 2019; 26:31763-31769. [PMID: 31485944 DOI: 10.1007/s11356-019-06226-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/02/2018] [Accepted: 08/16/2019] [Indexed: 06/10/2023]
Abstract
Psoriasis, a skin inflammatory disease, originates from dysregulated interactions of the immune system and environmental factors. In the present study, cadmium (Cd) and zinc (Zn) were analyzed in biological samples (blood and scalp hair) of smoker and nonsmoker males who have mild and severe psoriasis. The patients were evaluated according to criteria based on the standard clinical diagnosis and classified into mild and severe psoriasis groups using the Psoriasis Area Severity Index (PASI) score. Both elements were determined by atomic absorption spectrometry after matrix oxidation. In smoker psoriatic patients, the level of Cd in biological samples was significantly increased. The Zn was significantly decreased in smoker mild and severe psoriatic patients as related to nonsmokers' referents and patients. The resulted data indicated that the levels of Zn in smoker referents were about 5.0% lower than nonsmoker's referents. While the concentrations of Zn in blood samples of nonsmoker's mild and severe psoriatic patients have 17.8 to 33.3% lower than nonsmoker's referents. The results indicate that the level of Cd in blood samples of referent smokers has ≥ 25% than nonsmokers, whereas the psoriatic patients at different stages have two- to threefold higher Cd in both biological samples.
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Affiliation(s)
- Suraya Samejo
- National Centre of Excellence in Analytical Chemistry (NCEAC), University of Sindh, Jamshoro, 76080, Pakistan
| | - Atif G Kazi
- Department of Dermatology, Liaquat University of Medical and Health Sciences, Jamshoro, 76080, Pakistan
| | - Hassan I Afridi
- National Centre of Excellence in Analytical Chemistry (NCEAC), University of Sindh, Jamshoro, 76080, Pakistan.
| | - Tasneem G Kazi
- National Centre of Excellence in Analytical Chemistry (NCEAC), University of Sindh, Jamshoro, 76080, Pakistan
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Kazi TG, Samejo S, Afridi HI, Akhtar A, Baig JA. A switchable ionic liquid with polarity swing‐assisted regeneration properties used for the preconcentration of cadmium in biological samples. Appl Organomet Chem 2019. [DOI: 10.1002/aoc.5263] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Tasneem Gul Kazi
- National Centre of Excellence in Analytical ChemistryUniversity of Sindh Jamshoro Pakistan 76080
| | - Suraya Samejo
- National Centre of Excellence in Analytical ChemistryUniversity of Sindh Jamshoro Pakistan 76080
| | - Hassan Imran Afridi
- National Centre of Excellence in Analytical ChemistryUniversity of Sindh Jamshoro Pakistan 76080
| | - Asma Akhtar
- National Centre of Excellence in Analytical ChemistryUniversity of Sindh Jamshoro Pakistan 76080
| | - Jameel Ahmed Baig
- National Centre of Excellence in Analytical ChemistryUniversity of Sindh Jamshoro Pakistan 76080
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Kim JE, Lee HJ, Lee JS, Whang KU, Park YL, Lee SY, Kim HJ. Association between Homocysteine Levels and Psoriasis: A Meta-Analysis. Ann Dermatol 2019; 31:378-386. [PMID: 33911615 PMCID: PMC7992747 DOI: 10.5021/ad.2019.31.4.378] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2018] [Revised: 12/10/2018] [Accepted: 12/17/2018] [Indexed: 02/05/2023] Open
Abstract
Background Psoriasis is a multifactorial disease associated with an increased risk for metabolic syndrome and cardiovascular diseases. Elevated levels of homocysteine (Hcy) are a marker of cardiovascular risk. Several studies have evaluated the associations between psoriasis and Hcy levels; however, the results remain inconclusive. Objective We performed a systematic review of the literature and a meta-analysis to better understand the relationship between psoriasis and Hcy. Methods Five scientific databases (MEDLINE, Embase, Cochrane Library, Scopus, and Web of Science) were searched to identify relevant studies. A review of 307 publications identified 16 studies that directly assessed plasma levels of Hcy in psoriasis patients. Results A total of 16 studies including 2,091 subjects were included in the meta-analysis. Hcy levels were significantly higher in psoriasis patients relative to healthy controls (weighted mean difference [WMD], 3.30; 95% confidence interval [CI], 1.58∼5.02; I2=82.1%). Subgroup analyses revealed that patients with higher mean psoriasis area severity index (PASI) scores (PASI>10) had significantly higher Hcy levels compared to healthy controls (WMD, 4.17; 95% CI, 1.18∼7.16; I2=88.3%), whereas patients with lower mean PASI scores (PASI ≤10) had not (WMD, 0.76; 95% CI, −1.84∼3.35; I2=72.2%). Conclusion This meta-analysis found that psoriasis patients, in particular those with PASI >10, had significantly higher Hcy levels compared to healthy controls. Further research is needed to determine the association between Hcy levels and psoriasis severity.
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Affiliation(s)
- Jung Eun Kim
- Department of Dermatology, Soonchunhyang University Cheonan Hospital, Cheonan, Korea
| | - Ho Jung Lee
- Department of Dermatology, Soonchunhyang University Cheonan Hospital, Cheonan, Korea
| | - Jong Suk Lee
- Department of Dermatology, Soonchunhyang University Cheonan Hospital, Cheonan, Korea
| | - Kyu Uang Whang
- Department of Dermatology, Soonchunhyang University Seoul Hospital, Seoul, Korea
| | - Young Lip Park
- Department of Dermatology, Soonchunhyang University Bucheon Hospital, Bucheon, Korea
| | - Sung Yul Lee
- Department of Dermatology, Soonchunhyang University Cheonan Hospital, Cheonan, Korea
| | - Hyun Jung Kim
- Department of Preventive Medicine, Korea University College of Medicine, Seoul, Korea
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Thungaturthi S, Vadakedath S, Pavuluri P, Rani J, Gundu R, Bheem J, Kandi V. Atherogenesis in Psoriasis: Evaluation of the Serum Activities of Non-high-density Lipoprotein Cholesterol and Other Lipids Among Newly Diagnosed Psoriasis Patients. Cureus 2019; 11:e4203. [PMID: 31114722 PMCID: PMC6505732 DOI: 10.7759/cureus.4203] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
Introduction Psoriasis is a chronic inflammatory skin disorder which commonly affects people aged between 15-25 years with a 2-3 % prevalence rate throughout the world. Psoriasis is a systemic inflammatory disease associated with severe co-morbidities that include cardiovascular risk. Although changes in the atherogenic lipids among psoriasis patients is already documented, very little is known about their role in atherogenesis among the new onset cases of psoriasis. Hence, this study is undertaken to assess the activities of non-high-density lipoprotein cholesterol (non-HDL-C) and other lipids among newly diagnosed psoriasis patients. Methods The study included 25 new onset cases of psoriasis patients aged between 20-60 years (mean age 38.2 years) attending the Dermatology outpatient department (OPD) of the Chalmeda Anandrao Institute of Medical Sciences (CAIMS), Karimnagar, Telangana, India, a tertiary care teaching hospital. An equal number of healthy individuals were included as controls. Blood was collected from all the subjects included in the study and was analyzed for various lipid parameters that included total cholesterol (TC), HDL-C, and triglycerides. The non-HDL-C and low-density lipoprotein cholesterol (LDL-C) were later calculated manually by using the standard formulae. The data were tabulated using Microsoft Excel and was analyzed for their statistical significance using the Student t-test. Results The results demonstrated a statistically significant difference in the lipid parameters between the cases and controls. Among the parameters measured, the pro-atherogenic lipids including the LDL-C and non-HDL-C activities among the cases (LDL-C 171.46±17.13, p=0.0002; non-HDL-C 213.27±20.17, p ≤ 0.0001) and controls (LDL-C 91.04±11.41, p=0.0002; Non-HDL-C 119.0± 12.28, p ≤ 0.0001) were found to be statistically significant. The ratios of non-HDL-C to HDL-C and total cholesterol to HDL-C both among the cases (7.10±0.1, 8.13±1.2) and control groups (3.05±0.30, 4.03±0.42) were also showing a statistically significant difference. Conclusion The results clearly demonstrate the significance of the evaluation of lipids among newly diagnosed cases of psoriasis patients. The activities of different lipoproteins including the non-HDL-C and LDL-C revealed an increase among the psoriasis patients. The ratios of non-HDL-C to HDL-C and TC to HDL-C also showed significant variability. Further, to establish their clinical utility in the development of cardiovascular disease (CVD), and to manage appropriately, a regular follow-up of such parameters both before and after initiation of treatment is required.
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Affiliation(s)
| | - Sabitha Vadakedath
- Biochemistry, Chalmeda Anandrao Institute of Medical Sciences, Karimnagar, IND
| | - Prathyusha Pavuluri
- Biochemistry, RVM Institute of Medical Sciences and Research Center, Hyderabad, IND
| | - Jhansi Rani
- Biochemistry, Chalmeda Anandrao Institute of Medical Sciences, Karimnagar, IND
| | - Rajkumar Gundu
- Biochemistry, Chalmeda Anandrao Institute of Medical Sciences, Karimnagar, IND
| | - Jai Bheem
- Biochemistry, Chalmeda Anandrao Institute of Medical Sciences, Karimnagar, IND
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19
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Siudak Z, Wysocka-Dubielecka K, Malinowski K, Dziewierz A, Tokarek T, Plens K, Dudek D. Psoriasis is an independent predictor of increased risk of allergic reaction during percutaneous coronary interventions. Big data analysis from the Polish National PCI Registry (ORPKI). Cardiol J 2018; 27:278-284. [PMID: 30155870 DOI: 10.5603/cj.a2018.0076] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2018] [Revised: 06/11/2018] [Accepted: 07/07/2018] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND The presence of psoriasis is currently considered by the European Society of Cardiology cardiovascular prevention guidelines of 2016 as one possible cardiovascular risk factor. Patients with psoriasis and concomitant coronary artery disease treated by means of percutaneous coronary interven-tion (PCI) are a fairly large subgroup of patients that have been usually omitted in mainstream research. The aim herein, was to identify the incidence of psoriasis, baseline characteristics and periprocedural outcome with a special focus on procedural complications in patients undergoing percutaneous coronary procedures. METHODS All consecutive patients who had either coronary angiography or coronary angiography with immediate PCI in Poland in 2014 and 2015 were included. Patients were assigned to two groups based on previous diagnosis: with psoriasis and without psoriasis. Clinical outcome was defined as any periprocedural death. RESULTS There were 405,078 patients included in this analysis. Psoriasis (moderate or severe) was di-agnosed in 1507 (0.4%) of them. Psoriasis was an independent predictor of allergic reaction occurrence (odds ratio [OR] 6.02; 95% confidence interval [CI] 1.44-25.22; p = 0.014). After propensity score adjustment, psoriasis remained a significant predictor of allergic reaction (OR 5, 95% CI 1.2-20.7; p = 0.0245). There were no differences in rates of periprocedural deaths in patients with or without psoriasis (death: 0.95% vs. 0.62%, p > 0.05). CONCLUSIONS Severe or moderate psoriasis is an independent risk factor for the occurrence of allergic reaction during percutaneous coronary procedures. There were no differences in periprocedural mortal-ity and complications in patients with versus those without psoriasis.
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Affiliation(s)
- Zbigniew Siudak
- Faculty of Medicine and Health Science, Jan Kochanowski University, Kielce, Poland.
| | | | - Krzysztof Malinowski
- 2nd Department of Cardiology, Jagiellonian University Medical College, ul. Św. Anny 12, 31-008 Krakow, Poland
| | - Artur Dziewierz
- 2nd Department of Cardiology, Jagiellonian University Medical College, ul. Św. Anny 12, 31-008 Krakow, Poland
| | - Tomasz Tokarek
- 2nd Department of Cardiology, Jagiellonian University Medical College, ul. Św. Anny 12, 31-008 Krakow, Poland
| | | | - Dariusz Dudek
- 2nd Department of Cardiology, Jagiellonian University Medical College, ul. Św. Anny 12, 31-008 Krakow, Poland
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20
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Sanchez IM, Shankle L, Wan MT, Afifi L, Wu JJ, Doris F, Bridges A, Boas M, Lafoy B, Truman S, Orbai AM, Takeshita J, Gelfand JM, Armstrong AW, Siegel MP, Liao W. Building a Citizen Pscientist: Advancing Patient-Centered Psoriasis Research by Empowering Patients as Contributors and Analysts. Dermatol Ther (Heidelb) 2018; 8:405-423. [PMID: 29876724 PMCID: PMC6109031 DOI: 10.1007/s13555-018-0242-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2018] [Indexed: 01/16/2023] Open
Abstract
Introduction To design and implement a novel cloud-based digital platform that allows psoriatic patients and researchers to engage in the research process. Methods Citizen Pscientist (CP) was created by the National Psoriasis Foundation (NPF) to support and educate the global psoriatic disease community, where patients and researchers have the ability to analyze data. Psoriatic patients were invited to enroll in CP and contribute health data to a cloud database by responding to a 59-question online survey. They were then invited to perform their own analyses of the data using built-in visualization tools allowing for the creation of “discovery charts.” These charts were posted on the CP website allowing for further discussion. Results As of May 2017, 3534 patients have enrolled in CP and have collectively contributed over 200,000 data points on their health status. Patients posted 70 discovery charts, generating 209 discussion comments. Conclusion With the growing influence of the internet and technology in society, medical research can be enhanced by crowdsourcing and online patient portals. Patient discovery charts focused on the topics of psoriatic disease demographics, clinical features, environmental triggers, and quality of life. Patients noted that the CP platform adds to their well-being and allows them to express what research questions matter most to them in a direct and quantifiable way. The implementation of CP is a successful and novel method of allowing patients to engage in research. Thus, CP is an important tool to promote patient-centered psoriatic disease research.
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Affiliation(s)
- Isabelle M Sanchez
- Department of Dermatology, University of California San Francisco, San Francisco, USA
| | - Lindsey Shankle
- National Psoriasis Foundation, Portland, USA.,Citizen Pscientist Governance Council, National Psoriasis Foundation, Portland, USA
| | - Marilyn T Wan
- Department of Dermatology, University of Pennsylvania, Philadelphia, USA.,Citizen Pscientist Governance Council, National Psoriasis Foundation, Portland, USA
| | - Ladan Afifi
- Department of Dermatology, University of California San Francisco, San Francisco, USA.,Citizen Pscientist Governance Council, National Psoriasis Foundation, Portland, USA
| | - Jashin J Wu
- Department of Dermatology, Kaiser Permanente Los Angeles Medical Center, Los Angeles, USA.,Citizen Pscientist Governance Council, National Psoriasis Foundation, Portland, USA
| | - Frank Doris
- Citizen Pscientist Governance Council, National Psoriasis Foundation, Portland, USA
| | - Alisha Bridges
- Citizen Pscientist Governance Council, National Psoriasis Foundation, Portland, USA
| | - Marc Boas
- Citizen Pscientist Governance Council, National Psoriasis Foundation, Portland, USA
| | - Brian Lafoy
- Citizen Pscientist Governance Council, National Psoriasis Foundation, Portland, USA
| | - Sarah Truman
- Citizen Pscientist Governance Council, National Psoriasis Foundation, Portland, USA
| | - Ana-Maria Orbai
- Citizen Pscientist Governance Council, National Psoriasis Foundation, Portland, USA.,Division of Rheumatology, Johns Hopkins University School of Medicine, Baltimore, USA
| | - Junko Takeshita
- Department of Dermatology, University of Pennsylvania, Philadelphia, USA.,Citizen Pscientist Governance Council, National Psoriasis Foundation, Portland, USA
| | - Joel M Gelfand
- Department of Dermatology, University of Pennsylvania, Philadelphia, USA.,Citizen Pscientist Governance Council, National Psoriasis Foundation, Portland, USA
| | - April W Armstrong
- Citizen Pscientist Governance Council, National Psoriasis Foundation, Portland, USA
| | - Michael P Siegel
- National Psoriasis Foundation, Portland, USA.,Citizen Pscientist Governance Council, National Psoriasis Foundation, Portland, USA
| | - Wilson Liao
- Department of Dermatology, University of California San Francisco, San Francisco, USA. .,Citizen Pscientist Governance Council, National Psoriasis Foundation, Portland, USA.
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21
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Cozzani E, Rosa GM, Burlando M, Parodi A. Psoriasis as a cardiovascular risk factor: updates and algorithmic approach. GIORN ITAL DERMAT V 2018; 153:659-665. [PMID: 29683293 DOI: 10.23736/s0392-0488.18.06040-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
Although psoriasis is predominantly a chronic inflammatory skin disorder, it has been known to be associated with cardiovascular disease. Patients with psoriasis, particularly with moderate to severe forms, present an increased rate of cardiovascular mortality, myocardial infarction and stroke. However the pathophysiology of the relationship between psoriasis and cardiovascular risk and comorbidities has not yet completely known. Chronic inflammation may be considered a solid link between psoriasis and related cardiovascular events. Several cytokines and inflammatory cells play a pivotal role in the development of psoriatic lesions, resulting in angiogenesis and endothelial dysfunction. Furthermore, the imbalance between oxidative stress and antioxidant mechanisms in psoriatic patients may contribute to explain the pathogenesis of increased reactive oxygen species and the formation of atherosclerotic plaque. Other mechanistic pathways which may be involved in this relationship include cardiovascular effects of medications, a common genetic background and a higher prevalence of cardiovascular risk factors, which are often under-diagnosed and under-treated in psoriatic patients. Indeed, the early detection of specific markers of cardiovascular impairment, such as N-terminal pro B-type natriuretic peptide, homocysteine and YKL-40, may enable psoriatic patients at higher cardiovascular risk to be identified as soon as possible. This review examines the increased cardiovascular risk profile and high prevalence of cardiovascular disease associated with psoriasis, focusing on pathogenic links between psoriasis and atherosclerosis, serological markers of cardiovascular involvement and the implications of antipsoriatic therapies on cardiovascular risk and proposes a flow chart, that every dermatologist should follow to screen psoriatic patients.
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Affiliation(s)
- Emanuele Cozzani
- Department of Dermatology, San Martino Policlinic, University of Genoa, Genoa, Italy -
| | - Gian Marco Rosa
- Department of Cardiology, San Martino Policlinic, University of Genoa, Genoa, Italy
| | - Martina Burlando
- Department of Dermatology, San Martino Policlinic, University of Genoa, Genoa, Italy
| | - Aurora Parodi
- Department of Dermatology, San Martino Policlinic, University of Genoa, Genoa, Italy
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22
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Choi YM, Famenini S, Wu JJ. Incidence of Pulmonary Arterial Hypertension in Patients with Psoriasis: A Retrospective Cohort Study. Perm J 2018; 21:16-073. [PMID: 28678692 DOI: 10.7812/tpp/16-073] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
CONTEXT Inflammatory signaling may play an important role in the pathogenesis of pulmonary arterial hypertension (PAH). OBJECTIVE To assess the incidence of PAH in patients with mild and severe psoriasis compared with their respective controls. DESIGN From January 2004 to November 2012, we performed a retrospective cohort study of patients with psoriasis in the Kaiser Permanente Southern California Health Plan. Patients with an International Classification of Diseases, Ninth Revision Clinical Modification diagnostic code for psoriasis (696.1) or psoriatic arthritis (696.0) without a prior diagnosis of primary PAH (416.0) or secondary PAH (416.8) were eligible for inclusion. Patients who had never received a diagnosis of psoriasis were frequency-matched by age, sex, and race to form the control cohorts. MAIN OUTCOME MEASURES Incidence of PAH in patients with psoriasis compared with matched controls. RESULTS There were 10,115 patients with mild psoriasis, 3821 with severe psoriasis, and 69,360 matched controls. On multivariable analysis, there was a significantly increased risk of PAH developing in the severe psoriasis cohort vs their controls (hazard ratio = 1.46, 95% confidence interval = 1.09-1.94). CONCLUSION The systemic inflammatory process underlying psoriasis may be a cause for an increased risk of PAH, but there are numerous secondary causes of PAH, some of which were not accounted for in our study. Further prospective, randomized controlled trials are necessary to establish psoriasis as a risk factor for PAH.
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Affiliation(s)
- Young M Choi
- Resident Physician in Dermatology at the Los Angeles Medical Center in CA.
| | | | - Jashin J Wu
- Director of Dermatology Research for the Department of Dermatology at the Los Angeles Medical Center in CA.
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23
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Khobzey K, Liskova I, Szegedi A, Pavlovsky L, Lunder T, Kingo K, Miljković J, Péč J, Bohinc M, Hojnik M. Effectiveness of adalimumab in the treatment of scalp and nail affection in patients with moderate to severe plaque psoriasis in routine clinical practice. ACTA DERMATOVENEROLOGICA ALPINA PANNONICA ET ADRIATICA 2018; 26:11-14. [PMID: 28352929 DOI: 10.15570/actaapa.2017.3] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
INTRODUCTION Data on the effectiveness of biologics in the treatment of nail and scalp psoriasis (PSO) in a routine clinical setting are scarce. The aim of this study was therefore to evaluate the effectiveness of adalimumab in the treatment of nail and scalp psoriatic lesions in routine dermatologic practice. METHODS Five hundred one patients were analyzed in this observational study; 157 patients had nail involvement (nail PSO set; NPS) and 404 had scalp involvement (scalp PSO set; SPS). Patients treated with adalimumab were observed for up to 12 months. Outcomes were evaluated via changes in the Nail Psoriasis Severity Index (NAPSI), Psoriasis Scalp Severity Index (PSSI), Psoriasis Area and Severity Index (PASI), and QoL (using the Dermatology Life Quality Index). RESULTS Eighty-four percent of the patients in the NPS and 93.8% in the SPS achieved a good clinical response upon treatment with adalimumab. Complete clearing of local symptoms was achieved by 33.3% of the patients with nail involvement and 66.7% of the patients with scalp involvement. There was also a marked improvement in QoL. CONCLUSION Adalimumab appears to be an effective treatment for scalp and nail PSO in patients with moderate to severe plaque PSO. No new clinical concerns were established.
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Affiliation(s)
- Kuzma Khobzey
- Institute of Psoriasis and Chronic Dermatoses, Kyiv, Ukraine
| | - Iryna Liskova
- Medical Department, AbbVie Biopharmaceuticals GmbHKyiv, Ukraine
| | - Andrea Szegedi
- Department of Dermatology, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
| | - Lev Pavlovsky
- Department of Dermatology, Rabin Medical Center, Beilinson Hospital, Petah Tikva, Israel
| | - Tomaž Lunder
- Department of Dermatovenereology, University Medical Centre Ljubljana, Slovenia and Medical Faculty, University of Ljubljana, Ljubljana, Slovenia
| | - Külli Kingo
- Dermatology Clinic, Tartu University HospitalTartu, Estonia
| | - Jovan Miljković
- Department of Dermatovenerology, University Medical CenterMaribor, Slovenia
| | - Juraj Péč
- Department of Dermatovenereology, University Hospital in Martin, Jessenius Faculty of Medicine in Martin of Comenius University, Bratislava, Slovakia
| | - Maša Bohinc
- Medical Department, AbbVie d.o.o., Ljubljana, Slovenia
| | - Maja Hojnik
- Global Medical Affairs Immunology, AbbVie, Ljubljana, Slovenia
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Sbidian E, Chaimani A, Garcia‐Doval I, Do G, Hua C, Mazaud C, Droitcourt C, Hughes C, Ingram JR, Naldi L, Chosidow O, Le Cleach L. Systemic pharmacological treatments for chronic plaque psoriasis: a network meta-analysis. Cochrane Database Syst Rev 2017; 12:CD011535. [PMID: 29271481 PMCID: PMC6486272 DOI: 10.1002/14651858.cd011535.pub2] [Citation(s) in RCA: 92] [Impact Index Per Article: 13.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
BACKGROUND Psoriasis is an immune-mediated disease for which some people have a genetic predisposition. The condition manifests in inflammatory effects on either the skin or joints, or both, and it has a major impact on quality of life. Although there is currently no cure for psoriasis, various treatment strategies allow sustained control of disease signs and symptoms. Several randomised controlled trials (RCTs) have compared the efficacy of the different systemic treatments in psoriasis against placebo. However, the relative benefit of these treatments remains unclear due to the limited number of trials comparing them directly head to head, which is why we chose to conduct a network meta-analysis. OBJECTIVES To compare the efficacy and safety of conventional systemic agents (acitretin, ciclosporin, fumaric acid esters, methotrexate), small molecules (apremilast, tofacitinib, ponesimod), anti-TNF alpha (etanercept, infliximab, adalimumab, certolizumab), anti-IL12/23 (ustekinumab), anti-IL17 (secukinumab, ixekizumab, brodalumab), anti-IL23 (guselkumab, tildrakizumab), and other biologics (alefacept, itolizumab) for patients with moderate to severe psoriasis and to provide a ranking of these treatments according to their efficacy and safety. SEARCH METHODS We searched the following databases to December 2016: the Cochrane Skin Specialised Register, the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, Embase, and LILACS. We also searched five trials registers and the U.S. Food and Drug Administration (FDA) and European Medicines Agency (EMA) reports. We checked the reference lists of included and excluded studies for further references to relevant RCTs. We searched the trial results databases of a number of pharmaceutical companies and handsearched the conference proceedings of a number of dermatology meetings. SELECTION CRITERIA Randomised controlled trials (RCTs) of systemic and biological treatments in adults (over 18 years of age) with moderate to severe plaque psoriasis or psoriatic arthritis whose skin had been clinically diagnosed with moderate to severe psoriasis, at any stage of treatment, in comparison to placebo or another active agent. DATA COLLECTION AND ANALYSIS Three groups of two review authors independently undertook study selection, data extraction, 'Risk of bias' assessment, and analyses. We synthesised the data using pair-wise and network meta-analysis (NMA) to compare the treatments of interest and rank them according to their effectiveness (as measured by the Psoriasis Area and Severity Index score (PASI) 90) and acceptability (the inverse of serious adverse effects). We assessed the certainty of the body of evidence from the NMA for the two primary outcomes, according to GRADE; we evaluated evidence as either very low, low, moderate, or high. We contacted study authors when data were unclear or missing. MAIN RESULTS We included 109 studies in our review (39,882 randomised participants, 68% men, all recruited from a hospital). The overall average age was 44 years; the overall mean PASI score at baseline was 20 (range: 9.5 to 39). Most of these studies were placebo controlled (67%), 23% were head-to-head studies, and 10% were multi-armed studies with both an active comparator and placebo. We have assessed all treatments listed in the objectives (19 in total). In all, 86 trials were multicentric trials (two to 231 centres). All of the trials included in this review were limited to the induction phase (assessment at less than 24 weeks after randomisation); in fact, all trials included in the network meta-analysis were measured between 12 and 16 weeks after randomisation. We assessed the majority of studies (48/109) as being at high risk of bias; 38 were assessed as at an unclear risk, and 23, low risk.Network meta-analysis at class level showed that all of the interventions (conventional systemic agents, small molecules, and biological treatments) were significantly more effective than placebo in terms of reaching PASI 90.In terms of reaching PASI 90, the biologic treatments anti-IL17, anti-IL12/23, anti-IL23, and anti-TNF alpha were significantly more effective than the small molecules and the conventional systemic agents. Small molecules were associated with a higher chance of reaching PASI 90 compared to conventional systemic agents.At drug level, in terms of reaching PASI 90, all of the anti-IL17 agents and guselkumab (an anti-IL23 drug) were significantly more effective than the anti-TNF alpha agents infliximab, adalimumab, and etanercept, but not certolizumab. Ustekinumab was superior to etanercept. No clear difference was shown between infliximab, adalimumab, and etanercept. Only one trial assessed the efficacy of infliximab in this network; thus, these results have to be interpreted with caution. Tofacitinib was significantly superior to methotrexate, and no clear difference was shown between any of the other small molecules versus conventional treatments.Network meta-analysis also showed that ixekizumab, secukinumab, brodalumab, guselkumab, certolizumab, and ustekinumab outperformed other drugs when compared to placebo in terms of reaching PASI 90: the most effective drug was ixekizumab (risk ratio (RR) 32.45, 95% confidence interval (CI) 23.61 to 44.60; Surface Under the Cumulative Ranking (SUCRA) = 94.3; high-certainty evidence), followed by secukinumab (RR 26.55, 95% CI 20.32 to 34.69; SUCRA = 86.5; high-certainty evidence), brodalumab (RR 25.45, 95% CI 18.74 to 34.57; SUCRA = 84.3; moderate-certainty evidence), guselkumab (RR 21.03, 95% CI 14.56 to 30.38; SUCRA = 77; moderate-certainty evidence), certolizumab (RR 24.58, 95% CI 3.46 to 174.73; SUCRA = 75.7; moderate-certainty evidence), and ustekinumab (RR 19.91, 95% CI 15.11 to 26.23; SUCRA = 72.6; high-certainty evidence).We found no significant difference between all of the interventions and the placebo regarding the risk of serious adverse effects (SAEs): the relative ranking strongly suggested that methotrexate was associated with the best safety profile regarding all of the SAEs (RR 0.23, 95% CI 0.05 to 0.99; SUCRA = 90.7; moderate-certainty evidence), followed by ciclosporin (RR 0.23, 95% CI 0.01 to 5.10; SUCRA = 78.2; very low-certainty evidence), certolizumab (RR 0.49, 95% CI 0.10 to 2.36; SUCRA = 70.9; moderate-certainty evidence), infliximab (RR 0.56, 95% CI 0.10 to 3.00; SUCRA = 64.4; very low-certainty evidence), alefacept (RR 0.72, 95% CI 0.34 to 1.55; SUCRA = 62.6; low-certainty evidence), and fumaric acid esters (RR 0.77, 95% CI 0.30 to 1.99; SUCRA = 57.7; very low-certainty evidence). Major adverse cardiac events, serious infections, or malignancies were reported in both the placebo and intervention groups. Nevertheless, the SAEs analyses were based on a very low number of events with low to very low certainty for just over half of the treatment estimates in total, moderate for the others. Thus, the results have to be considered with caution.Considering both efficacy (PASI 90 outcome) and acceptability (SAEs outcome), highly effective treatments also had more SAEs compared to the other treatments, and ustekinumab, infliximab, and certolizumab appeared to have the better trade-off between efficacy and acceptability.Regarding the other efficacy outcomes, PASI 75 and Physician Global Assessment (PGA) 0/1, the results were very similar to the results for PASI 90.Information on quality of life was often poorly reported and was absent for a third of the interventions. AUTHORS' CONCLUSIONS Our review shows that compared to placebo, the biologics ixekizumab, secukinumab, brodalumab, guselkumab, certolizumab, and ustekinumab are the best choices for achieving PASI 90 in people with moderate to severe psoriasis on the basis of moderate- to high-certainty evidence. At class level, the biologic treatments anti-IL17, anti-IL12/23, anti-IL23, and anti-TNF alpha were significantly more effective than the small molecules and the conventional systemic agents, too. This NMA evidence is limited to induction therapy (outcomes were measured between 12 to 16 weeks after randomisation) and is not sufficiently relevant for a chronic disease. Moreover, low numbers of studies were found for some of the interventions, and the young age (mean age of 44 years) and high level of disease severity (PASI 20 at baseline) may not be typical of patients seen in daily clinical practice.Another major concern is that short-term trials provide scanty and sometimes poorly reported safety data and thus do not provide useful evidence to create a reliable risk profile of treatments. Indeed, we found no significant difference in the assessed interventions and placebo in terms of SAEs. Methotrexate appeared to have the best safety profile, but as the evidence was of very low to moderate quality, we cannot be sure of the ranking. In order to provide long-term information on the safety of the treatments included in this review, it will be necessary to evaluate non-randomised studies and postmarketing reports released from regulatory agencies as well.In terms of future research, randomised trials comparing directly active agents are necessary once high-quality evidence of benefit against placebo is established, including head-to-head trials amongst and between conventional systemic and small molecules, and between biological agents (anti-IL17 versus anti-IL23, anti-IL23 versus anti-IL12/23, anti-TNF alpha versus anti-IL12/23). Future trials should also undertake systematic subgroup analyses (e.g. assessing biological-naïve patients, baseline psoriasis severity, presence of psoriatic arthritis, etc.). Finally, outcome measure harmonisation is needed in psoriasis trials, and researchers should look at the medium- and long-term benefit and safety of the interventions and the comparative safety of different agents.
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Affiliation(s)
| | | | - Ignacio Garcia‐Doval
- Complexo Hospitalario Universitario de VigoDepartment of DermatologyTorrecedeira 10, 2º AVigoSpain36202
| | - Giao Do
- Hôpital Henri MondorDepartment of Dermatology51 Avenue du Maréchal de Lattre de TassignyCréteilFrance94000
| | - Camille Hua
- Hôpital Henri MondorDepartment of Dermatology51 Avenue du Maréchal de Lattre de TassignyCréteilFrance94000
| | - Canelle Mazaud
- Hôpital Henri MondorDepartment of Dermatology51 Avenue du Maréchal de Lattre de TassignyCréteilFrance94000
| | - Catherine Droitcourt
- Université de Rennes 1Department of Dermatology2 rue Henri le GuillouxRennesFrance35000
| | - Carolyn Hughes
- The University of Nottinghamc/o Cochrane Skin GroupA103, King's Meadow CampusLenton LaneNottinghamUKNG7 2NR
| | - John R Ingram
- Cardiff UniversityDepartment of Dermatology & Wound Healing, Cardiff Institute of Infection & Immunity3rd Floor Glamorgan HouseHeath ParkCardiffUKCF14 4XN
| | - Luigi Naldi
- Padiglione Mazzoleni ‐ Presidio Ospedaliero Matteo RotaCentro Studi GISED (Italian Group for Epidemiologic Research in Dermatology) ‐ FROM (Research Foundation of Ospedale Maggiore Bergamo)Via Garibaldi 13/15BergamoItaly24122
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Wacewicz M, Socha K, Soroczyńska J, Niczyporuk M, Aleksiejczuk P, Ostrowska J, Borawska MH. Concentration of selenium, zinc, copper, Cu/Zn ratio, total antioxidant status and c-reactive protein in the serum of patients with psoriasis treated by narrow-band ultraviolet B phototherapy: A case-control study. J Trace Elem Med Biol 2017; 44:109-114. [PMID: 28965564 DOI: 10.1016/j.jtemb.2017.06.008] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2017] [Revised: 06/21/2017] [Accepted: 06/24/2017] [Indexed: 01/07/2023]
Abstract
BACKGROUND Psoriasis is a common, an inflammatory skin disease. Trace elements may play an active role in the pathogenesis of psoriasis. OBJECTIVE The aim of this study was to estimate the concentration of selenium (Se), zinc (Zn), copper (Cu) and Cu/Zn ratio as well as total antioxidant status (TAS) and c-reactive protein (CRP) in the serum of patients with psoriasis. METHODS In this case-control study sixty patients with psoriasis and fifty-eight healthy people were examined. Serum levels of Se, Zn and Cu were determined by atomic absorption spectrometry. Cu/Zn ratio was calculated. TAS was measured spectrophotometrically. CRP was analyzed by immunoturbidimetric method. Clinical activity of psoriasis was evaluated using Psoriasis Area and Severity Index (PASI). RESULTS Serum concentration of Se in patients with psoriasis (71.89±16.90μg/L) was lower as compared to the control group (79.42±18.97μg/L) and after NB-UVB. Cu level of patients was higher (1.151±0.320mg/L) as compared to controls (1.038±0.336mg/L), but Zn level did not differ. We observed higher Cu/Zn ratio (p<0.05) in examined patients than in the control group and after NB-UVB. We found decrease TAS before and after NB-UVB. CRP levels was found to be normal range. A significant correlation coefficient between CRP and Cu/Zn was observed. CONCLUSIONS The study showed some disturbances in the serum levels of trace elements and TAS in psoriatic patients.
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Affiliation(s)
- Marta Wacewicz
- Laboratory of Cosmetology, Medical University of Bialystok, Akademicka 3 St., 15-267 Bialystok, Poland.
| | - Katarzyna Socha
- Department of Bromatology, Medical University of Bialystok,Mickiewicza 2D St., 15-222 Bialystok, Poland
| | - Jolanta Soroczyńska
- Department of Bromatology, Medical University of Bialystok,Mickiewicza 2D St., 15-222 Bialystok, Poland
| | - Marek Niczyporuk
- Department of Esthetic Medicine, Medical University of Bialystok, Akademicka 3 St., 15-267 Bialystok, Poland; Outdoor-Patients Dermatological Department, Medical University of Bialystok Clinical Hospital, Żurawia 14 St.,15-540 Bialystok, Poland
| | - Piotr Aleksiejczuk
- Outdoor-Patients Dermatological Department, Medical University of Bialystok Clinical Hospital, Żurawia 14 St.,15-540 Bialystok, Poland
| | - Jolanta Ostrowska
- Outdoor-Patients Dermatological Department, Medical University of Bialystok Clinical Hospital, Żurawia 14 St.,15-540 Bialystok, Poland
| | - Maria H Borawska
- Department of Bromatology, Medical University of Bialystok,Mickiewicza 2D St., 15-222 Bialystok, Poland
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Rodríguez-Zúñiga MJM, García-Perdomo HA. Systematic review and meta-analysis of the association between psoriasis and metabolic syndrome. J Am Acad Dermatol 2017; 77:657-666.e8. [DOI: 10.1016/j.jaad.2017.04.1133] [Citation(s) in RCA: 73] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2016] [Revised: 04/28/2017] [Accepted: 04/30/2017] [Indexed: 02/06/2023]
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Liaw FY, Chen WL, Kao TW, Chang YW, Huang CF. Exploring the link between cadmium and psoriasis in a nationally representative sample. Sci Rep 2017; 7:1723. [PMID: 28496169 PMCID: PMC5431928 DOI: 10.1038/s41598-017-01827-9] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2016] [Accepted: 04/04/2017] [Indexed: 02/01/2023] Open
Abstract
Psoriasis, a skin inflammatory disease, originates from dysregulated interactions of the immune system. Cadmium, an environment pollutant, increases the levels of inflammation markers and influences the immune system. To clarify the relationship between cadmium and psoriasis, 5,927 participants, ≥20 years, in the National Health and Nutrition Examination Survey (NHANES) 2003–2006 were studied. Psoriasis severity was assessed using self-reported dermatology questionnaires. Cadmium was measured using blood chemistry. Three adjusted models were applied for the interaction between serum cadmium and severity of psoriasis. Psoriasis patients had significantly higher blood cadmium (0.67 vs. 0.52 μg/L, p = 0.006). There was a strong linear increase in predicted blood cadmium values with an increase in severity of psoriasis (p for trend = 0.002). The β coefficient of the predicted serum cadmium in the “few patches to extensive psoriasis” group was 0.234 (p = 0.002) after adjusting covariates. Participants with severe psoriasis have higher blood cadmium. Environmental exposure to cadmium can predispose to the worsening of psoriasis. Although there are still limitations in this study, such as not included treatment data, these results have substantial public health implications for the general population, as they demonstrate the importance of cadmium exposure prevention, particularly among psoriasis patients.
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Affiliation(s)
- Fang-Yih Liaw
- Family Medicine and Geriatric Medicine, Department of Family and Community health, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | - Wei-Liang Chen
- Family Medicine and Geriatric Medicine, Department of Family and Community health, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan.,Graduate Institute of Medical Sciences, National Defense Medical Center, Taipei, Taiwan
| | - Tung-Wei Kao
- Family Medicine and Geriatric Medicine, Department of Family and Community health, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan.,Graduate Institute of Clinical Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Yaw-Wen Chang
- Family Medicine and Geriatric Medicine, Department of Family and Community health, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan.,Graduate Institute of Medical Sciences, National Defense Medical Center, Taipei, Taiwan
| | - Ching-Fu Huang
- Department of Dermatology, Taoyuan Armed Forces General Hospital, Taoyuan and National Defense Medical Center, Taipei, Taiwan.
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Honma M, Shibuya T, Iwasaki T, Iinuma S, Takahashi N, Kishibe M, Minami-Hori M, Ishida-Yamamoto A. Prevalence of coronary artery calcification in Japanese patients with psoriasis: A close correlation with bilateral diagonal earlobe creases. J Dermatol 2017; 44:1122-1128. [PMID: 28464401 DOI: 10.1111/1346-8138.13895] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2016] [Accepted: 03/23/2017] [Indexed: 11/28/2022]
Abstract
Psoriasis is a multifactorial inflammatory disorder, in which the inflammation affects not only the skin but also the other internal organs, and can induce cardiovascular and cerebrovascular involvements. However, few predictive factors of cardiovascular diseases have been clarified in patients with psoriasis. This study was performed to verify whether diagonal earlobe creases (ELC) can reflect the hidden comorbidities in Japanese psoriatic patients. Prevalence and subtypes of ELC were analyzed in patients with psoriatic and with non-psoriatic skin diseases, and the correlation with coronary artery calcification (CAC) or fatty liver (FL) detected by computed tomography. Prevalence of CAC was approximately twice higher than data of a Japanese resident-based study previously reported. Generally, prevalence of ELC in a psoriatic group and mean age of psoriatic groups accompanied by ELC were higher and younger than those of a non-psoriatic skin disease group, respectively. Statistically significant differences were detected in the mean age of total or male subjects accompanied by bilateral ELC with complete and incomplete length. Bilateralism of ELC was closely correlated with prevalence of CAC and CAC on multiple branches in psoriatic patients (P = 6.6e-6 and odds ratio [OR] = 14.1, P = 0.00884 and OR = 10.7, respectively), but not with that of FL. On the contrary, body mass index of more than 25 was closely correlated with prevalence of FL, but not that of CAC. Comorbidities of psoriatic patients are frequently unnoticed. ELC, an apparatus-related feature, can be a useful predictive factor for hidden coronary artery involvements in psoriatic patients.
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Affiliation(s)
- Masaru Honma
- Department of Dermatology, Asahikawa Medical University, Asahikawa, Japan
| | - Takashi Shibuya
- Department of Dermatology, Asahikawa Medical University, Asahikawa, Japan
| | - Takeshi Iwasaki
- Department of Dermatology, Asahikawa Medical University, Asahikawa, Japan
| | - Shin Iinuma
- Department of Dermatology, Asahikawa Medical University, Asahikawa, Japan
| | | | - Mari Kishibe
- Department of Dermatology, Asahikawa Medical University, Asahikawa, Japan
| | - Masako Minami-Hori
- Department of Dermatology, Asahikawa Medical University, Asahikawa, Japan
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Rodríguez-Zúñiga M, Cortez-Franco F, Quijano-Gomero E. Association of Psoriasis and Metabolic Syndrome in Latin America: A Systematic Review and Meta-Analysis. ACTAS DERMO-SIFILIOGRAFICAS 2017. [DOI: 10.1016/j.adengl.2017.03.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
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Rodríguez-Zúñiga M, Cortez-Franco F, Quijano-Gomero E. Relación entre psoriasis y síndrome metabólico en Latinoamérica. Revisión sistemática y metaanálisis. ACTAS DERMO-SIFILIOGRAFICAS 2017; 108:326-334. [DOI: 10.1016/j.ad.2016.11.009] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2016] [Revised: 09/02/2016] [Accepted: 11/06/2016] [Indexed: 01/30/2023] Open
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Assessment of subclinical cardiac damage in chronic plaque psoriasis patients: a case control study. ARCHIVES OF MEDICAL SCIENCES. ATHEROSCLEROTIC DISEASES 2016; 1:e126-e132. [PMID: 28905034 PMCID: PMC5421544 DOI: 10.5114/amsad.2016.64165] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/01/2016] [Accepted: 11/25/2016] [Indexed: 12/22/2022]
Abstract
Introduction Epidemiological studies have suggested that patients with psoriasis are at an increased risk of developing cardiovascular diseases. Chronic inflammation may play a role in the pathogenesis of atherosclerosis in psoriasis patients. Recent studies have evaluated the expression of plasma endocan and homocysteine levels. Endocan is a marker of vascular endothelial damage, and homocysteine plays a role in the development of atherosclerosis. Plasma endocan and homocysteine levels, as well as echocardiographic parameters, were evaluated in patients with psoriasis to assess cardiovascular disease risk. Material and methods This was a prospective cohort analysis of 40 patients who were diagnosed with psoriasis and 40 healthy controls matched to the patient group according to demographic and biochemical parameters. Results Serum endocan and homocysteine concentrations were significantly higher in the psoriasis group than the control group (p < 0.001). Serum endocan concentrations correlated positively with disease duration (p < 0.001; r = 0.725). The Tei index (myocardial performance) was elevated in psoriasis patients (p < 0.001). Additionally, the E/A (mitral valve early diastolic peak flow velocity/mitral valve late diastolic peak flow velocity) and E/Em (early diastolic myocardial velocity) ratios were reduced in psoriasis patients (p < 0.001). Parameters indicative of left ventricular asynchrony were elevated significantly in the psoriasis group versus the control group (p < 0.001). Conclusions We observed a substantial increase in serum endocan and homocysteine concentrations, and significant differences in key parameters of cardiac function, in psoriasis patients relative to controls. These results are consistent with the hypothesis that subclinical cardiac damage is increased in patients with psoriasis and that psoriasis itself may be a cardiovascular risk factor.
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Can pregnancy-associated plasma protein-A be a marker for the assessment of atherosclerosis risk in patients with chronic plaque psoriasis? Postepy Dermatol Alergol 2016; 33:340-344. [PMID: 27881939 PMCID: PMC5110623 DOI: 10.5114/ada.2016.62839] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2015] [Accepted: 10/02/2015] [Indexed: 11/24/2022] Open
Abstract
Introduction Psoriasis is an immune-mediated chronic inflammatory dermatosis. Several studies have shown that patients with psoriasis have a much greater risk of cardiovascular diseases than the normal population. The chronic inflammation observed in psoriasis is thought to have a role in the development of atherosclerosis and vascular endothelial injury. Aim To examine serum pregnancy-associated plasma protein-A (PAPP-A) levels, which has been regarded as a marker of early stage atherosclerosis in patients with psoriasis that do not have concurrent conventional cardiovascular risk markers. Material and methods Forty-one patients diagnosed with a chronic plaque type of psoriasis and 42 equally matched healthy volunteers were included in this study. The PAPP-A levels were compared between patient and control groups and the association between PAPP-A levels and disease duration and severity were evaluated in the patient group. Results Statistically, serum PAPP-A levels were significantly higher in the psoriasis group than in the control group (p = 0.015). Serum PAPP-A levels were found to be positively correlated with severity (p = 0.036, r = 0.329) and duration (p = 0.014, r = 0.269) of the disease. Conclusions As a marker of early stage atherosclerosis, PAPP-A levels were elevated in the psoriasis group and were correlated with disease duration and severity. This elevation reveals the presence of atherosclerosis in patients with psoriasis. Further studies are needed to confirm the use of PAPP-A as an available and inexpensive screening test and cardiovascular risk assessment for all centers.
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Kim J, Bissonnette R, Lee J, Correa da Rosa J, Suárez-Fariñas M, Lowes MA, Krueger JG. The Spectrum of Mild to Severe Psoriasis Vulgaris Is Defined by a Common Activation of IL-17 Pathway Genes, but with Key Differences in Immune Regulatory Genes. J Invest Dermatol 2016; 136:2173-2182. [DOI: 10.1016/j.jid.2016.04.032] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2016] [Revised: 04/19/2016] [Accepted: 04/26/2016] [Indexed: 01/07/2023]
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Carotid intima–media thickness, nonalcoholic fatty liver disease, and hemoglobin A1c are independently associated with the severity of psoriasis. DERMATOL SIN 2016. [DOI: 10.1016/j.dsi.2016.03.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
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Robati RM, Partovi-Kia M, Sadat-Amini H, Haghighatkhah HR, Younespour S, Toossi P. Serum osteopontin level and common carotid artery intima-media wall thickness in psoriasis. Int J Dermatol 2016; 55:e262-7. [PMID: 26769367 DOI: 10.1111/ijd.13167] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2015] [Revised: 05/25/2015] [Accepted: 07/29/2015] [Indexed: 11/29/2022]
Abstract
BACKGROUND The association between psoriasis and cardiovascular disease is well documented, but the underlying mechanisms remain unknown. The relationship between osteopontin and psoriasis has been studied. High serum levels of osteopontin are reported in psoriasis, with increased cardiovascular risk factors in these patients. OBJECTIVES We evaluate the extent of subclinical atherosclerosis by measuring the mean intima-media wall thickness (MIMT) of the common carotid artery (CCA) in patients with psoriasis and assessing its correlation with osteopontin to identify vascular risk factors associated with psoriasis. METHODS Intima-media wall thickness of the CCA and plasma osteopontin were determined in 40 patients and 40 age- and sex-matched healthy control subjects. RESULTS Median serum osteopontin was significantly higher in patients with psoriasis than in healthy control subjects. Mean intima-media wall thickness of the CCA was positively associated with plasma osteopontin level (r = 0.47, P < 0.0001), body mass index (r = 0.62, P < 0.0001), age (r = 0.54, P < 0.0001), total cholesterol (r = 0.54, P < 0.0001), and triglycerides (r = 0.65, P < 0.0001). CONCLUSIONS This study shows higher levels of plasma osteopontin and MIMT-CCA in psoriasis patients than in healthy controls. This is the first study to show a positive correlation between plasma osteopontin and MIMT-CCA.
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Affiliation(s)
- Reza M Robati
- Skin Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Masoud Partovi-Kia
- Skin Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Hadi Sadat-Amini
- Skin Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Hamid Reza Haghighatkhah
- Department of Radiology, Shohada-e-Tajrish Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Shima Younespour
- Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Parviz Toossi
- Skin Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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Ryu H, Chung Y. Regulation of IL-17 in atherosclerosis and related autoimmunity. Cytokine 2015; 74:219-27. [DOI: 10.1016/j.cyto.2015.03.009] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2015] [Revised: 03/11/2015] [Accepted: 03/12/2015] [Indexed: 12/14/2022]
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Shahidi-Dadras M, Haghighatkhah HR, Abdollahimajd F, Younespour S, Partovi kia M, Zargari O. Correlation between vascular endothelial growth factor and subclinical atherosclerosis in patients with psoriasis. Int J Dermatol 2015; 55:52-9. [DOI: 10.1111/ijd.12842] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2014] [Revised: 08/10/2014] [Accepted: 08/14/2014] [Indexed: 01/22/2023]
Affiliation(s)
| | - Hamid Reza Haghighatkhah
- Department of Radiology and Medical Imaging Center; Shohada-e Tajrish Hospital; Shahid Beheshti University of Medical Sciences; Tehran Iran
| | | | - Shima Younespour
- Skin Research Center; Shahid Beheshti University of Medical Sciences; Tehran Iran
| | - Masoud Partovi kia
- Skin Research Center; Shahid Beheshti University of Medical Sciences; Tehran Iran
| | - Omid Zargari
- Skin Research Center; Shahid Beheshti University of Medical Sciences; Tehran Iran
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Milaniuk S, Pietrzak A, Mosiewicz B, Mosiewicz J, Reich K. Influence of psoriasis on circulatory system function assessed in echocardiography. Arch Dermatol Res 2015; 307:855-61. [PMID: 26121943 PMCID: PMC4643101 DOI: 10.1007/s00403-015-1586-7] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2015] [Revised: 04/27/2015] [Accepted: 06/05/2015] [Indexed: 01/08/2023]
Abstract
Psoriasis vulgaris is a chronic disease with a multifactorial pathogenesis. It affects about 2–4 % of the population all over the world. In course of psoriatic arthritis, joints’ damages are observed. In patients with psoriasis vulgaris and psoriatic arthritis, there is increased morbidity and mortality caused by cardiovascular diseases observed. The aim of the study is to analyze the echocardiography of patients with psoriasis vulgaris and psoriatic arthritis on the basis of the literature available in PubMed database. Abnormalities found in echocardiography of patients with psoriasis include valvular defects (40.7 % of the patients), left ventricle diastolic dysfunction (27.8 %), and left ventricle hypertrophy (11.1 %). Left ventricle’s systolic disorders, increased aorta stiffness index and increased pulmonary artery blood pressure were also observed in this group of patients.
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Affiliation(s)
- Sylwia Milaniuk
- Department of Internal Medicine, Medical University, Staszica St 16, Lublin, Poland
| | - Aldona Pietrzak
- Department of Dermatology, Venereology and Paediatric Dermatology, Medical University, Radziwillowska St 13, Lublin, Poland
| | - Barbara Mosiewicz
- Students Medical Association, Medical University, Staszica St 16, Lublin, Poland
| | - Jerzy Mosiewicz
- Department of Internal Medicine, Medical University, Staszica St 16, Lublin, Poland.
| | - Kristian Reich
- Dermatologikum Hamburg, Stephansplatz 5, Hamburg, Germany
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Zhang Z, Li G, Liu T. Psoriasis and risk of atrial fibrillation. Int J Cardiol 2015; 185:301-3. [PMID: 25828669 DOI: 10.1016/j.ijcard.2015.03.149] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2015] [Accepted: 03/15/2015] [Indexed: 12/20/2022]
Affiliation(s)
- Zhiwei Zhang
- Tianjin Key Laboratory of Ionic-Molecular Function of Cardiovascular Disease, Department of Cardiology, Tianjin Institute of Cardiology, Second Hospital of Tianjin Medical University, Tianjin 300211, People's Republic of China
| | - Guangping Li
- Tianjin Key Laboratory of Ionic-Molecular Function of Cardiovascular Disease, Department of Cardiology, Tianjin Institute of Cardiology, Second Hospital of Tianjin Medical University, Tianjin 300211, People's Republic of China
| | - Tong Liu
- Tianjin Key Laboratory of Ionic-Molecular Function of Cardiovascular Disease, Department of Cardiology, Tianjin Institute of Cardiology, Second Hospital of Tianjin Medical University, Tianjin 300211, People's Republic of China.
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Sbidian E, Le Cleach L, Trinquart L, Do G, Hughes C, Naldi L, Garcia-Doval I, Ingram JR, Chosidow O. Systemic pharmacological treatments for chronic plaque psoriasis. THE COCHRANE DATABASE OF SYSTEMATIC REVIEWS 2015. [DOI: 10.1002/14651858.cd011535] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Emilie Sbidian
- Hôpital Henri Mondor; Department of Dermatology; 51 Avenue du Maréchal de Lattre de Tassigny Créteil France 94000
| | - Laurence Le Cleach
- Hôpital Henri Mondor; Department of Dermatology; 51 Avenue du Maréchal de Lattre de Tassigny Créteil France 94000
| | - Ludovic Trinquart
- Hôpital Hôtel-Dieu; French Cochrane Centre; 1 place du Parvis Notre-Dame Paris France 75004
| | - Giao Do
- Hôpital Henri Mondor; Department of Dermatology; 51 Avenue du Maréchal de Lattre de Tassigny Créteil France 94000
| | - Carolyn Hughes
- The University of Nottingham; c/o Cochrane Skin Group; A103, King's Meadow Campus Lenton Lane Nottingham UK NG7 2NR
| | - Luigi Naldi
- Padiglione Mazzoleni - Presidio Ospedaliero Matteo Rota; Centro Studi GISED (Italian Group for Epidemiologic Research in Dermatology) - FROM (Research Foundation of Ospedale Maggiore Bergamo); Via Garibaldi 13/15 Bergamo Italy 24122
| | - Ignacio Garcia-Doval
- Complexo Hospitalario Universitario de Vigo; Department of Dermatology; Torrecedeira 10, 2º A Vigo Spain 36202
| | - John R Ingram
- Cardiff University; Department of Dermatology & Wound Healing, Cardiff Institute of Infection & Immunity; 3rd Floor Glamorgan House Heath Park Cardiff UK CF14 4XN
| | - Olivier Chosidow
- Hôpital Henri Mondor; Department of Dermatology; 51 Avenue du Maréchal de Lattre de Tassigny Créteil France 94000
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Kubota K, Kamijima Y, Sato T, Ooba N, Koide D, Iizuka H, Nakagawa H. Epidemiology of psoriasis and palmoplantar pustulosis: a nationwide study using the Japanese national claims database. BMJ Open 2015; 5:e006450. [PMID: 25588781 PMCID: PMC4298108 DOI: 10.1136/bmjopen-2014-006450] [Citation(s) in RCA: 192] [Impact Index Per Article: 21.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2014] [Revised: 12/31/2014] [Accepted: 01/05/2015] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVE The primary objective was to estimate the national prevalence of psoriasis and palmoplantar pustulosis (PPP) in Japan. Secondary objectives were to determine (1) whether psoriasis and PPP disease activity varies by season, and (2) whether disease severity is associated with concurrent diabetes mellitus, hyperlipidaemia and hypertension. SETTINGS Patients with a psoriasis or PPP diagnosis code between April 2010 and March 2011 were identified using a Japanese national database. PARTICIPANTS 565 903 patients with psoriasis or PPP were identified. No patient was excluded. PRIMARY AND SECONDARY OUTCOME MEASURES National prevalence was calculated using census data. We estimated the difference in the proportion of patients who used healthcare services, as a proxy for disease activity, between the hot and cold seasons and the difference in the standardised prevalence of comorbidities between severe and mild disease. The measures were estimated separately for the two broad disease categories of psoriasis and PPP but not in all patients as planned because the two disease categories had major differences. RESULTS The national prevalence of psoriasis and PPP was 0.34% (95% CI 0.34% to 0.34%) and 0.12% (0.12% to 0.12%), respectively. The difference in the proportion of patients who used healthcare services in the hot compared to the cold season was -0.3% (-0.5% to -0.1%) for psoriasis and 10.0% (9.8% to 10.3%) for PPP. The difference in the standardised prevalence between severe and mild psoriasis was 3.1% (2.7% to 3.4%), 3.2% (2.8% to 3.6%) and 5.1% (4.7% to 5.6%) for concurrent diabetes mellitus, hyperlipidaemia and hypertension, respectively. No significant difference in the prevalence of comorbidity was observed for PPP. CONCLUSIONS The national prevalence, seasonal variation in disease activity and prevalence of comorbidities in Japanese patients with psoriasis and PPP estimated in this descriptive study may be used as basic information for future studies.
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Affiliation(s)
- Kiyoshi Kubota
- Department of Pharmacoepidemiology, Graduate School of Medicine, University of Tokyo, Tokyo, Japan
- NPO Drug Safety Research Unit Japan, Tokyo, Japan
| | - Yukari Kamijima
- Department of Pharmacoepidemiology, Graduate School of Medicine, University of Tokyo, Tokyo, Japan
- NPO Drug Safety Research Unit Japan, Tokyo, Japan
| | - Tsugumichi Sato
- Department of Pharmacoepidemiology, Graduate School of Medicine, University of Tokyo, Tokyo, Japan
- Faculty of Pharmaceutical Sciences, Tokyo University of Science, Chiba, Japan
| | - Nobuhiro Ooba
- Department of Pharmacoepidemiology, Graduate School of Medicine, University of Tokyo, Tokyo, Japan
- Department of Clinical Pharmacy, Nihon University School of Pharmacy, Chiba, Japan
| | - Daisuke Koide
- Department of Clinical Epidemiology and Systems, Graduate School of Medicine, University of Tokyo, Tokyo, Japan
| | - Hajime Iizuka
- Department of Dermatology, Asahikawa Medical University, Hokkaido, Japan
| | - Hidemi Nakagawa
- Department of Dermatology, Jikei University, School of Medicine, Tokyo, Japan
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Kinahan CE, Mazloom S, Fernandez AP. Impact of smoking on response to systemic treatment in patients with psoriasis: a retrospective case-control study. Br J Dermatol 2014; 172:428-36. [PMID: 25142556 DOI: 10.1111/bjd.13359] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/14/2014] [Indexed: 12/27/2022]
Abstract
BACKGROUND Smoking is a well-established risk factor for developing psoriasis and is associated with development of more severe disease. Smoking cessation does not appear to result in clinical improvement of psoriasis. Whether smoking in patients with psoriasis impacts response to systemic therapy is unknown. OBJECTIVES To determine whether smokers with psoriasis with or without psoriatic arthritis respond to systemic agents as well as nonsmokers do. METHODS We performed a retrospective review of patients with moderate-to-severe psoriasis with or without psoriatic arthritis seen at our institution, who were either active smokers or nonsmokers, and calculated changes in Physician's Global Assessment (PGA) scores after 3-16 months of systemic treatment. We also calculated the average number of systemic treatments tried per patient. RESULTS Sixty-six patients (46 nonsmokers, 20 smokers) met our inclusion criteria. Changes in PGA scores between baseline and 3-16 months after initiation of systemic treatment did not significantly differ between smokers and nonsmokers, nor did the average number of systemic treatments tried per patient. We detected a borderline significant trend in the percentage of patients who had significant outcomes after treatment, with a higher percentage of patients smoking < 10 cigarettes daily achieving target PGA scores compared with those smoking > 10 cigarettes daily. Limitations of our study include its retrospective nature and the relatively small number of patients meeting our inclusion criteria. CONCLUSIONS In our retrospectively studied cohort, smoking did not affect response to systemic treatment in patients with psoriasis. A prospective study examining the complex relationship between smoking, psoriasis and response to systemic therapy is warranted to explore this association better.
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Affiliation(s)
- C E Kinahan
- Royal College of Surgeons, 123 St Stephen's Green, Dublin 2, Ireland
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Erfan G, Guzel S, Alpsoy S, Rifaioglu EN, Kaya S, Kucukyalcın V, Topcu B, Kulac M. Serum YKL-40: a potential biomarker for psoriasis or endothelial dysfunction in psoriasis? Mol Cell Biochem 2014; 400:207-12. [PMID: 25421412 DOI: 10.1007/s11010-014-2277-y] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2014] [Accepted: 11/15/2014] [Indexed: 12/15/2022]
Abstract
Psoriasis is a disease that can contribute to a risk of atherosclerosis. In several studies, impaired endothelial dysfunction (ED) is correlated with psoriasis. Serum YKL-40 is a new inflammatory biomarker of vascular damage, like ED and cardiovascular diseases. The aim of the study was to compare relevance of serum YKL-40 levels in psoriasis patients and healthy subjects according to ED diagnosis and identifiable cardiovascular risk factors. Sixty (31 female, 29 male) patients with plaque psoriasis, and 30 (18 female, 12 male) healthy controls were selected according to whether they had at least one or no identifiable risk factors for cardiovascular disease. All subjects were evaluated ultrasonographically for endothelial function and diagnosed as with or without ED and all groups compared for serum YKL-40 levels. YKL-40 levels of psoriatic patients with ED were higher than healthy controls with ED (P = <0.05). There were no statistical differences in between subjects without ED. YKL-40 levels of patients over age of 40 were higher than younger ones (P < 0.05). But in healthy controls, there were no differences. In comparison of cardiovascular risk-positive (RP) patients and RP healthy subjects, YKL-40 levels were higher in RP patients (P = <0.05). The elevation of plasma YKL-40 in psoriasis can be associated not only with inflammation of the disease, but also with ED. YKL-40 can be used as a marker for predicting and preventing cardiovascular diseases in RP psoriatic patients with age above 40.
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Affiliation(s)
- Gamze Erfan
- Department of Dermatology, Faculty of Medicine, Namık Kemal University, Tunca Cad. 100. Yıl Mah., Tekirdag, Turkey,
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Evensen K, Slevolden E, Skagen K, Rønning OM, Brunborg C, Krogstad AL, Russell D. Increased subclinical atherosclerosis in patients with chronic plaque psoriasis. Atherosclerosis 2014; 237:499-503. [PMID: 25463081 DOI: 10.1016/j.atherosclerosis.2014.10.008] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2014] [Revised: 10/10/2014] [Accepted: 10/13/2014] [Indexed: 10/24/2022]
Abstract
BACKGROUND Psoriasis is an immune-mediated inflammatory skin condition of unknown aetiology which usually requires life-long treatment. It is regarded a systemic inflammatory disease with a possible increased risk of cardiovascular disease. The aim of this study was to assess carotid intima-media thickness (IMT), plaque prevalence and carotid stenosis as surrogate measures for cardiovascular disease in psoriasis patients and healthy controls. METHODS Sixty-two patients with psoriasis and thirty-one healthy controls were included in the study. All were examined by Colour duplex ultrasound of the carotid arteries to compare carotid IMT values, carotid plaques and carotid stenosis in the two groups. Adjustments were made for traditional cardiovascular risk factors. RESULTS Patients with psoriasis had increased carotid IMT values compared to the controls: mean ± SD 0.71 ± 0.17 mm vs. 0.59 ± 0.08 mm; p = 0.001. When adjusted for known atherosclerotic risk factors this difference remained significant (p = 0.04). Carotid plaques were also more common (p = 0.03) in patients with psoriasis 13 (21%) compared to controls 1 (3%). There was no difference with regard to the number of carotid stenoses in patients and controls. CONCLUSION The results of this study support previous evidence which suggests that psoriasis is associated with an increased risk for atherosclerosis and subsequent cardiovascular disease.
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Affiliation(s)
- Kristin Evensen
- Department of Neurology, Oslo University Hospital, Rikshospitalet, Oslo, Norway; University of Oslo, Oslo, Norway
| | - Ellen Slevolden
- Department of Dermatology, Oslo University Hospital, Rikshospitalet, Oslo, Norway
| | - Karolina Skagen
- Department of Neurology, Oslo University Hospital, Rikshospitalet, Oslo, Norway; University of Oslo, Oslo, Norway
| | - Ole Morten Rønning
- Department of Neurology, Akershus University Hospital, Lorenskog, Norway; University of Oslo, Oslo, Norway
| | - Cathrine Brunborg
- Department of Biostatistics, Epidemiology and Health Economics, Oslo University Hospital, Ullevål, Norway
| | - Anne-Lene Krogstad
- Department of Dermatology, Oslo University Hospital, Rikshospitalet, Oslo, Norway
| | - David Russell
- Department of Neurology, Oslo University Hospital, Rikshospitalet, Oslo, Norway; University of Oslo, Oslo, Norway.
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Menegon DB, Pereira AG, Camerin AC, Cestari T. Psoriasis and comorbidities in a southern Brazilian population: a case-control study. Int J Dermatol 2014; 53:e518-25. [DOI: 10.1111/ijd.12186] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- Dóris B. Menegon
- School of Medicine; Federal University of Rio Grande do Sul (Universidade Federal do Rio Grande do Sul [UFRGS]); Porto Alegre RS Brazil
- Department of Dermatology; Hospital de Clínicas de Porto Alegre; Porto Alegre RS Brazil
- Public Health Nursing Service; Hospital de Clínicas de Porto Alegre; Porto Alegre RS Brazil
| | | | - Anna C. Camerin
- School of Medicine; Federal University of Rio Grande do Sul (Universidade Federal do Rio Grande do Sul [UFRGS]); Porto Alegre RS Brazil
| | - Tania Cestari
- School of Medicine; Federal University of Rio Grande do Sul (Universidade Federal do Rio Grande do Sul [UFRGS]); Porto Alegre RS Brazil
- Department of Dermatology; Hospital de Clínicas de Porto Alegre; Porto Alegre RS Brazil
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Chularojanamontri L, Kulthanan K, Suthipinittharm P, Jiamton S, Wongpraparut C, Silpa-Archa N, Tuchinda P, Sirikuddta W. Clinical differences between early- and late-onset psoriasis in Thai patients. Int J Dermatol 2014; 54:290-4. [PMID: 25069524 DOI: 10.1111/ijd.12515] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
OBJECTIVES There is a paucity of data regarding clinical differences between early-onset psoriasis (EOP) and late-onset psoriasis (LOP) in Asian populations. This study aimed to investigate clinical differences between EOP (onset at the age of <40 years) and LOP (onset at the age of ≥40 years) in Thai patients. METHODS From 2002 until 2008, staff and residents in the Department of Dermatology, Siriraj Hospital, were asked to complete a questionnaire detailing the age of onset, family history of psoriasis, comorbid diseases, clinical features, nail and joint involvement, and severity of psoriasis in all psoriasis patients. Data were analyzed using descriptive statistics and chi-squared tests. RESULTS A total of 1017 patients were enrolled. Of these, 663 (65.2%) patients had EOP and 354 (34.8%) had LOP. The mean ± standard deviation age of onset was 24.8 ± 8.7 years in the EOP group and 51.6 ± 9.6 years in the LOP group. The two most common comorbid diseases were hypertension and diabetes mellitus in both groups. Patients with EOP had a significantly higher likelihood of both a family history of disease and guttate psoriasis. Palmoplantar psoriasis was more commonly found in LOP patients. Nail and joint involvement and disease severity were not associated significantly with age of onset. CONCLUSIONS The present study supports the hypothesis that there are clinical differences between EOP and LOP in Asian populations.
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Affiliation(s)
- Leena Chularojanamontri
- Department of Dermatology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
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Robati RM, Partovi-Kia M, Haghighatkhah HR, Younespour S, Abdollahimajd F. Increased serum leptin and resistin levels and increased carotid intima-media wall thickness in patients with psoriasis: is psoriasis associated with atherosclerosis? J Am Acad Dermatol 2014; 71:642-8. [PMID: 25043845 DOI: 10.1016/j.jaad.2014.06.006] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2014] [Revised: 05/26/2014] [Accepted: 06/01/2014] [Indexed: 10/25/2022]
Abstract
BACKGROUND Patients with psoriasis may have an increased risk of cardiovascular disease. OBJECTIVE We sought to evaluate the potential association between subclinical atherosclerosis and psoriasis by measuring the intima-media wall thickness (IMT) of the common carotid artery (CCA) in patients with psoriasis and evaluating its correlation with serum leptin and resistin levels. METHODS The mean IMT (MIMT) of the CCA and leptin, resistin, triglyceride (TG), and total cholesterol levels in serum were determined in 60 patients and 60 healthy sex- and age-matched control subjects. RESULTS Compared with the healthy control subjects, patients with psoriasis had significantly higher MIMT of the CCA and higher levels of serum leptin, resistin, TG, and total cholesterol. In addition, MIMT of the CCA was positively correlated with serum leptin, resistin, TG, and total cholesterol levels in patients with psoriasis. LIMITATIONS This was a cross-sectional single-center study, and we could not evaluate additional biomarkers such as adipokine or adiponectin because of our restricted facilities. CONCLUSION Although serum leptin, resistin, TG, and total cholesterol levels and MIMT of the CCA were significantly increased in patients with psoriasis, MIMT of the CCA was also positively correlated with these biomarkers. Therefore, psoriasis could be an independent risk factor for subclinical atherosclerosis.
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Affiliation(s)
- Reza M Robati
- Skin Research Center, Department of Dermatology, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
| | - Masoud Partovi-Kia
- Skin Research Center, Department of Dermatology, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Hamid Reza Haghighatkhah
- Department of Radiology, Shohada-e-Tajrish Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Shima Younespour
- Skin Research Center, Department of Dermatology, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Fahimeh Abdollahimajd
- Skin Research Center, Department of Dermatology, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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Ogretmen Z, Hiz MM, Silan F, Uludag A, Ozdemirc O. Association of endothelial nitric oxide synthase Glu298Asp gene polymorphism in psoriasis cases with hypertension. Ann Saudi Med 2014; 34:340-5. [PMID: 25811208 PMCID: PMC6152563 DOI: 10.5144/0256-4947.2014.340] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
Abstract
BACKGROUND AND OBJECTIVES Psoriasis is a common autoimmune-mediated chronic, inflammatory skin disease. Although, the molecular mechanism is not completely understood, psoriasis is caused by genetic and non-genetic parameters. The current study aimed (1) to define genotype and allele frequency of endothelial nitric oxide synthase (eNOS Glu298Asp) gene polymorphism in hypertensive and/or non-hypertensive psoriatic patients (2) to investigate the possible relationship between the eNOS Glu298Asp polymorphism and the risk of hypertension among psoriatic patients in the Turkish population. DESIGN AND SETTINGS This cross-sectional, case-control study was performed between March 2010 and November 2012 at the University hospital in Çanakkale, Turkey Patients and Methods: Gene profiles of 75 psoriatic patients (21 hypertensive and 54 normotensive pa.tients) and 55 healthy (normotensive and non-psoriatic) volunteers were compared. Peripheral blood-EDTA samples were used for total genomic DNA isolation and genotyping. Target eNOS gene was genotyped for patients and control groups by real-time PCR melting-curve analysis system (LightCycler 2.0,Roche, Germany, and results were compared statistically. RESULTS An increased T allele frequency in eNOS Glu298Asp single-nucleotide polymorphism (SNP) was determined in psoriatic patients when compared with normotensive non-psoriatic healthy volunteers (OR 2.3, CI 1.14-3.99), (P=.017). The T allele frequency was also found to be increased in hypertensive psoriatic patients when compared with healthy volunteers (4.83-fold increased, 95% CI 1.62-14.43 ([P=.003]) and normotensive psoriatic patients (3.03-fold increased, 95% CI 1.03-8.94 [P=.041]), respectively. CONCLUSION The current preliminary results suggested that there was a correlation between eNOS Glu298Asp polymorphism and hypertension among psoriatic patients in the Turkish population. The T allele frequency of eNOS Glu298Asp SNP was different in hypertensive psoriatic patients, and the difference was statistically significant when compared with the normotensive psoriatic patients and healthy controls. These results need to be confirmed by large-scale studies.
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Affiliation(s)
| | - Meliha Merve Hiz
- Dr. Meliza M. Hiz, Department of Molecular Biology and Genetics, Canakkale Onsekiz Mart University, Canakkale 17100, Burslem, Turkey, T: +905332444545, ,
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