1
|
Kar BR, Sathishkumar D, Tahiliani S, Parthasarathi A, Neema S, Ganguly S, Venkatachalam K, Parasramani SG, Komeravelli H, Thomas J. Biomarkers in Psoriasis: The Future of Personalised Treatment. Indian J Dermatol 2024; 69:256-263. [PMID: 39119310 PMCID: PMC11305507 DOI: 10.4103/ijd.ijd_167_24] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/10/2024] Open
Abstract
Psoriasis is a chronic and complex immune-mediated papulosquamous disease affecting almost 2% of the world population. The interaction between a genetically predisposed individual and environmental triggers leads to a vicious cycle involving autoreactive T cells, dendritic cells, keratinocytes and dermal cells. Up to 40% of the psoriasis cases develop disabling psoriatic arthritis and an equal number of patients also tend to develop metabolic syndrome as well as cardiovascular comorbidities; hence, this is no more considered to be a disease limited to skin only. Being a systemic disease, there is an urgent need to develop potential biomarkers for the assessment of disease severity, prediction of outcome of the therapeutic intervention and association with various systemic comorbidities. Diverse genetic markers not only function as predictors of diseases pathogenesis, but also help to predict development of psoriasis and psoriatic arthritis. Personalised medicine is customising the therapeutic needs of a psoriasis patient and improving the outcome as per the hints we receive from the various biomarkers. This review deals with the list of potential biomarkers proposed to be useful in psoriasis, though there is limited data validating their routine use in clinical practice and the progress so far made in the field of precision medicine for psoriasis.
Collapse
Affiliation(s)
- Bikash R. Kar
- From the Department of DVL, IMS and SUM Hospital, Bhubaneswar, Odisha, India
| | | | - Sushil Tahiliani
- Senior Consultatnt, P. D. Hinduja Hospital and Research Centre, Mumbai, Maharashtra, India
| | | | | | | | | | | | | | - Jaykar Thomas
- Senior Consultant Dermatologist at Apollo Hospitals & KK Child Trust Hospital, Chennai, Tamil Nadu, India
| |
Collapse
|
2
|
Esen M. The effect of IL17 and IL23 inhibitors on hematological parameters and C-reactive protein in psoriasis patients. Cutan Ocul Toxicol 2024; 43:38-45. [PMID: 37897439 DOI: 10.1080/15569527.2023.2275020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2023] [Accepted: 10/09/2023] [Indexed: 10/30/2023]
Abstract
INTRODUCTION In the quest for objective biomarkers for psoriasis, the neutrophil/lymphocyte ratio (NLR), platelet/lymphocyte ratio (PLR), C-reactive protein (CRP), and mean platelet volume (MPV) have been used to assess disease severity, treatment efficacy, and follow-up in psoriasis, and their relationship with the Psoriasis Area Severity Index (PASI) has been investigated. PURPOSE The evaluation of pre-treatment, 3rd and 6th-month levels of NLR, PLR, MPV, and CRP along with PASI scores in psoriasis patients treated with secukinumab, ixekizumab, risankizumab, and guselkumab. MATERIALS AND METHODS In our study, 83 patients aged 18 and over, who were followed up with moderate-severe plaque type psoriasis vulgaris and psoriatic arthritis and received secukinumab, ixekizumab, risankizumab, and guselkumab treatment in the chronic skin diseases clinic of Fırat University Faculty of Medicine Hospital between January 2019 and 2023, were evaluated retrospectively. RESULTS Post-treatment leukocyte, neutrophil, lymphocyte, platelet, CRP, and PASI values were statistically significantly lower in all biological agent groups and all patients. The post-treatment NLR value was statistically significantly higher in all patients and in the group using ixekizumab. The post-treatment PLR value was statistically significantly higher in the group using guselkumab and ixekizumab and in all patients. The post-treatment MPV was statistically significantly higher in all patients and in the group using secukinumab. No correlation was found between post-treatment PASI and other values (p > 0.05). There was no statistically significant difference between the post-treatment 6-month values among all biological agent groups. The effects of different drugs on outcomes after treatment were found to be similar (p > 0.05). CONCLUSION Our study supports the view that MPV and CRP can be used in patients with psoriasis using IL17 and IL23 inhibitors, while NLR and PLR parameters derived from blood count may not be used to evaluate treatment response, contrary to other studies.
Collapse
Affiliation(s)
- Mustafa Esen
- Department of Dermatological and Venereal Diseases, Fırat University Faculty of Medicine, Elazığ, Türkiye
| |
Collapse
|
3
|
Teniou A, Rhouati A, Marty JL. Recent Advances in Biosensors for Diagnosis of Autoimmune Diseases. SENSORS (BASEL, SWITZERLAND) 2024; 24:1510. [PMID: 38475046 DOI: 10.3390/s24051510] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/07/2024] [Revised: 02/01/2024] [Accepted: 02/14/2024] [Indexed: 03/14/2024]
Abstract
Over the last decade, autoimmune diseases (ADs) have undergone a significant increase because of genetic and/or environmental factors; therefore, their simple and fast diagnosis is of high importance. The conventional diagnostic techniques for ADs require tedious sample preparation, sophisticated instruments, a dedicated laboratory, and qualified personnel. For these reasons, biosensors could represent a useful alternative to these methods. Biosensors are considered to be promising tools that can be used in clinical analysis for an early diagnosis due to their high sensitivity, simplicity, low cost, possible miniaturization (POCT), and potential ability for real-time analysis. In this review, recently developed biosensors for the detection of autoimmune disease biomarkers are discussed. In the first part, we focus on the main AD biomarkers and the current methods of their detection. Then, we discuss the principles and different types of biosensors. Finally, we overview the characteristics of biosensors based on different bioreceptors reported in the literature.
Collapse
Affiliation(s)
- Ahlem Teniou
- Bioengineering Laboratory, Higher National School of Biotechnology, Constantine 25100, Algeria
| | - Amina Rhouati
- Bioengineering Laboratory, Higher National School of Biotechnology, Constantine 25100, Algeria
| | - Jean-Louis Marty
- Laboratoire BAE, Université de Perpignan through Domitia, 66860 Perpignan, France
| |
Collapse
|
4
|
Reali E, Caliceti C, Lorenzini A, Rizzo P. The Use of Microbial Modifying Therapies to Prevent Psoriasis Exacerbation and Associated Cardiovascular Comorbidity. Inflammation 2024; 47:13-29. [PMID: 37953417 PMCID: PMC10799147 DOI: 10.1007/s10753-023-01915-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2023] [Revised: 10/02/2023] [Accepted: 10/03/2023] [Indexed: 11/14/2023]
Abstract
Psoriasis has emerged as a systemic disease characterized by skin and joint manifestations as well as systemic inflammation and cardiovascular comorbidities. Many progresses have been made in the comprehension of the immunological mechanisms involved in the exacerbation of psoriatic plaques, and initial studies have investigated the mechanisms that lead to extracutaneous disease manifestations, including endothelial disfunction and cardiovascular disease. In the past decade, the involvement of gut dysbiosis in the development of pathologies with inflammatory and autoimmune basis has clearly emerged. More recently, a major role for the skin microbiota in establishing the immunological tolerance in early life and as a source of antigens leading to cross-reactive responses towards self-antigens in adult life has also been evidenced. Gut microbiota can indeed be involved in shaping the immune and inflammatory response at systemic level and in fueling inflammation in the cutaneous and vascular compartments. Here, we summarized the microbiota-mediated mechanisms that, in the skin and gut, may promote and modulate local or systemic inflammation involved in psoriatic disease and endothelial dysfunction. We also analyze the emerging strategies for correcting dysbiosis or modulating skin and gut microbiota composition to integrate systemically existing pharmacological therapies for psoriatic disease. The possibility of merging systemic treatment and tailored microbial modifying therapies could increase the efficacy of the current treatments and potentially lower the effect on patient's life quality.
Collapse
Affiliation(s)
- Eva Reali
- Department of Translational Medicine, University of Ferrara, Ferrara, Italy.
| | - Cristiana Caliceti
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy
| | - Antonello Lorenzini
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy
- Istituto Nazionale Biosistemi e Biostrutture (INBB), Rome, Italy
| | - Paola Rizzo
- Department of Translational Medicine, University of Ferrara, Ferrara, Italy.
- Laboratory for Technologies of Advanced Therapies (LTTA) Centre, University of Ferrara, Ferrara, Italy.
- Maria Cecilia Hospital, GVM Care & Research, Cotignola, Ravenna, Italy.
| |
Collapse
|
5
|
Zhang Y, Lv Z, Peng P, Zhao T. Association between red blood cell distribution width and psoriasis among the US adults. Front Med (Lausanne) 2023; 10:1290514. [PMID: 38179271 PMCID: PMC10764517 DOI: 10.3389/fmed.2023.1290514] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2023] [Accepted: 12/11/2023] [Indexed: 01/06/2024] Open
Abstract
Introduction The association between red blood cell distribution width (RDW) and psoriasis among the US adults is still unknown. We aimed to assess whether RDW is associated with psoriasis in the US adults. Method We conducted a cross-sectional study consisting of 14,089 participants from National Health and Nutrition Examination Survey (NHANES) 2009-2014. Psoriasis status were assessed by self-reported questionnaire. We evaluated the association between RDW and risk of psoriasis using multivariate regression models. Subgroup and interaction analysis were performed. Results The higher RDW level was associated with an increased risk of psoriasis (OR = 1.10 [95% CI, 1.01, 1.19]; p = 0.025) after adjusting for confounders in female. However, there is no significant association between RDW and risk of psoriasis among male (OR = 0.99 [95% CI, 0.87, 1.15]; p = 0.992). Subgroup and interaction analysis found that the strongest positive association mainly exists in female participants with BMD greater than 29.9 kg/m2 (OR = 1.20 [95% CI, 1.09, 1.32], Pint = 0.004). Discussion In conclusion, we found that increased RDW levels were associated with an increased risk of psoriasis in females, which could provide clinicians with auxiliary data for the early diagnosis of psoriasis.
Collapse
Affiliation(s)
- Yunqi Zhang
- Department of Pharmacy, Guangzhou Institute of Dermatology, Guangzhou, China
| | - Zheng Lv
- The First Affiliated Hospital, Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Peng Peng
- The First Affiliated Hospital, Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Tie Zhao
- Department of Pharmacy, Guangzhou Institute of Dermatology, Guangzhou, China
| |
Collapse
|
6
|
Shapiro J, Getz B, Cohen S, Jenudi Y, Underberger D, Dreyfuss M, Ber T, Steinberg-Koch S, Ben-Tov A, Shoenfeld Y, Shovman O. Evaluation of a machine learning tool for the early identification of patients with undiagnosed psoriatic arthritis - A retrospective population-based study. J Transl Autoimmun 2023; 7:100207. [PMID: 37577138 PMCID: PMC10412462 DOI: 10.1016/j.jtauto.2023.100207] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Accepted: 07/11/2023] [Indexed: 08/15/2023] Open
Abstract
Background Psoriatic arthritis (PsA), an immune-mediated chronic inflammatory skin and joint disease, affects approximately 0.27% of the adult population, and 20% of patients with psoriasis. Up to 10% of psoriasis patients are estimated for having undiagnosed PsA. Early diagnosis and treatment can prevent irreversible joint damage, disability and deformity. Questionnaires for screening to identify undiagnosed PsA patients require patient and physician involvement. Objective To evaluate a proprietary machine learning tool (PredictAI™) developed for identification of undiagnosed PsA patients 1-4 years prior to the first time that they were suspected of having PsA (reference event). Methods This retrospective study analyzed data of the adult population from Maccabi Healthcare Service between 2008 and 2020. We created 2 cohorts: The general adult population ("GP Cohort") including patients with and without psoriasis and the Psoriasis cohort ("PsO Cohort") including psoriasis patients only. Each cohort was divided into two non-overlapping train and test sets. The PredictAI™ model was trained and evaluated with 3 years of data predating the reference event by at least one year. Receiver operating characteristic (ROC) analysis was used to investigate the performance of the model, built using gradient boosted trees, at different specificity levels. Results Overall, 2096 patients met the criteria for PsA. Undiagnosed PsA patients in the PsO cohort were identified with a specificity of 90% one and four years before the reference event, with a sensitivity of 51% and 38%, and a PPV of 36.1% and 29.6%, respectively. In the GP cohort and with a specificity of 99% and for the same time windows, the model achieved a sensitivity of 43% and 32% and a PPV of 10.6% and 8.1%, respectively. Conclusions The presented machine learning tool may aid in the early identification of undiagnosed PsA patients, and thereby promote earlier intervention and improve patient outcomes.
Collapse
Affiliation(s)
| | - B. Getz
- Predicta Med Analytics Ltd, Israel
| | - S.B. Cohen
- Metroplex Clinical Research Center, Dallas, TX, USA
| | | | | | | | - T.I. Ber
- Predicta Med Analytics Ltd, Israel
| | | | - A. Ben-Tov
- Maccabi Institute for Research & Innovation, Maccabi Healthcare Services, Tel Aviv, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Y. Shoenfeld
- Zabludowicz Center for Autoimmune Diseases, Sheba Medical Center, affiliated with Tel-Aviv University, Israel
| | - O. Shovman
- Maccabi Healthcare Services, Israel
- Maccabi Institute for Research & Innovation, Maccabi Healthcare Services, Tel Aviv, Israel
- Department of Medicine B, Center for Autoimmune Diseases, Sheba Medical Center, Tel Hashomer, Israel
| |
Collapse
|
7
|
[Recommendations for individual comorbidity risk assessment in adult patients with psoriasis]. DERMATOLOGIE (HEIDELBERG, GERMANY) 2023; 74:350-355. [PMID: 36811642 PMCID: PMC10169877 DOI: 10.1007/s00105-023-05116-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 01/20/2023] [Indexed: 02/24/2023]
Abstract
It has long been known that chronic inflammatory systemic diseases, such as psoriasis, pose a high risk of developing comorbidities. In everyday clinical practice, it is therefore of particular importance to identify patients who have an individually increased risk profile. In patients with psoriasis, the comorbidity patterns "metabolic syndrome", "cardiovascular comorbidity" and "mental illness" were identified as particularly relevant in epidemiological studies depending on the duration and severity of the disease. In the everyday care of patients with psoriasis in dermatological practice, the use of an interdisciplinary checklist for risk analysis and the initiation of professional follow-up care has proven valuable. On the basis of an existing checklist, the contents were critically evaluated by an interdisciplinary group of experts and a guideline-oriented update was prepared. In the opinion of the authors, the new analysis sheet represents a practicable, factually focused and updated tool for comorbidity risk assessment in patients with moderate and severe psoriasis.
Collapse
|
8
|
Deng M, Su Y, Wu R, Li S, Zhu Y, Tang G, Shi X, Zhou T, Zhao M, Lu Q. DNA methylation markers in peripheral blood for psoriatic arthritis. J Dermatol Sci 2022; 108:39-47. [DOI: 10.1016/j.jdermsci.2022.11.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2022] [Revised: 10/25/2022] [Accepted: 11/06/2022] [Indexed: 11/11/2022]
|
9
|
Lorenzo Martín JA, Pardo Campo E, Pino Martinez M, Colazo Burlato M, Queiro Silva MR. Psoriatic arthritis: interaction between cardiometabolic diseases and inflammatory burden of the disease. REUMATOLOGIA CLINICA 2022; 18:387-392. [PMID: 34799299 DOI: 10.1016/j.reumae.2021.05.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/16/2020] [Accepted: 05/26/2021] [Indexed: 06/13/2023]
Abstract
BACKGROUND AND OBJETIVES Psoriatic arthritis is accompained by several cardiometabolic comorbidities. Obesity causes a low-grade systemic inflammation and is a negative predictor of treatment response. We wanted to evaluate if there are interactions between metabolic status, inflammatory parameters and disease activity; and whether metabolic or cardiovascular diseases have any association with the reduction of the inflammatory burden by treating the psoriatic arthritis. MATERIAL AND METHODS We have carried out a cross-sectional descriptive study of 160 patients with psoriatic arthritis. Sociodemographic, clinical and analytical variables were collected, as well as the presence of dactylitis and enthesitis; and HAQ, DAPSA and Minimal Disease Activity criteria. Chi-square test and the H of Kruskall Wallis were used to carry out comparisons, considering P < .05 as statistically significant. To establish correlations, Pearson correlation coefficient was used. RESULTS BMI and waist circumference correlate with CRP and ESR (significance: < .05) although the correlation strenght is low (Pearson <.4), but there is no such relationship with DAPSA or meeting MDA criteria. Using biologic therapies is associated with a lower prevalence of cardiovascular events (P = 0.047; OR: 0.12, 95% CI: 0.01-0.9) and enthesitis (P = .008; OR: 0.3, CI 95%: 0.16-0.56); and normal levels of CRP (P = .029; OR: 0.25, 95% CI: 0.07-0.87) and ESR (P = 0.024; OR: 0.36, 95% CI: 0.16-0.82) when comparing to conventional therapies. DISCUSSION AND CONCLUSIONS Anti-TNFα treatment could reduce cardiovascular risk in patients with psoriatic arthritis. There may be higher levels of CRP and ESR in obese individuals without this necessarily implying higher disease activity.
Collapse
|
10
|
Lee TL, Tsai TF. Non-immune functions of inflammatory cytokines targeted by anti-psoriatic biologics: a review. Inflamm Res 2022; 71:157-168. [PMID: 34981130 DOI: 10.1007/s00011-021-01528-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2021] [Revised: 11/25/2021] [Accepted: 11/25/2021] [Indexed: 12/01/2022] Open
Abstract
PURPOSE Psoriasis is an inflammatory disease characterized by skin thickening with silvery white desquamation due to dysregulated inflammatory pathways and elevated levels of inflammatory cytokines. Biologic agents targeting these inflammatory cytokines have brought about significant improvement in clearing psoriatic lesions in patients with moderate-to-severe psoriasis. Moreover, biologics exert both beneficial and detrimental effects on comorbidities in psoriasis, which include increased risk of cardiovascular events, metabolic syndrome, among other conditions. However, non-immune functions of cytokines targeted by biologics, and, hence, the potential risks and benefits of biologics for psoriasis to different organs/systems and comorbidities, have not been well elucidated. RESULTS This review summarizes current understanding of the pathogenesis of psoriasis-related comorbidities and emerging discoveries of roles of cytokines targeted in psoriasis treatment, including tumor necrosis factor α and interleukins 12, 23, and 17, aiming to complete the safety profile of each biologics and provide therapeutic implications on psoriasis-related comorbidities, and on diseases involving other organs or systems.
Collapse
Affiliation(s)
- Tung-Lin Lee
- Department of Medical Education, National Taiwan University Hospital, Taipei, Taiwan
| | - Tsen-Fang Tsai
- Department of Dermatology, National Taiwan University Hospital and National Taiwan University College of Medicine, 7 Chung-Shan S. Rd., Taipei, 100, Taiwan.
| |
Collapse
|
11
|
Campanati A, Marani A, Martina E, Diotallevi F, Radi G, Offidani A. Psoriasis as an Immune-Mediated and Inflammatory Systemic Disease: From Pathophysiology to Novel Therapeutic Approaches. Biomedicines 2021; 9:biomedicines9111511. [PMID: 34829740 PMCID: PMC8615182 DOI: 10.3390/biomedicines9111511] [Citation(s) in RCA: 44] [Impact Index Per Article: 14.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Revised: 10/10/2021] [Accepted: 10/17/2021] [Indexed: 12/17/2022] Open
Abstract
Psoriasis is an immune-mediated inflammatory disease, with a chronic relapsing-remitting course, which affects 2–3% of the worldwide population. The progressive acquisitions of the inflammatory pathways involved in the development of psoriasis have led to the identification of the key molecules of the psoriatic inflammatory cascade. At the same time, psoriasis therapy has radically evolved with the introduction of target molecules able to modify the natural history of the disease, acting specifically on these inflammatory pathways. For these reasons, biologics have been demonstrated to be drugs able to change the disease’s natural history, as they reduce the inflammatory background to avoid irreversible organ damage and prevent systemic complications. However, several issues related to the use of biologics in patients with systemic comorbidities, remain open. All these data reflect the extraordinary potentiality of biologics, but also the unmet medical need to improve our knowledge on the long-term risk related to continuous use of these drugs, and their administration in special populations. This narrative review aims to highlight both the efficacy and safety profile of biologics in psoriasis, starting from pathophysiology and moving towards their clinical application.
Collapse
|
12
|
Bao W, Yang M, Xu Z, Yan F, Yang Q, Li X, Yang W. Coronary Inflammation Assessed by Perivascular Fat Attenuation Index in Patients with Psoriasis: A Propensity Score-Matched Study. Dermatology 2021; 238:562-570. [PMID: 34535598 DOI: 10.1159/000518771] [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: 03/23/2021] [Accepted: 07/29/2021] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVES This study aimed to evaluate coronary inflammation by measuring the perivascular fat attenuation index (FAI) and quantify the atherosclerosis burden in patients with psoriasis and control individuals without psoriasis based on coronary computed tomography angiography (CCTA) images. METHODS A total of 98 consecutive patients with psoriasis (76 male [77.6%], aged 56.5 years, range 45.5-65.0) were recruited, and 196 patients (157 male [80.1%]; aged 54.6 ± 14.1 years) without established cardiovascular disease (CVD) who underwent CCTA within the same period were enrolled in the control group. Coronary plaque burden was quantified using the computed tomography-adapted Leaman score (CT-LeSc), and the FAI surrounding the proximal of three main epicardial vessels was measured to represent coronary inflammation. RESULTS Patients with psoriasis and the control subjects were well matched in CVD risk factors (all p > 0.05). Psoriasis patients had a greater overall CT-LeSc (5.86 vs. 4.69, p = 0.030) and lower perivascular FAI (-80.19 ± 7.48 vs. -78.14 ± 7.81 HU, p < 0.001). A similar result was found upon comparing psoriasis patients without biological or statin therapy with non-psoriasis individuals without statin treatments. Furthermore, the psoriasis group had a higher prevalence of non-calcified plaques (30.3% in the psoriasis group vs. 20.1% in the control subjects, p = 0.001). No difference in perivascular FAI on either calcified and mixed plaques or non-calcified plaques between the two groups was found. CONCLUSION Patients with psoriasis have a higher atherosclerotic burden as quantified by CT-LeSc and less coronary inflammation as detected by perivascular FAI around the most proximal of the three major epicardial vessels. The usefulness of perivascular FAI for evaluating coronary inflammation in patients with chronic low-grade inflammatory disease such as psoriasis should be verified.
Collapse
Affiliation(s)
- Wenrui Bao
- Department of Radiology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Min Yang
- Department of Radiology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Zhihan Xu
- Siemens Healthineers CT Collaboration, Shanghai, China
| | - Fuhua Yan
- Department of Radiology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Qi Yang
- Department of Dermatology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Xia Li
- Department of Dermatology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Wenjie Yang
- Department of Radiology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| |
Collapse
|
13
|
Mosca M, Hong J, Hadeler E, Hakimi M, Brownstone N, Liao W, Bhutani T. Psoriasis and Cardiometabolic Comorbidities: An Evaluation of the Impact of Systemic Treatments in Randomized Clinical Trials. Dermatol Ther (Heidelb) 2021; 11:1497-1520. [PMID: 34505985 PMCID: PMC8484473 DOI: 10.1007/s13555-021-00590-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2021] [Accepted: 08/06/2021] [Indexed: 02/07/2023] Open
Abstract
The association between psoriasis, metabolic syndrome, and cardiovascular disease is well established. The shared pathways between psoriasis, metabolic syndrome, and atherosclerosis suggest that treatments targeting the inflammatory pathways of psoriasis may also be beneficial in the treatment of associated cardiometabolic comorbidities. This paper reviews the most recent data regarding the impact of systemic psoriasis treatments on comorbid cardiovascular and metabolic disease. Data from randomized clinical trials with systemic and biologic agents are presented. Overall, studies demonstrate beneficial effects on several cardiometabolic markers and risk factors in psoriasis patients; however, longer randomized controlled trials to characterize the direct benefit for cardiovascular outcomes are needed.
Collapse
Affiliation(s)
- Megan Mosca
- Department of Dermatology, University of California San Francisco, Psoriasis and Skin Treatment Center, 515 Spruce Street, San Francisco, CA, 94118, USA.
| | - Julie Hong
- Department of Dermatology, University of California San Francisco, Psoriasis and Skin Treatment Center, 515 Spruce Street, San Francisco, CA, 94118, USA
| | - Edward Hadeler
- Department of Dermatology, University of California San Francisco, Psoriasis and Skin Treatment Center, 515 Spruce Street, San Francisco, CA, 94118, USA
| | - Marwa Hakimi
- Department of Dermatology, University of California San Francisco, Psoriasis and Skin Treatment Center, 515 Spruce Street, San Francisco, CA, 94118, USA
| | - Nicholas Brownstone
- Department of Dermatology, University of California San Francisco, Psoriasis and Skin Treatment Center, 515 Spruce Street, San Francisco, CA, 94118, USA
| | - Wilson Liao
- Department of Dermatology, University of California San Francisco, Psoriasis and Skin Treatment Center, 515 Spruce Street, San Francisco, CA, 94118, USA
| | - Tina Bhutani
- Department of Dermatology, University of California San Francisco, Psoriasis and Skin Treatment Center, 515 Spruce Street, San Francisco, CA, 94118, USA
| |
Collapse
|
14
|
Lorenzo Martín JA, Pardo Campo E, Pino Martinez M, Colazo Burlato M, Queiro Silva MR. Psoriatic arthritis: interaction between cardiometabolic diseases and inflammatory burden of the disease. REUMATOLOGIA CLINICA 2021; 18:S1699-258X(21)00153-4. [PMID: 34275767 DOI: 10.1016/j.reuma.2021.05.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/16/2020] [Revised: 04/11/2021] [Accepted: 05/26/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND AND OBJETIVES Psoriatic arthritis is accompained by several cardiometabolic comorbidities. Obesity causes a low-grade systemic inflammation and is a negative predictor of treatment response. We wanted to evaluate if there are interactions between metabolic status, inflammatory parameters and disease activity; and whether metabolic or cardiovascular diseases have any association with the reduction of the inflammatory burden by treating the psoriatic arthritis. MATERIAL AND METHODS We have carried out a cross-sectional descriptive study of 160 patients with psoriatic arthritis. Sociodemographic, clinical and analytical variables were collected, as well as the presence of dactylitis and enthesitis; and HAQ, DAPSA and Minimal Disease Activity criteria. Chi-square test and the H of Kruskall Wallis were used to carry out comparisons, considering P<.05 as statistically significant. To establish correlations, Pearson correlation coefficient was used. RESULTS BMI and waist circumference correlate with CRP and ESR (significance: <.05) although the correlation strenght is low (Pearson<.4), but there is no such relationship with DAPSA or meeting MDA criteria. Using biologic therapies is associated with a lower prevalence of cardiovascular events (P=0.047; OR: 0.12, 95% CI: 0.01-0.9) and enthesitis (P=.008; OR: 0.3, CI 95%: 0.16-0.56); and normal levels of CRP (P=.029; OR: 0.25, 95% CI: 0.07-0.87) and ESR (P=0.024; OR: 0.36, 95% CI: 0.16-0.82) when comparing to conventional therapies. DISCUSSION AND CONCLUSIONS Anti-TNFα treatment could reduce cardiovascular risk in patients with psoriatic arthritis. There may be higher levels of CRP and ESR in obese individuals without this necessarily implying higher disease activity.
Collapse
|
15
|
Umezawa Y. Psoriatic arthritis. J Dermatol 2021; 48:741-749. [PMID: 34060132 DOI: 10.1111/1346-8138.15954] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2021] [Revised: 04/15/2021] [Accepted: 04/16/2021] [Indexed: 12/11/2022]
Abstract
Psoriatic arthritis (PsA) is a chronic inflammatory arthritis associated with psoriasis. It is found in approximately 10% of psoriatic patients in Japan. PsA mainly affects the peripheral joints, spine, and/or sacroiliac joints. Left untreated, there is progressive, irreversible bone destruction leading to joint deformation and dysfunction. Before the era of biologic treatments, the diagnosis of PsA was difficult and available treatments were limited. Over time the pathology of PsA has become better understood, and many treatments now exist. Early detection and treatment of impending joint deformities are necessary to avoid impairment of PsA patients' quality of life. Most patients develop the arthritis following the onset of the skin manifestations of psoriasis. The process of diagnosing PsA sometimes encounters difficulties because some patients may not show radiographic findings in the early stage, and may have normal levels of C-reactive protein and matrix metalloproteinase-3. For these cases, approaches such as magnetic resonance imaging or ultrasound imaging, as well as symptom questionnaires, are helpful. Currently, non-steroidal anti-inflammatory drugs, disease-modifying antirheumatic drugs, and several biologics are the main treatments for PsA, which when used with an aggressive approach, will result in better patient outcomes.
Collapse
Affiliation(s)
- Yoshinori Umezawa
- Department of Dermatology, The Jikei University School of Medicine, Tokyo, Japan
| |
Collapse
|
16
|
Skornicki M, Prince P, Suruki R, Lee E, Louder A. Clinical Burden of Concomitant Joint Disease in Psoriasis: A US-Linked Claims and Electronic Health Records Database Analysis. Adv Ther 2021; 38:2458-2471. [PMID: 33818686 PMCID: PMC8107168 DOI: 10.1007/s12325-021-01698-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2021] [Accepted: 03/06/2021] [Indexed: 12/26/2022]
Abstract
BACKGROUND Few studies have evaluated the clinical burden of concomitant joint disease in patients with psoriasis (PSO). The objective of this study was to assess comorbidity rates in patients with psoriatic arthritis (PsA) compared with PSO alone. METHODS This was a retrospective study of US patients with prevalent PSO. Linked medical claims and electronic health records (EHR) in Optum's de-identified Integrated Claims-Clinical dataset were analyzed from 2007 to 2018. Patients were followed for up to 5 years after the first claim/diagnostic code for PSO (index date). Baseline comorbidity prevalence and follow-up rates (cases per 1000 person-years) were assessed using descriptive statistics. Comorbidity rate analysis included patients with the respective comorbidity at baseline. RESULTS Baseline demographics and comorbidity prevalence were numerically similar between patients with concomitant joint disease (PSO-PsA) and those with PSO alone (PSO-only). During follow-up, comorbidity rates were higher in patients in the PSO-PsA group than patients in the PSO-only group. Ratios of PSO-PsA comorbidity rates relative to PSO-only ranged from 1.1 for allergies and infections to 1.7 for fatigue, diabetes, and obesity. Comorbidity rate ratios increased from year 1 to year 5 for hypertension (1.05-1.34), hyperlipidemia (0.94-1.13), diabetes (1.00-1.49), cardiovascular disease (1.03-1.66), depression (0.97-1.19), and anxiety (0.87-0.98). CONCLUSIONS Patients with PsA have a larger clinical burden, characterized by higher comorbidity rates, than those with PSO. Future research should explore PsA risk factors and how physicians can monitor and treat patients with PSO to reduce the risk of PsA and the associated clinical burden.
Collapse
|
17
|
Xu LB, Yue JK, Korley F, Puccio AM, Yuh EL, Sun X, Rabinowitz M, Vassar MJ, Taylor SR, Winkler EA, Puffer RC, Deng H, McCrea M, Stein MB, Robertson CS, Levin HS, Dikmen S, Temkin NR, Giacino JT, Mukherjee P, Wang KK, Okonkwo DO, Markowitz AJ, Jain S, Manley GT, Diaz-Arrastia R. High-Sensitivity C-Reactive Protein is a Prognostic Biomarker of Six-Month Disability after Traumatic Brain Injury: Results from the TRACK-TBI Study. J Neurotrauma 2021; 38:918-927. [PMID: 33161875 PMCID: PMC7987360 DOI: 10.1089/neu.2020.7177] [Citation(s) in RCA: 40] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
Systemic inflammation impacts outcome after traumatic brain injury (TBI), but most TBI biomarker studies have focused on brain-specific proteins. C-reactive protein (CRP) is a widely used biomarker of inflammation with potential as a prognostic biomarker after TBI. The Transforming Research and Clinical Knowledge in Traumatic Brain Injury (TRACK-TBI) study prospectively enrolled TBI patients within 24 h of injury, as well as orthopedic injury and uninjured controls; biospecimens were collected at enrollment. A subset of hospitalized participants had blood collected on day 3, day 5, and 2 weeks. High-sensitivity CRP (hsCRP) and glial fibrillary acidic protein (GFAP) were measured. Receiver operating characteristic analysis was used to evaluate the prognostic ability of hsCRP for 6-month outcome, using the Glasgow Outcome Scale-Extended (GOSE). We included 1206 TBI subjects, 122 orthopedic trauma controls (OTCs), and 209 healthy controls (HCs). Longitudinal biomarker sampling was performed in 254 hospitalized TBI subjects and 19 OTCs. hsCRP rose between days 1 and 5 for TBI and OTC subjects, and fell by 2 weeks, but remained elevated compared with HCs (p < 0.001). Longitudinally, hsCRP was significantly higher in the first 2 weeks for subjects with death/severe disability (GOSE <5) compared with those with moderate disability/good recovery (GOSE ≥5); AUC was highest at 2 weeks (AUC = 0.892). Combining hsCRP and GFAP at 2 weeks produced AUC = 0.939 for prediction of disability. Serum hsCRP measured within 2 weeks of TBI is a prognostic biomarker for disability 6 months later. hsCRP may have utility as a biomarker of target engagement for anti-inflammatory therapies.
Collapse
Affiliation(s)
- Linda B. Xu
- Department of Neurology, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - John K. Yue
- Department of Neurosurgery, University of California San Francisco, San Francisco, California, USA
- Brain and Spinal Injury Center, Zuckerberg San Francisco General Hospital, San Francisco, California, USA
| | - Frederick Korley
- Department of Emergency Medicine, University of Michigan, Ann Arbor, Michigan, USA
| | - Ava M. Puccio
- Department of Neurosurgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Esther L. Yuh
- Department of Radiology, University of California San Francisco, San Francisco, California, USA
- Brain and Spinal Injury Center, Zuckerberg San Francisco General Hospital, San Francisco, California, USA
| | - Xiaoying Sun
- Department of Family Medicine and Public Health, University of California San Diego, San Diego, California, USA
| | - Miri Rabinowitz
- Department of Neurosurgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Mary J. Vassar
- Department of Neurosurgery, University of California San Francisco, San Francisco, California, USA
- Brain and Spinal Injury Center, Zuckerberg San Francisco General Hospital, San Francisco, California, USA
| | - Sabrina R. Taylor
- Department of Neurosurgery, University of California San Francisco, San Francisco, California, USA
- Brain and Spinal Injury Center, Zuckerberg San Francisco General Hospital, San Francisco, California, USA
| | - Ethan A. Winkler
- Department of Neurosurgery, University of California San Francisco, San Francisco, California, USA
- Brain and Spinal Injury Center, Zuckerberg San Francisco General Hospital, San Francisco, California, USA
| | - Ross C. Puffer
- Department of Neurosurgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
- Department of Neurosurgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Hansen Deng
- Department of Neurosurgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Michael McCrea
- Department of Neurosurgery, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Murray B. Stein
- Department of Psychiatry and Family Medicine, University of California San Diego, San Diego, California, USA
| | - Claudia S. Robertson
- Department of Neurosurgery and Critical Care, Baylor College of Medicine, Houston, Texas, USA
| | - Harvey S. Levin
- Department of Neurosurgery and Neurology, Baylor College of Medicine, Houston, Texas, USA
| | - Sureyya Dikmen
- Department of Rehabilitation Medicine, University of Washington, Seattle, Washington, USA
| | - Nancy R. Temkin
- Department of Neurosurgery and Biostatistics, University of Washington, Seattle, Washington, USA
| | - Joseph T. Giacino
- Department of Rehabilitation Medicine, Spaulding Rehabilitation Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Pratik Mukherjee
- Department of Radiology, University of California San Francisco, San Francisco, California, USA
- Brain and Spinal Injury Center, Zuckerberg San Francisco General Hospital, San Francisco, California, USA
| | - Kevin K.W. Wang
- Department of Psychiatry and Neurosciences, McKnight Brain Institute, University of Florida, Gainesville, Florida, USA
| | - David O. Okonkwo
- Department of Neurosurgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Amy J. Markowitz
- Brain and Spinal Injury Center, Zuckerberg San Francisco General Hospital, San Francisco, California, USA
| | - Sonia Jain
- Department of Family Medicine and Public Health, University of California San Diego, San Diego, California, USA
| | - Geoffrey T. Manley
- Department of Neurosurgery, University of California San Francisco, San Francisco, California, USA
- Brain and Spinal Injury Center, Zuckerberg San Francisco General Hospital, San Francisco, California, USA
| | - Ramon Diaz-Arrastia
- Department of Neurology, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| |
Collapse
|
18
|
Nast A, Smith C, Spuls P, Avila Valle G, Bata‐Csörgö Z, Boonen H, De Jong E, Garcia‐Doval I, Gisondi P, Kaur‐Knudsen D, Mahil S, Mälkönen T, Maul J, Mburu S, Mrowietz U, Reich K, Remenyik E, Rønholt K, Sator P, Schmitt‐Egenolf M, Sikora M, Strömer K, Sundnes O, Trigos D, Van Der Kraaij G, Yawalkar N, Dressler C. EuroGuiDerm Guideline on the systemic treatment of Psoriasis vulgaris – Part 2: specific clinical and comorbid situations. J Eur Acad Dermatol Venereol 2021; 35:281-317. [DOI: 10.1111/jdv.16926] [Citation(s) in RCA: 32] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2020] [Accepted: 08/13/2020] [Indexed: 12/15/2022]
Affiliation(s)
- A. Nast
- Charité – Universitätsmedizin Berlin Corporate Member of Freie Universität Berlin Department of Dermatology, Venereology and Allergology Humboldt‐Universität zu Berlin, and Berlin Institute of Health Berlin Germany
| | - C. Smith
- St John’s Institute of Dermatology London UK
| | - P.I. Spuls
- Academic Medical Centre Amsterdam Amsterdam Netherlands
| | - G. Avila Valle
- Charité – Universitätsmedizin Berlin Corporate Member of Freie Universität Berlin Department of Dermatology, Venereology and Allergology Humboldt‐Universität zu Berlin, and Berlin Institute of Health Berlin Germany
| | | | - H. Boonen
- Office‐Based Dermatology Practice Geel Belgium
| | - E. De Jong
- Radboud University Medical Centre Nijmegen Nijmegen Netherlands
| | - I. Garcia‐Doval
- Unidad de Investigación. Fundación Piel Sana AEDV Madrid Spain
| | | | | | - S. Mahil
- Guy's and St Thomas' NHS Foundation Trust London UK
| | - T. Mälkönen
- Helsinki University Central Hospital Helsinki Finland
| | - J.T. Maul
- Department of Dermatology University Hospital of Zürich Zürich Switzerland
| | - S. Mburu
- International Federation of Psoriasis Associations (IFPA)
| | - U. Mrowietz
- Universitätsklinikum Schleswig‐Holstein Kiel Germany
| | - K. Reich
- Translational Research in Inflammatory Skin Diseases Institute for Health Services Research in Dermatology and Nursing University Medical Center Hamburg‐Eppendorf Hamburg Germany
| | | | | | - P.G. Sator
- Municipal Hospital Hietzing Vienna Austria
| | - M. Schmitt‐Egenolf
- Dermatology Department of Public Health & Clinical Medicine Umeå University Umeå Sweden
| | - M. Sikora
- Department of Dermatology Medical University of Warsaw Warsaw Poland
| | - K. Strömer
- Office‐Based Dermatology Practice Mönchengladbach Germany
| | | | - D. Trigos
- International Federation of Psoriasis Associations (IFPA)
| | | | - N. Yawalkar
- Department of Dermatology, Inselspital Bern University HospitalUniversity of Bern Bern Switzerland
| | - C. Dressler
- Charité – Universitätsmedizin Berlin Corporate Member of Freie Universität Berlin Department of Dermatology, Venereology and Allergology Humboldt‐Universität zu Berlin, and Berlin Institute of Health Berlin Germany
| |
Collapse
|
19
|
Aksentijevich M, Lateef SS, Anzenberg P, Dey AK, Mehta NN. Chronic inflammation, cardiometabolic diseases and effects of treatment: Psoriasis as a human model. Trends Cardiovasc Med 2020; 30:472-478. [PMID: 31837960 PMCID: PMC7428846 DOI: 10.1016/j.tcm.2019.11.001] [Citation(s) in RCA: 44] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2019] [Revised: 10/22/2019] [Accepted: 11/02/2019] [Indexed: 01/25/2023]
Abstract
Chronic inflammation in humans is associated with accelerated development of cardiometabolic diseases such as myocardial infarction, stroke, and diabetes. Strong evidence from animal models and human interventional trials including CANTOS (The Canakinumab Anti-inflammatory Thrombosis Outcome Study) suggests that targeting residual systemic inflammation in humans may impart a benefit in reducing cardiometabolic diseases. Diseases associated with heightened immune-activation and systemic inflammation including psoriasis, rheumatoid arthritis, systemic lupus erythematosus, and human immunodeficiency virus infection are associated with upwards of two to seven-fold risk of future adverse cardiac events even when adjusted for traditional risk factors. Over the past decade, psoriasis has been utilized as a human model to study inflammatory-induced cardiometabolic dysfunction and to better understand residual risk due to inflammation. The high prevalence and early onset of cardiovascular disease in psoriasis enhances the likelihood of discovering novel pathways in vascular disease progression when followed over time. Furthermore, the United States Food and Drug Administration approved treatments for psoriasis include cytokine inhibitors (anti-tumor necrosis factor, anti-interleukin 17, anti-interleukin 12/23) which while treating the skin disease provide a unique opportunity to characterize how treating the inflammatory pathways may impact atherosclerosis. Herein, we provide a review of chronic inflammation, cardiometabolic disease associations, and treatment effects with a focus on psoriasis as a human model of study.
Collapse
Affiliation(s)
- Milena Aksentijevich
- National Heart, Lung, Blood Institute, National Institutes of Health, 10 Center Drive, Clinical Research Center, Room 5-5140 Bethesda, MD 20892, USA
| | - Sundus S Lateef
- National Heart, Lung, Blood Institute, National Institutes of Health, 10 Center Drive, Clinical Research Center, Room 5-5140 Bethesda, MD 20892, USA
| | - Paula Anzenberg
- National Heart, Lung, Blood Institute, National Institutes of Health, 10 Center Drive, Clinical Research Center, Room 5-5140 Bethesda, MD 20892, USA
| | - Amit K Dey
- National Heart, Lung, Blood Institute, National Institutes of Health, 10 Center Drive, Clinical Research Center, Room 5-5140 Bethesda, MD 20892, USA
| | - Nehal N Mehta
- National Heart, Lung, Blood Institute, National Institutes of Health, 10 Center Drive, Clinical Research Center, Room 5-5140 Bethesda, MD 20892, USA.
| |
Collapse
|
20
|
Nada HA, Elshabrawy MM, Aly DM, Jafferany M, Elsaie ML. Therapeutic implications of narrow band ultraviolet B on psoriasis severity and serum levels of acute phase reactants. Dermatol Ther 2020. [DOI: 10.1111/dth.13856] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- Hesham A. Nada
- Department of Dermatology and Venereology, Faculty of Medicine Suez Canal University Ismailia Egypt
| | - Mohamed M. Elshabrawy
- Department of Dermatology and Venereology, Faculty of Medicine Suez Canal University Ismailia Egypt
| | - Doaa M. Aly
- Department of Dermatology and Venereology, Faculty of Medicine Suez Canal University Ismailia Egypt
| | | | - Mohamed L. Elsaie
- Department of Dermatology and Venereology National Research Centre Giza Egypt
| |
Collapse
|
21
|
Ritchlin CT, Giles JT, Ogdie A, Gomez‐Reino JJ, Helliwell P, Young P, Wang C, Wu J, Romero AB, Woolcott J, Stockert L. Tofacitinib in Patients With Psoriatic Arthritis and Metabolic Syndrome: A Post hoc Analysis of Phase 3 Studies. ACR Open Rheumatol 2020; 2:543-554. [PMID: 32910531 PMCID: PMC7571390 DOI: 10.1002/acr2.11166] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2020] [Accepted: 06/26/2020] [Indexed: 12/19/2022] Open
Abstract
OBJECTIVE Metabolic syndrome (MetS) is a cluster of concurrent risk factors for cardiovascular disease and type 2 diabetes. This post hoc analysis explored key efficacy and safety endpoints in patients with psoriatic arthritis (PsA) and MetS treated with tofacitinib. METHODS Tofacitinib 5 and 10 mg twice daily and placebo data were pooled from two Phase 3 studies (OPAL Broaden [12 months; ClinicalTrials.gov identifier NCT01877668]; OPAL Beyond [6 months; ClinicalTrials.gov identifier NCT01882439]); patients received one background conventional synthetic disease-modifying antirheumatic drug. Patients were stratified by baseline presence/absence of MetS. Efficacy and safety were reported to month 3 (tofacitinib and placebo) and 6 (tofacitinib only). Efficacy outcomes included: American College of Rheumatology (ACR)20/50/70, Health Assessment Questionnaire-Disability Index (HAQ-DI) response, Psoriasis Area Severity Index (PASI)75 response, and enthesitis/dactylitis resolution rates; and changes from baseline (Δ) in C-reactive protein, HAQ-DI, Patient's/Physician's Global Assessment of Arthritis, and patient-reported outcomes. Safety outcomes included treatment-emergent all-causality adverse events (AEs), Δ in lipid/hepatic values, and liver parameter increases. RESULTS Of 710 patients, 41.4% (n = 294) had baseline MetS. All efficacy outcomes improved with both tofacitinib doses versus placebo, to month 3; tofacitinib efficacy was consistent to month 6, regardless of MetS status. MetS did not appear to affect the incidence of AEs or Δ in lipid/hepatic values with tofacitinib up to month 3 or 6. Arterial thromboembolism and myocardial infarction (adjudicated major adverse cardiovascular events) were each reported once in tofacitinib-treated patients with MetS. CONCLUSION Regardless of baseline MetS status, tofacitinib showed greater efficacy versus placebo in patients with active PsA. The tofacitinib safety profile appeared similar in patients with versus without MetS.
Collapse
Affiliation(s)
| | | | - Alexis Ogdie
- Perelman School of Medicine at the University of PennsylvaniaPhiladelphiaPennsylvania
| | | | - Philip Helliwell
- Leeds Institute of Rheumatic and Musculoskeletal MedicineUniversity of LeedsLeedsUK
| | | | | | | | | | | | | |
Collapse
|
22
|
Barrea L, Megna M, Cacciapuoti S, Frias-Toral E, Fabbrocini G, Savastano S, Colao A, Muscogiuri G. Very low-calorie ketogenic diet (VLCKD) in patients with psoriasis and obesity: an update for dermatologists and nutritionists. Crit Rev Food Sci Nutr 2020; 62:398-414. [PMID: 32969257 DOI: 10.1080/10408398.2020.1818053] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Psoriasis is a chronic skin immune-mediated disease with systemic pro-inflammatory activation; both genetic and lifestyles factors contribute to its pathogenesis and severity. In this context, nutrition plays a significant role, per se, in psoriasis' pathogenesis. Obesity is another important risk factor for psoriasis, and weight reduction may improve psoriasis' clinical severity. The excess body weight, particularly visceral fat mass, can affect both drug's pharmacokinetics and pharmacodynamics. Therefore, psoriasis and obesity share a certain degree of synergy, and the chronic inflammatory state represents the basis of this vicious cycle. Evidence reported that nutrition has different impact on the clinical severity of psoriasis, though some specific diets have been more investigated in clinical studies compared to others. Diets with systemic anti-inflammatory properties seem to have a higher effect on improving the clinical severity of psoriasis. Of interest, very-low-calorie ketogenic diet (VLCKD), through the production of ketone bodies, has been associated with both a significant reduction of body weight and inflammatory state. VLCKD leading to both weight loss and reduction of systemic inflammation may decrease the exacerbation of the clinical manifestations or even it may block the trigger of psoriatic disease. This dietary pattern could represent a potential first-line treatment in psoriatic patients with obesity. The review aims to summarize the current evidence regarding VLCKD and psoriasis with specific reference to antioxidant and anti-inflammatory effects of this dietary pattern.
Collapse
Affiliation(s)
- Luigi Barrea
- Dipartimento di Medicina Clinica e Chirurgia, Unit of Endocrinology, Federico II University Medical School of Naples, Naples, Italy.,Department of Clinical Medicine and Surgery, Centro Italiano per la cura e il Benessere del paziente con Obesità (C.I.B.O), Endocrinology Unit, University Medical School of Naples, Naples, Italy
| | - Matteo Megna
- Department of Clinical Medicine and Surgery, Section of Dermatology, University of Naples Federico II, Naples, Italy
| | - Sara Cacciapuoti
- Department of Clinical Medicine and Surgery, Section of Dermatology, University of Naples Federico II, Naples, Italy
| | - Evelyn Frias-Toral
- Research Committee, SOLCA Guayaquil, Guayaquil, Ecuador.,Clinical Research Associate Professor for Palliative Care Residency, Universidad Católica Santiago de Guayaquil, Guayaquil, Ecuador
| | - Gabriella Fabbrocini
- Department of Clinical Medicine and Surgery, Section of Dermatology, University of Naples Federico II, Naples, Italy
| | - Silvia Savastano
- Dipartimento di Medicina Clinica e Chirurgia, Unit of Endocrinology, Federico II University Medical School of Naples, Naples, Italy.,Department of Clinical Medicine and Surgery, Centro Italiano per la cura e il Benessere del paziente con Obesità (C.I.B.O), Endocrinology Unit, University Medical School of Naples, Naples, Italy
| | - Annamaria Colao
- Dipartimento di Medicina Clinica e Chirurgia, Unit of Endocrinology, Federico II University Medical School of Naples, Naples, Italy.,Department of Clinical Medicine and Surgery, Centro Italiano per la cura e il Benessere del paziente con Obesità (C.I.B.O), Endocrinology Unit, University Medical School of Naples, Naples, Italy.,Cattedra Unesco "Educazione alla salute e allo sviluppo sostenibile", University Federico II, Naples, Italy
| | - Giovanna Muscogiuri
- Dipartimento di Medicina Clinica e Chirurgia, Unit of Endocrinology, Federico II University Medical School of Naples, Naples, Italy.,Department of Clinical Medicine and Surgery, Centro Italiano per la cura e il Benessere del paziente con Obesità (C.I.B.O), Endocrinology Unit, University Medical School of Naples, Naples, Italy
| |
Collapse
|
23
|
Ungar B, Pavel AB, Robson PM, Kaufman A, Pruzan A, Brunner P, Kaushik S, Krueger JG, Lebwohl MG, Mani V, Fayad ZA, Guttman-Yassky E. A Preliminary 18F-FDG-PET/MRI Study Shows Increased Vascular Inflammation in Moderate-to-Severe Atopic Dermatitis. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY-IN PRACTICE 2020; 8:3500-3506. [PMID: 32721606 DOI: 10.1016/j.jaip.2020.07.018] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Revised: 06/20/2020] [Accepted: 07/14/2020] [Indexed: 02/08/2023]
Abstract
BACKGROUND Recent data suggest that patients with atopic dermatitis (AD) have increased systemic immune activation and cardiovascular risk. However, unlike psoriasis, evaluation of active vascular inflammation using state-of-the-art imaging is lacking in AD. OBJECTIVE To assess aortic and carotid vascular inflammation using 18F-fluorodeoxyglucose-positron emission tomography/magnetic resonance imaging (18F-FDG-PET/MRI) imaging in moderate-to-severe AD versus healthy individuals. METHODS A total of 27 patients with moderate-to-severe AD and 12 healthy controls were imaged using 18F-FDG-PET/MRI. Target-to-background ratio (TBR) values were calculated in multiple segments of the aorta and carotid vessels. RESULTS Patients with AD had elevated aortic max TBR (fold change [FCH] = 1.45, P = .057) versus healthy controls and significantly elevated mean TBR (FCH = 1.20; P < .05) in the right carotid (RC) arteries versus controls. When examining greatest focal inflammation (most diseased segment [MDS] TBR), patients with AD had higher aortic inflammation (FCH = 1.28; P = .052). AD clinical severity significantly correlated with C-reactive protein (ρ = 0.60, P < .01) and with RC mean TBR levels (ρ = 0.60, P = .04). Stratifying patients into moderate-to-severe and very severe AD showed greater RC mean TBR in patients with very severe AD versus controls (FCH = 1.31; P = .02) and versus patients with moderate/severe AD (FCH = 1.23, P = .05). Aortic inflammation was also significantly greater in patients with very severe AD versus controls (max TBR: FCH = 1.6, P = .04; MDS TBR: FCH = 1.73, P = .03). CONCLUSIONS This preliminary study is the first that establishes greater vascular (aorta and carotid) inflammation in moderate-to-severe AD versus healthy controls. Furthermore, very severe AD showed higher inflammation than both moderate/severe patients and healthy controls. Future studies with larger patient cohorts and evaluation before and after treatment are needed to determine the extent to which vascular inflammation in AD is modifiable.
Collapse
Affiliation(s)
- Benjamin Ungar
- Department of Dermatology, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Ana B Pavel
- Department of Dermatology, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Philip M Robson
- Department of Radiology, Icahn School of Medicine at Mount Sinai, New York, NY; The BioMedical Engineering and Imaging Institute, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Audrey Kaufman
- Department of Radiology, Icahn School of Medicine at Mount Sinai, New York, NY; The BioMedical Engineering and Imaging Institute, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Alison Pruzan
- Department of Radiology, Icahn School of Medicine at Mount Sinai, New York, NY; The BioMedical Engineering and Imaging Institute, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Patrick Brunner
- The Laboratory for Investigative Dermatology, The Rockefeller University, New York, NY
| | - Shivani Kaushik
- Department of Dermatology, Icahn School of Medicine at Mount Sinai, New York, NY
| | - James G Krueger
- The Laboratory for Investigative Dermatology, The Rockefeller University, New York, NY
| | - Mark G Lebwohl
- Department of Dermatology, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Venkatesh Mani
- Department of Radiology, Icahn School of Medicine at Mount Sinai, New York, NY; The BioMedical Engineering and Imaging Institute, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Zahi A Fayad
- Department of Radiology, Icahn School of Medicine at Mount Sinai, New York, NY; The BioMedical Engineering and Imaging Institute, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Emma Guttman-Yassky
- Department of Dermatology, Icahn School of Medicine at Mount Sinai, New York, NY; The Laboratory for Investigative Dermatology, The Rockefeller University, New York, NY; Department of Dermatology and the Immunology Institute, Icahn School of Medicine at Mount Sinai, New York, NY.
| |
Collapse
|
24
|
The effect of biological agent treatment on neutrophil-to-lymphocyte ratio, platelet-to-lymphocyte ratio, mean platelet volume, and C-reactive protein in psoriasis patients. Postepy Dermatol Alergol 2020; 37:202-206. [PMID: 32489355 PMCID: PMC7262800 DOI: 10.5114/ada.2020.94838] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2018] [Accepted: 10/02/2018] [Indexed: 02/07/2023] Open
Abstract
Introduction In recent years, the neutrophil/lymphocyte ratio (NLR), platelet/lymphocyte ratio (PLR), mean platelet volume (MPV) and C reactive protein (CRP) have been shown to be important indicators of systemic inflammation. Studies have shown that NLR, PLR, MPV and CRP are higher in psoriasis patients than in the control group. Aim To investigate the NLR, PLR, MPV and serum CRP levels in patients who were treated with biological agents for psoriasis. Material and methods In our study, 75 patients who were followed up and had a diagnosis of psoriasis vulgaris and took a biological agent therapy between January 2014 and December 2017 in the Dermatology Clinic of the Dicle University Medical Faculty Hospital were evaluated before treatment, and 3 and 6 months after treatment. Results Neutrophil count, lymphocyte count, thrombocyte count, NLR, PLR, MPV and CRP values before the biological agent treatment were statistically higher than the values at 3 and 6 months of treatment. There was no statistically significant difference between pre-treatment neutrophil, lymphocyte, leukocyte, platelet, NLR, PLR, MPV, CRP values and values at 3 and 6 months after treatment when we compared four different biological agents. Conclusions It was seen that NLR, PLR, MPV and CRP values decreased independently of the type of the biological agent used in our study. Therefore, we think that these parameters can be used to evaluate the effects of biological agent treatment on systemic inflammation in psoriasis patients and to monitor the course of the disease.
Collapse
|
25
|
Rida MA, Chandran V. Challenges in the clinical diagnosis of psoriatic arthritis. Clin Immunol 2020; 214:108390. [PMID: 32200113 DOI: 10.1016/j.clim.2020.108390] [Citation(s) in RCA: 33] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2020] [Accepted: 03/17/2020] [Indexed: 01/15/2023]
Abstract
Psoriatic arthritis (PsA) is a chronic heterogeneous inflammatory musculoskeletal disease. The non-specific and often subtle manifestations make early diagnosis and subsequent treatment challenging. In the absence of diagnostic criteria and biomarkers, the diagnosis is often delayed leading to poor long-term outcomes. In addition, the differential diagnosis of a patient presenting with arthritis in the setting of skin psoriasis is wide due to symptom overlap with many other diseases. Peripheral arthritis, dactylitis, enthesitis and axial arthritis are the 4 domains of musculoskeletal involvement in PsA and careful examination of each domain by a rheumatologist is the first step for a correct diagnosis. Other extra-musculoskeletal features such as the presence of uveitis, inflammatory bowel disease, nail psoriasis and elevated acute phase reactants aid in the diagnosis of PsA. Screening patients with skin psoriasis using validated questionnaires might help in early diagnosis especially when coupled with imaging.
Collapse
Affiliation(s)
- Mohamad Ali Rida
- Psoriatic Disease Program, Centre for Prognosis Studies in the Rheumatic Diseases, Krembil Research Institute, Toronto Western Hospital, Toronto, Ontario, Canada; Division of Rheumatology, Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Vinod Chandran
- Psoriatic Disease Program, Centre for Prognosis Studies in the Rheumatic Diseases, Krembil Research Institute, Toronto Western Hospital, Toronto, Ontario, Canada; Division of Rheumatology, Department of Medicine, University of Toronto, Toronto, Ontario, Canada; Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Ontario, Canada; Institute of Medical Science, University of Toronto, Toronto, Ontario, Canada; Department of Medicine, Memorial University, St. John's, Newfoundland and Labrador, Canada.
| |
Collapse
|
26
|
Grechin C, Gheucă Solovăstru L, Vâță D, Ionela Pătrașcu A, Ioana Grăjdeanu A, Porumb-Andrese E. Inflammatory marker alteration in response to systemic therapies in psoriasis. Exp Ther Med 2020; 20:42-46. [PMID: 32508991 PMCID: PMC7271695 DOI: 10.3892/etm.2020.8535] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2019] [Accepted: 01/13/2020] [Indexed: 11/20/2022] Open
Abstract
Substantial research has focused on the presence of biomarkers involved in both the pathogenesis of psoriasis and its comorbidities. The identification of these biomarkers has a crucial role in establishing the diagnosis and prognosis, in understanding the physiopathological mechanism and in determining the therapeutic response. The aim of this study was to emphasize the alteration in inflammatory markers in response to systemic therapies in psoriasis. Evolution of inflammatory marker alteration was studied in 194 patients with psoriasis, aged between 7 and 87 years. Two groups were set up: the first comprised of patients treated with methotrexate (n=51), while the second comprised patients treated with biological therapy (n=143). Each group was evaluated for blood values of C-reactive protein (CRP), erythrocyte sedimentation rate (ESR) and fibrinogen before and after treatment, the fluctuation of these values according to the treatment, the interrelation between inflammatory markers and inflammatory activity of the disease and the evolution of the disease after treatment. In group I, 46 out of 51 patients had elevated levels of acute phase reactants before treatment. After treatment with methotrexate 7.5 mg/week, 12 out of 46 patients had elevated blood levels of ESR and 18 out of 46 patients of CRP and fibrinogen. Before treatment with biological therapy, 138 patients out of 143 presented abnormal high range for acute phase reactants. After treatment with biological therapy, 18 patients out of 138 had elevated blood levels of ESR and 37 patients out of 138 had elevated CRP and fibrinogen. A favorable evolution was noted in 98 patients out of 138. It was concluded that the systemic treatment with both methotrexate and biological therapy showed a marked decline in the patients with abnormal values of CRP, ESR and fibrinogen, indirectly showing a decline in the inflammatory activity of psoriasis.
Collapse
Affiliation(s)
- Cristina Grechin
- Department of Gastroenterology, Sligo University Hospital, Sligo, F91 H684, Ireland
| | - Laura Gheucă Solovăstru
- Department of Dermatology, 'Gr. T. Popa' University of Medicine and Pharmacy, 700115 Iasi, Romania.,Department of Dermatology, 'Sf. Spiridon' Clinical Emergency County Hospital, 700111 Iasi, Romania
| | - Dan Vâță
- Department of Dermatology, 'Gr. T. Popa' University of Medicine and Pharmacy, 700115 Iasi, Romania.,Department of Dermatology, 'Sf. Spiridon' Clinical Emergency County Hospital, 700111 Iasi, Romania
| | - Adriana Ionela Pătrașcu
- Department of Dermatology, 'Sf. Spiridon' Clinical Emergency County Hospital, 700111 Iasi, Romania
| | - Alina Ioana Grăjdeanu
- Department of Dermatology, 'Gr. T. Popa' University of Medicine and Pharmacy, 700115 Iasi, Romania
| | - Elena Porumb-Andrese
- Department of Dermatology, 'Gr. T. Popa' University of Medicine and Pharmacy, 700115 Iasi, Romania.,Department of Dermatology, 'Sf. Spiridon' Clinical Emergency County Hospital, 700111 Iasi, Romania
| |
Collapse
|
27
|
Chandran V, Rahman P. Predicting therapeutic response through biomarker analysis in psoriatic arthritis, an example of precision medicine. EXPERT REVIEW OF PRECISION MEDICINE AND DRUG DEVELOPMENT 2020. [DOI: 10.1080/23808993.2020.1724509] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Affiliation(s)
- Vinod Chandran
- Faculty of Medicine, University of Toronto, Toronto, Canada
- Division of Rheumatology, Department of Medicine, University of Toronto, Toronto, Canada
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Canada
- Institute of Medical Science, University of Toronto, Toronto, Canada
- Krembil Research Institute, University Health Network, Toronto, Canada
| | - Proton Rahman
- Division of Rheumatology, Department of Medicine, Memorial University, St. John’s, Newfoundland, Canada
| |
Collapse
|
28
|
Aktaş Karabay E, Aksu Çerman A, Demir D, Kıvanç Altunay I. The Effects of Systemic Psoriasis Therapies on the C-Reactive Protein and the Neutrophil-Lymphocyte Ratio. Ann Dermatol 2019; 31:601-610. [PMID: 33911659 PMCID: PMC7992605 DOI: 10.5021/ad.2019.31.6.601] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2019] [Revised: 07/24/2019] [Accepted: 07/31/2019] [Indexed: 11/24/2022] Open
Abstract
Background Currently, no generally accepted laboratory marker for monitorizing the disease activity and therapy response of psoriasis is known. Objective The aim of the study is to evaluate the effects of systemic therapies on C-reactive protein (CRP) and the neutrophil-lymphocyte ratio (NLR) in psoriasis. Methods One hundred patients with psoriasis treated with narrow band ultraviolet B, acitretin, cyclosporine, methotrexate, adalimumab, etanercept, and ustekinumab were prospectively evaluated. At baseline and at week 12, CRP, NLR, and Psoriasis Area and Severity Index (PASI) were evaluated. Results A statistically significant decrease was observed in PASI scores, CRP, and NLR values from the baseline to the 12-week visit (p=0.001, p=0.001, p=0.001, respectively). The reduction in PASI scores and NLR values was positively correlated (r=0.460, p=0.001). The comparisons between treatment groups revealed that the median decrease in NLR values was statistically higher in the adalimumab group than in the methotrexate group (p=0.007). And the median decrease in PASI scores was significantly higher in the adalimumab group compared with the methotrexate and acitretin therapy group (p=0.007, p=0.042, respectively). Conclusion In the present study, systemic therapy of psoriasis was demonstrated to decrease the levels of CRP and NLR, which are known to be indicators of systemic inflammation and cardiovascular comorbidities.
Collapse
Affiliation(s)
- Ezgi Aktaş Karabay
- Department of Dermatology and Venereology, Bahçeşehir University, Faculty of Medicine, Istanbul, Turkey
| | - Aslı Aksu Çerman
- Department of Dermatology and Venereology, Health Sciences University, Sisli Hamidiye Etfal Training and Research Hospital, Istanbul, Turkey
| | - Damla Demir
- Department of Dermatology and Venereology, Health Sciences University, Sisli Hamidiye Etfal Training and Research Hospital, Istanbul, Turkey
| | - Ilknur Kıvanç Altunay
- Department of Dermatology and Venereology, Health Sciences University, Sisli Hamidiye Etfal Training and Research Hospital, Istanbul, Turkey
| |
Collapse
|
29
|
Gratacós J, Galíndez E, Otón T. Is obesity a predictor for lack of response to treatment in psoriatic arthritis? A systematic review. ACTA ACUST UNITED AC 2019; 17:268-278. [PMID: 31708450 DOI: 10.1016/j.reuma.2019.06.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2019] [Revised: 04/23/2019] [Accepted: 06/05/2019] [Indexed: 10/25/2022]
Abstract
OBJECTIVES To update the study of the association between obesity and treatment response in psoriatic arthritis. METHODS Updating a systematic review of clinical trials, prospective or retrospective longitudinal studies and case-control studies in psoriatic arthritis in which obesity was assessed as a predictor of efficacy or toxicity. Risks of bias were assessed with validated scales. A meta-analysis of the results of studies with similar outcome variables and weight measurements was performed. RESULTS Twenty-one studies were included (6 review of clinical trials, 6 longitudinal studies, 7 registers and one case-control studie), with moderate quality. The risk of achieving an ACR20 response if weight≥100kg was estimated at OR=1.42 (1-2.08) and that of withdrawing treatment in an OR of 1.60 (95% CI: 1.34 - 1.92). CONCLUSIONS There seems to be a greater risk of withdrawal of treatment due to inefficacy and difficulty in achieving remission in patients with psoriatic arthritis if they are obese.
Collapse
Affiliation(s)
- Jordi Gratacós
- Servicio de Reumatología, Hospital Universitari Parc Taulí, Universitat Autònoma de Barcelona, Sabadell (Barcelona), España
| | - Eva Galíndez
- Servicio de Reumatología, Hospital Universitario Basurto, Bilbao, Vizcaya, España
| | - Teresa Otón
- Instituto de Salud Musculoesquelética, Madrid, España.
| |
Collapse
|
30
|
Korman NJ. Management of psoriasis as a systemic disease: what is the evidence? Br J Dermatol 2019; 182:840-848. [PMID: 31225638 PMCID: PMC7187293 DOI: 10.1111/bjd.18245] [Citation(s) in RCA: 227] [Impact Index Per Article: 45.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/19/2019] [Indexed: 12/16/2022]
Abstract
Background Psoriasis is a chronic, systemic immune‐mediated disease characterized by development of erythematous, indurated, scaly, pruritic and often painful skin plaques. Psoriasis pathogenesis is driven by proinflammatory cytokines and psoriasis is associated with increased risk for comorbidities, including, but not limited to, psoriatic arthritis, cardiovascular disease, diabetes mellitus, obesity, inflammatory bowel disease and nonalcoholic fatty liver disease compared with the general population. Objectives To explore the pathophysiological relationship between psoriasis and its common comorbidities and discuss the need for new treatment paradigms that include strategies to reduce systemic inflammation in patients with moderate‐to‐severe psoriasis. Methods This narrative review summarizes the published evidence related to the ability of biological therapies to ameliorate the consequences of systemic inflammation in patients with psoriasis. Results Current evidence suggests that preventing damage associated with inflammation, and preventing development of future inflammatory damage and comorbidities, may be a potentially achievable treatment goal for many patients with moderate‐to‐severe plaque psoriasis when biological therapies are utilized early in the disease. Encouraging data from recent studies suggest that the loftier goal of reversing existing inflammatory damage and improving signs and symptoms of inflammatory comorbidities could also possibly be attainable. Conclusions Results from ongoing prospective studies regarding the effects of biologics on markers of systemic inflammation in patients with psoriasis will strengthen the clinical evidence base that can be used to inform treatment decisions for patients with moderate‐to‐severe psoriasis. What's already known about this topic? Psoriasis is a systemic inflammatory disease and treatments are needed to optimize patient outcomes.
What does this study add? This review discusses new psoriasis treatment paradigms that may potentially reduce effects of systemic inflammation. Evidence demonstrating that biological treatment may prevent or reverse inflammatory damage associated with psoriasis comorbidities is reviewed.
Linked Comment:https://doi.org/10.1111/bjd.18456
Collapse
Affiliation(s)
- N J Korman
- Department of Dermatology, Case Western Reserve University, Cleveland, OH, U.S.A.,University Hospitals Cleveland Medical Center, Cleveland, OH, U.S.A
| |
Collapse
|
31
|
Lee JW, Jung KJ, Kim TG, Lee M, Oh J, Jee SH, Lee MG. Risk of malignancy in patients with psoriasis: a 15-year nationwide population-based prospective cohort study in Korea. J Eur Acad Dermatol Venereol 2019; 33:2296-2304. [PMID: 31287593 DOI: 10.1111/jdv.15783] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2019] [Accepted: 06/06/2019] [Indexed: 12/13/2022]
Abstract
BACKGROUND The association between psoriasis and risk of malignancy has not been thoroughly evaluated in a large longitudinal cohort of Asian population. OBJECTIVE To determine the long-term risk of malignancy in Korean adult patients with psoriasis. METHODS We conducted a nationwide population-based prospective cohort study with a 15-year observational period. During the baseline period (1997-2000), total 1 773 786 Korean subjects who received health insurance from the National Health Insurance System were enrolled and 5788 subjects were defined as a psoriasis group. The number of new-onset malignancy was collected during the observational period (2001-2015). RESULTS Patients with psoriasis had a higher adjusted hazard ratio (aHR) for development of overall malignancy [aHR 1.08, 95% confidence interval (CI) 1.00-1.18] and gastric cancer (aHR 1.31, 95% CI 1.08-1.58) compared to controls. The risks of non-Hodgkin lymphoma and non-melanoma skin cancer were significantly increased only in patients with psoriasis who received systemic treatments (aHR 2.86, 95% CI 1.07-7.61 and aHR 3.93, 95% CI 1.47-10.47, respectively). CONCLUSION Psoriasis is associated with long-term risk for overall malignancy in Koreans, which was primarily driven by the increased risk of gastric cancer.
Collapse
Affiliation(s)
- J W Lee
- Department of Dermatology, Severance Hospital, Cutaneous Biology Research Institute, Yonsei University College of Medicine, Seoul, South Korea
| | - K J Jung
- Department of Epidemiology and Health Promotion, Institute for Health Promotion, Graduate School of Public Health, Yonsei University, Seoul, South Korea
| | - T G Kim
- Department of Dermatology, Severance Hospital, Cutaneous Biology Research Institute, Yonsei University College of Medicine, Seoul, South Korea
| | - M Lee
- Department of Dermatology, Severance Hospital, Cutaneous Biology Research Institute, Yonsei University College of Medicine, Seoul, South Korea
| | - J Oh
- Department of Dermatology, Severance Hospital, Cutaneous Biology Research Institute, Yonsei University College of Medicine, Seoul, South Korea
| | - S H Jee
- Department of Epidemiology and Health Promotion, Institute for Health Promotion, Graduate School of Public Health, Yonsei University, Seoul, South Korea
| | - M G Lee
- Department of Dermatology, Severance Hospital, Cutaneous Biology Research Institute, Yonsei University College of Medicine, Seoul, South Korea.,Brain Korea 21 PLUS Project for Medical Science, Yonsei University College of Medicine, Seoul, South Korea
| |
Collapse
|
32
|
Abstract
BACKGROUND Psoriasis, psoriatic arthritis, spondyloarthritis, rheumatoid arthritis, ulcerative colitis, and Crohn disease share similar underlying pathophysiological processes, providing the opportunity to treat the patients using similar biological therapies. Failure of biological treatments due to underexposure can be managed by therapeutic drug monitoring. Adjusting the treatment based on pharmacokinetic monitoring can be further improved by taking pharmacodynamic parameters such as clinical and molecular markers into account. METHODS Here, we critically evaluate the existing evidence, the hurdles to be taken, and the opportunities for a widespread implementation of pharmacodynamic monitoring. RESULTS Pharmacodynamic monitoring typically is the monitoring of biochemical markers. A pharmacodynamic marker preferably is specific for the pharmacological action of a drug, but most of the time nonspecific pharmacodynamic markers are used, such as C-reactive protein and the erythrocyte sedimentation rate. Clinical pharmacodynamic markers typically evaluate physical variables or symptoms. Although physician-reported outcomes have been studied for a longer time and often have been shown to correlate well with molecular pharmacodynamic markers and treatment outcomes, the introduction of mobile health or mHealth technologies caused a shift toward patient-reported outcomes, with the associated challenge to consistently reflect the inflammatory state, thereby preventing undertreatment or unnecessary overdosing of patients. CONCLUSIONS The primary goal of pharmacodynamic monitoring is to optimize the response, but it can also have an impact on safety, costs, patient adherence, etc. Ideally, the constant remote monitoring of patient-reported disease activity is expected to become the standard, facilitated by mHealth technologies.
Collapse
|
33
|
Furst DE, Belasco J, Louie JS. Genetic and inflammatory factors associated with psoriatic arthritis: Relevance to diagnosis and management. Clin Immunol 2019; 202:59-75. [DOI: 10.1016/j.clim.2019.02.001] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2018] [Revised: 01/21/2019] [Accepted: 02/04/2019] [Indexed: 12/22/2022]
|
34
|
Elnady B, El Shaarawy NK, Dawoud NM, Elkhouly T, Desouky DES, ElShafey EN, El Husseiny MS, Rasker JJ. Subclinical synovitis and enthesitis in psoriasis patients and controls by ultrasonography in Saudi Arabia; incidence of psoriatic arthritis during two years. Clin Rheumatol 2019; 38:1627-1635. [DOI: 10.1007/s10067-019-04445-0] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2018] [Revised: 01/12/2019] [Accepted: 01/16/2019] [Indexed: 01/27/2023]
|
35
|
Moustafa YM, Elsaied MA, Abd-Elaaty EM, Elsayed RA. Evaluation of Serum Adenosine Deaminase and Inflammatory Markers in Psoriatic Patients. Indian J Dermatol 2019; 64:207-212. [PMID: 31148859 PMCID: PMC6537700 DOI: 10.4103/ijd.ijd_420_17] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
Background: Adenosine deaminase (ADA) is an enzyme involved in purine metabolism and it is a marker of nonspecific T-cell activation. Few studies have shown high levels of ADA in the epidermis and sera of psoriatic patients. Other inflammatory markers such as high-sensitive C-reactive protein (hsCRP), erythrocyte sedimentation rate (ESR), and serum uric acid (SUA) have shown correlations with psoriasis area severity index (PASI) score. The correlation between ADA and PASI score is still a matter of debate. Aims: The aim of this study was to evaluate serum ADA, hsCRP, SUA, and ESR in psoriatic patients and their correlation with PASI score. Patients and Methods: This study included 60 psoriatic patients divided according to PASI score into three groups (mild, moderate, and severe) each containing 20 patients. PASI score <10 was defined as mild, (10–20) moderate, and >20 severe. Twenty healthy subjects of matched age and sex were included as control. Serum ADA, hsCRP, SUA, and ESR were evaluated for patients and controls. Correlations of ADA, hsCRP, SUA, and ESR with PASI scores were done. Results: While ADA, hsCRP, SUA, and ESR showed a significant increase in psoriatic patients compared with that of the controls (P<001), they showed no significant difference between different psoriatic groups (P>0.05) and no correlations with PASI score (P>0.05). The frequency of joint affection increased with increasing severity of psoriasis (5%, 10%, and 25% in mild, moderate, and severe psoriasis, respectively). Conclusion: Serum ADA, hsCRP, SUA, and ESR showed higher levels among psoriatic patients than in controls. The increased ADA in psoriatic patients supports the role of T-cell activation and proliferative disorder in the pathogenesis of psoriasis. No significant correlations were found between these biomarkers and PASI score. Further studies are needed to validate these biomarkers as diagnostic and prognostic factors in psoriasis.
Collapse
Affiliation(s)
- Yousry M Moustafa
- Department of Dermatology, Faculty of Medicine, Mansoura University, Mansoura, Egypt
| | | | - Ehsan M Abd-Elaaty
- Department of Clinical Pathology, Faculty of Medicine, Mansoura University, Mansoura, Egypt
| | - Rasha A Elsayed
- Department of Dermatology, Faculty of Medicine, Mansoura University, Mansoura, Egypt
| |
Collapse
|
36
|
Coates LC, Gottlieb AB, Merola JF, Boone C, Szumski A, Chhabra A. Comparison of Different Remission and Low Disease Definitions in Psoriatic Arthritis and Evaluation of Their Prognostic Value. J Rheumatol 2018; 46:160-165. [DOI: 10.3899/jrheum.180249] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/28/2018] [Indexed: 02/07/2023]
Abstract
Objective.There is no agreement on the optimal definitions for assessing disease state in patients with psoriatic arthritis (PsA), and some of the commonly used definitions do not include assessment of skin lesions. We investigated the performance of various definitions in patients with PsA and psoriasis.Methods.This was a posthoc analysis of data from the PRESTA study. The remission definitions analyzed were very low disease activity (VLDA) index, defined as 7/7 of the minimal disease activity (MDA) cutoffs; Disease Activity Index for PsA (DAPSA); and clinical (c-) DAPSA. The low disease activity (LDA) definitions analyzed were as follows: MDA defined as 5/7 cutoffs; MDA joint with both the tender joint count (TJC) and swollen joint count (SJC) cutoffs mandated; MDA skin where skin cutoff was mandated; MDA joint + skin where TJC, SJC, and skin cutoffs were mandated; DAPSA LDA; and cDAPSA LDA.Results.At Week 24, the proportions of patients achieving VLDA, DAPSA, and cDAPSA remission were 10%, 35%, and 37%, respectively. Of the patients achieving DAPSA and cDAPSA remission, 55% and 56%, respectively, had Psoriasis Area and Severity Index > 1. The proportions of patients achieving MDA 5/7, MDA skin, MDA joint, and MDA joint + skin were 44%, 19%, 36%, and 14%, respectively, versus 70% achieving DAPSA and cDAPSA LDA. Notable residual levels of psoriasis were observed in patients achieving the definitions that did not require skin disease control.Conclusion.VLDA and MDA definitions are more stringent than DAPSA and cDAPSA definitions for the assessment of PsA. The relevance of residual disease to patients, however, remains to be determined. [Clinical Trial registration:ClinicalTrials.govNCT00245960]
Collapse
|
37
|
Liu Y, Qin G, Meng Z, Du T, Wang X, Tang Y, Cao J. IL-1β, IL-17A and combined phototherapy predicts higher while previous systemic biologic treatment predicts lower treatment response to etanercept in psoriasis patients. Inflammopharmacology 2018; 27:57-66. [PMID: 30242748 DOI: 10.1007/s10787-018-0530-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2018] [Accepted: 09/07/2018] [Indexed: 12/18/2022]
Abstract
BACKGROUND This study aimed to explore the correlation of circulating inflammatory cytokines' levels with treatment response to etanercept (ETN) treatment in psoriasis patients. METHODS 97 moderate-to-severe plaque-psoriasis patients were continuously recruited in this prospective cohort study, and all patients received ETN treatment. Serum samples were collected before and at 6 months (M6) after treatment, and nine inflammatory cytokines expressions were detected by enzyme-linked immuno sorbent assay. Psoriasis Area and Severity Index (PASI) score was evaluated at baseline (M0), 1 month (M1), 3 months (M3) and M6 after treatment, and the corresponding PASI 75/90 responses' rates were calculated. RESULTS Tumor necrosis factor-alpha (TNF-α), interleukin (IL)-1β, IL-6, IL-12, IL-17A, IL-22, IL-23, and IL-32 levels were reduced, while IL-10 level was elevated at M6 after ETN treatment compared to baseline. PASI 75/90 responses' rates to ETN were 69.1 and 38.1% at M6, respectively. IL-1β and IL-17A levels were elevated in PASI 75-response patients compared to PASI 75 non-response patients, while IL-17A level was also increased in PASI 90-response patients compared to PASI 90 non-response patients. Multivariate logistic regression revealed that IL-1β, IL-17A and combined phototherapy during study predicted higher, while previous systemic biologic treatment predicted lower PASI 75 response to ETN independently. In addition, IL-17A independently predicted higher PASI 90 response to ETN as well. CONCLUSIONS IL-1β, IL-17A, and combined phototherapy predicts higher while previous systemic biologic treatment predicts lower treatment response to ETN independently in psoriasis patients.
Collapse
Affiliation(s)
- Yufang Liu
- Department of Dermatology, The People's Hospital of Shiyan, The Affiliated People's Hospital, Hubei University of Medicine, 39 Middle Chaoyang Road, Shiyan, 442000, China
| | - Guifang Qin
- Department of Dermatology, The People's Hospital of Shiyan, The Affiliated People's Hospital, Hubei University of Medicine, 39 Middle Chaoyang Road, Shiyan, 442000, China
| | - Zudong Meng
- Department of Dermatology, The People's Hospital of Shiyan, The Affiliated People's Hospital, Hubei University of Medicine, 39 Middle Chaoyang Road, Shiyan, 442000, China.
| | - Tianping Du
- Department of Neurosurgery, The People's Hospital of Shiyan, The Affiliated People's Hospital, Hubei University of Medicine, Shiyan, China
| | - Xiaolan Wang
- Department of Dermatology, The People's Hospital of Shiyan, The Affiliated People's Hospital, Hubei University of Medicine, 39 Middle Chaoyang Road, Shiyan, 442000, China
| | - Yong Tang
- Department of Rehabilitation, Sinopharm Dong Feng General Hospital, The Affiliated Dong Feng Hospital, Hubei University of Medicine, Shiyan, China
| | - Jingjing Cao
- Department of Dermatology, The People's Hospital of Shiyan, The Affiliated People's Hospital, Hubei University of Medicine, 39 Middle Chaoyang Road, Shiyan, 442000, China
| |
Collapse
|
38
|
Khan SA, Agrawal S, Baral N, Lamsal M. Evaluation of ADA activity as a potential marker of disease severity in psoriasis patients. PSORIASIS (AUCKLAND, N.Z.) 2018; 8:59-63. [PMID: 30234006 PMCID: PMC6130266 DOI: 10.2147/ptt.s174119] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
BACKGROUND Psoriasis is a dermatological disorder with a multifactorial origin and is associated with many biochemical and immunological changes. PURPOSE This study aimed to examine the association of serum ADA activity, uric acid (UA), and high-sensitivity CRP (hs-CRP) with psoriasis and the role of ADA in disease severity. MATERIALS AND METHODS In this comparative cross-sectional study, 50 clinically and histopathologically diagnosed psoriasis patients and 50 age- and sex-matched healthy controls were enrolled. Blood samples were taken and analysis of the biochemical parameters was performed according to Giuisti and Galanti method, uricase and ELISA technique for ADA activity, UA, and hs-CRP, respectively. The severity of the disease was scored according to Psoriasis Area and Severity Index (PASI). Statistical analysis of differences within and between the study groups was carried out using the Student's t-test, one-way post hoc ANOVA, and Pearson's correlation. Linear regression was used to establish the independent association of ADA with disease severity. RESULTS The serum ADA activity, UA, and hs-CRP levels of the psoriatic patients were found to be significantly higher (P<0.001). hs-CRP was positively correlated with ADA and UA in patients (P<0.001). There was no significant difference in total cholesterol, low-density lipoprotein, and triacylglycerol in psoriasis patients, whereas we noted a decreased high-density lipoprotein level in psoriasis patients as compared to controls. Linear regression showed that ADA was independently associated with the disease severity and was statistically significant (P<0.001). CONCLUSION ADA activity was positively and significantly associated with the severity of psoriasis, therefore, it could be suggested as a marker for disease severity in psoriasis patients.
Collapse
Affiliation(s)
- Seraj Ahmed Khan
- Department of Biochemistry, B.P. Koirala Institute of Health Sciences, Dharan, Nepal,
| | - Sudha Agrawal
- Department of Dermatology and Venereology, B.P. Koirala Institute of Health Sciences, Dharan, Nepal
| | - Nirmal Baral
- Department of Biochemistry, B.P. Koirala Institute of Health Sciences, Dharan, Nepal,
| | - Madhab Lamsal
- Department of Biochemistry, B.P. Koirala Institute of Health Sciences, Dharan, Nepal,
| |
Collapse
|
39
|
Khalilieh S, Hussain A, Montgomery D, Levine V, Shaw PM, Bodrug I, Mekokishvili L, Bailey-Smith C, Glasgow XS, Cheng A, Martinho M, Iwamoto M. Effect of tildrakizumab (MK-3222), a high affinity, selective anti-IL23p19 monoclonal antibody, on cytochrome P450 metabolism in subjects with moderate to severe psoriasis. Br J Clin Pharmacol 2018; 84:2292-2302. [PMID: 29926968 DOI: 10.1111/bcp.13670] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2017] [Revised: 05/21/2018] [Accepted: 05/29/2018] [Indexed: 01/05/2023] Open
Abstract
AIMS Tildrakizumab, an interleukin (IL)-23 inhibitor, is indicated for the treatment of moderate to severe chronic plaque psoriasis. Although tildrakizumab is not metabolized by, and does not alter, cytochrome P450 (CYP) expression in vitro, clinically significant pharmacokinetic effects through changes in systemic inflammation, which alters CYP metabolism, have been well documented. At the time of study conduct, the effect of modulation of inflammation/cytokines, including IL-23 inhibition with tildrakizumab, on CYP metabolism, and therefore the potential for disease-drug interactions, in psoriasis patients was unknown. We therefore assessed whether tildrakizumab alters CYP metabolism in subjects with moderate to severe psoriasis. METHODS This was an open-label, fixed-sequence, two-period trial. In Period 1 (Day 1), subjects received an oral CYP probe cocktail of up to five drugs (midazolam 2 mg [3A4], caffeine 200 mg [1A2], warfarin 10 mg [2C9], omeprazole 40 mg [2C19] and dextromethorphan 30 mg [2D6]), followed by a 7-day washout. In Period 2, subjects received tildrakizumab 200 mg subcutaneously on Days 1 and 29 and a second CYP probe cocktail on Day 57. Substrate or metabolite pharmacokinetics, safety and changes in Psoriasis Severity Area Index (PASI), interleukin-6 (IL-6) and high-sensitivity C-reactive protein (hs-CRP), were assessed. RESULTS Twenty subjects (13 men, 7 women) were enrolled. Tildrakizumab had no clinically relevant effect on the pharmacokinetics of any of the probe substrates tested. On Day 57 of Period 2, the median percentage decrease from baseline in PASI score following tildrakizumab was ~93%. There were no clinically relevant changes in IL-6 or hs-CRP. Treatment with tildrakizumab was generally well tolerated. CONCLUSION In subjects with moderate to severe psoriasis, tildrakizumab 200 mg did not have a discernible effect on CYP metabolism. The potential for clinically significant drug-drug interactions (DDIs) with tildrakizumab in patients with psoriasis is low. The difference in the occurrence of DDIs seen with anti-inflammatory agents in rheumatoid arthritis patients compared with psoriasis patients may be due to the much greater extent of systemic inflammation in rheumatoid arthritis as compared to psoriasis.
Collapse
Affiliation(s)
| | | | | | | | | | - Inga Bodrug
- F.C.E. ARENSIA Exploratory Medicine LLC, Chisinau, Republic of Moldova
| | | | | | | | - Amy Cheng
- Merck & Co., Inc., Kenilworth, NJ, USA
| | | | | |
Collapse
|
40
|
Boehncke WH. Systemic Inflammation and Cardiovascular Comorbidity in Psoriasis Patients: Causes and Consequences. Front Immunol 2018; 9:579. [PMID: 29675020 PMCID: PMC5895645 DOI: 10.3389/fimmu.2018.00579] [Citation(s) in RCA: 190] [Impact Index Per Article: 31.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2018] [Accepted: 03/07/2018] [Indexed: 11/26/2022] Open
Abstract
Psoriasis is a common inflammatory skin disease characterized by the appearance of red scaly plaques that can affect any part of the body. High prevalence, chronicity, disfiguration, disability, and associated comorbidity make it a challenge for clinicians of multiple specialties. Likewise, its complex pathogenesis, comprising inflammation, hyperproliferation, and angioneogenesis, intrigues numerous scientific disciplines, namely, immunology. From a clinical perspective, the severity of psoriasis is highlighted by its increased mortality, with cardiovascular diseases contributing the highest excess risk. From a scientific point of view, psoriasis has to be considered a systemic inflammatory condition, as blood biomarkers of inflammation are elevated and imaging techniques document sites of inflammation beyond the skin. While the association of psoriasis with cardiovascular diseases is now widely accepted, causes and consequences of this association are controversially discussed. This review comments on epidemiologic, genetic, and mechanistic studies that analyzed the relation between psoriasis and cardiovascular comorbidity. The hypothesis of psoriasis potentially being an independent cardiovascular risk factor, driving atherosclerosis via inflammation-induced endothelial dysfunction, will be discussed. Finally, consequences for the management of psoriasis with the objective to reduce the patients’ excess cardiovascular risk will be pointed out.
Collapse
Affiliation(s)
- Wolf-Henning Boehncke
- Department of Pathology and Immunology, Faculty of Medicine, University of Geneva, Geneva, Switzerland.,Division of Dermatology and Venereology, Geneva University Hospitals, Geneva, Switzerland
| |
Collapse
|
41
|
Carrascosa JM, Del-Alcazar E. New therapies versus first-generation biologic drugs in psoriasis: a review of adverse events and their management. Expert Rev Clin Immunol 2018; 14:259-273. [DOI: 10.1080/1744666x.2018.1454835] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Affiliation(s)
- J. M. Carrascosa
- Department of Dermatology, Hospital Universitari Germans Trias I Pujol, Badalona, Spain
| | | |
Collapse
|
42
|
Paschoal RS, Silva DA, Cardili RN, Souza CDS. Metabolic syndrome, C-reactive protein and cardiovascular risk in psoriasis patients: a cross-sectional study. An Bras Dermatol 2018; 93:222-228. [PMID: 29723366 PMCID: PMC5916394 DOI: 10.1590/abd1806-4841.20186397] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2016] [Accepted: 03/14/2017] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND Psoriasis has been associated with co-morbidities and elevated cardiovascular risk. OBJECTIVES To analyze the relationships among metabolic syndrome, cardiovascular risk, C-reactive protein, gender, and Psoriasis severity. METHODS In this cross-sectional study, plaque Psoriasis patients (n=90), distributed equally in gender, were analyzed according to: Psoriasis Area and Severity Index, cardiovascular risk determined by the Framingham risk score and global risk assessment, C-reactive protein and metabolic syndrome criteria (NCEPT-ATP III). RESULTS Metabolic syndrome frequency was 43.3% overall, without significance between genders (P=0.14); but women had higher risk for obesity (OR 2.56, 95%CI 1.02-6.41; P=0.04) and systemic arterial hypertension (OR 3.29, 95%CI 1.39-7.81; P=0.006). The increase in the Psoriasis Area and Severity Index also increased the risk for metabolic syndrome (OR 1.060, 95%CI 1.006-1.117; P=0.03). Absolute 10-year cardiovascular risk was higher in males (P=0.002), but after global risk assessment, 51.1% patients, 52.2% women, were re-classified as high-intermediate cardiovascular risk; without significance between genders (P=0.83). C-reactive protein level was elevated nearly six-fold overall, higher in metabolic syndrome (P=0.05), systemic arterial hypertension (P=0.004), and high-intermediate 10-year cardiovascular risk patients (P<0.001); positively correlated to: Framingham risk score (P<0.001; r=0.60), absolute 10-year cardiovascular risk (P<0.001; r=0.58), and age (P=0.001; r=0.35); but not to Psoriasis Area and Severity Index (P=0.14; r=0.16); increased the 10-year cardiovascular risk (R2=33.6; P<0.001), MetS risk (OR 1.17, 95%CI 0.99-1.37; P=0.05) and with age (P=0.001). HDL-cholesterol level was higher in normal C-reactive protein patients (t=1.98; P=0.05). STUDY LIMITATIONS Restricted sample, hospital-based and representative of a single center and no specification of psoriatic arthritis. CONCLUSIONS Psoriasis, metabolic syndrome, systemic arterial hypertension and age share the increase in C-reactive protein, which could implicate in additional burden for increasing the cardiovascular risk and be an alert for effective interventions.
Collapse
Affiliation(s)
- Renato Soriani Paschoal
- Postgraduate program of Internal Medicine Department, Faculdade de
Medicina de Ribeirão Preto, Universidade de São Paulo (USP) -
Ribeirão Preto (SP), Brazil
| | - Daniela Antoniali Silva
- Division of Dermatology, Internal Medicine Department, Hospital das
Clínicas da Faculdade de Medicina de Ribeirão Preto da Universidade de
São Paulo (USP) - Ribeirão Preto (SP), Brazil
| | - Renata Nahas Cardili
- Division of Dermatology, Internal Medicine Department, Hospital das
Clínicas da Faculdade de Medicina de Ribeirão Preto da Universidade de
São Paulo (USP) - Ribeirão Preto (SP), Brazil
| | - Cacilda da Silva Souza
- Division of Dermatology, Internal Medicine Department, Hospital das
Clínicas da Faculdade de Medicina de Ribeirão Preto da Universidade de
São Paulo (USP) - Ribeirão Preto (SP), Brazil
| |
Collapse
|
43
|
Hu SCS, Lan CCE. Psoriasis and Cardiovascular Comorbidities: Focusing on Severe Vascular Events, Cardiovascular Risk Factors and Implications for Treatment. Int J Mol Sci 2017; 18:ijms18102211. [PMID: 29065479 PMCID: PMC5666891 DOI: 10.3390/ijms18102211] [Citation(s) in RCA: 100] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2017] [Revised: 10/16/2017] [Accepted: 10/16/2017] [Indexed: 12/19/2022] Open
Abstract
Psoriasis is a common and chronic inflammatory disease of the skin. It may impair the physical and psychosocial function of patients and lead to decreased quality of life. Traditionally, psoriasis has been regarded as a disease affecting only the skin and joints. More recently, studies have shown that psoriasis is a systemic inflammatory disorder which can be associated with various comorbidities. In particular, psoriasis is associated with an increased risk of developing severe vascular events such as myocardial infarction and stroke. In addition, the prevalence rates of cardiovascular risk factors are increased, including hypertension, diabetes mellitus, dyslipidemia, obesity, and metabolic syndrome. Consequently, mortality rates have been found to be increased and life expectancy decreased in patients with psoriasis, as compared to the general population. Various studies have also shown that systemic treatments for psoriasis, including methotrexate and tumor necrosis factor-α inhibitors, may significantly decrease cardiovascular risk. Mechanistically, the presence of common inflammatory pathways, secretion of adipokines, insulin resistance, angiogenesis, oxidative stress, microparticles, and hypercoagulability may explain the association between psoriasis and cardiometabolic disorders. In this article, we review the evidence regarding the association between psoriasis and cardiovascular comorbidities, focusing on severe vascular events, cardiovascular risk factors and implications for treatment.
Collapse
Affiliation(s)
- Stephen Chu-Sung Hu
- Department of Dermatology, College of Medicine, Kaohsiung Medical University, Kaohsiung 807, Taiwan.
- Department of Dermatology, Kaohsiung Medical University Hospital, Kaohsiung 807, Taiwan.
| | - Cheng-Che E Lan
- Department of Dermatology, College of Medicine, Kaohsiung Medical University, Kaohsiung 807, Taiwan.
- Department of Dermatology, Kaohsiung Medical University Hospital, Kaohsiung 807, Taiwan.
| |
Collapse
|
44
|
Vekaria AS, Brunner PM, Aleisa AI, Bonomo L, Lebwohl MG, Israel A, Guttman-Yassky E. Moderate-to-severe atopic dermatitis patients show increases in serum C-reactive protein levels, correlating with skin disease activity. F1000Res 2017; 6:1712. [PMID: 29188018 PMCID: PMC5698919 DOI: 10.12688/f1000research.12422.2] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/22/2017] [Indexed: 12/30/2022] Open
Abstract
Background: Atopic dermatitis (AD), the most common chronic inflammatory skin disease, is evolving as a systemic disease, and associated systemic inflammation is possibly linked to increases in cardiovascular disease. Methods: We assessed levels of the inflammatory marker CRP in 59 patients with moderate-to-severe AD compared to matched healthy controls, and to determine correlation with skin disease severity. Clinical severity was measured using SCORing of Atopic Dermatitis (SCORAD) and body surface area (BSA). Control subjects (n=118), matched by age, gender, smoking status and ethnicity, were obtained from the National Health and Nutrition Survey (NHANES). Results: AD patients had significantly increased serum CRP levels compared to controls (0.7±1.0 vs. 0.4±0.7mg/dl; p=0.001), and 52.5% of them showed CRP levels >0.3mg/dl, predicting high cardiovascular risk. CRP levels were significantly correlated with both SCORAD (r=0.427, p=0.0008) and BSA (r=0.407, p=0.0015). IgE levels in AD were highly elevated (median 2903U/ml, IQR [234,10655]), but only weakly correlated with SCORAD (r=0.282, p=0.0427) and BSA (r=0.382, p=0.0052), but not with CRP levels. AD patients also showed increased LDH levels, but without significant correlations with disease severity (SCORAD, BSA) or CRP. Conclusions: Our study strongly supports CRP as a marker for disease severity in moderate-to-severe AD patients, further demonstrating its chronic systemic nature.
Collapse
Affiliation(s)
- Anjali S Vekaria
- Department of Dermatology, Icahn School of Medicine at Mount Sinai, New York, NY, 10029, USA
| | - Patrick M Brunner
- The Laboratory for Investigative Dermatology, The Rockefeller University, New York, NY, 10065, USA
| | - Ahmad I Aleisa
- Department of Dermatology, Icahn School of Medicine at Mount Sinai, New York, NY, 10029, USA
| | - Lauren Bonomo
- Department of Dermatology, Icahn School of Medicine at Mount Sinai, New York, NY, 10029, USA
| | - Mark G Lebwohl
- Department of Dermatology, Icahn School of Medicine at Mount Sinai, New York, NY, 10029, USA
| | - Ariel Israel
- Department of Family Medicine, Clalit Health Services, Jerusalem, 954323, Israel
| | - Emma Guttman-Yassky
- Department of Dermatology, Icahn School of Medicine at Mount Sinai, New York, NY, 10029, USA.,The Laboratory for Investigative Dermatology, The Rockefeller University, New York, NY, 10065, USA
| |
Collapse
|
45
|
Psoriasis and Cardiovascular Risk-Do Promising New Biomarkers Have Clinical Impact? Mediators Inflamm 2017; 2017:7279818. [PMID: 28947858 PMCID: PMC5602647 DOI: 10.1155/2017/7279818] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2017] [Revised: 08/01/2017] [Accepted: 08/07/2017] [Indexed: 12/14/2022] Open
Abstract
Epidemiological studies suggest an increased prevalence of cardiovascular disease (CVD) in patients with psoriasis (PS). Therefore, emphasis has lately been laid on the necessity for clinical evaluation of the risk of CVD in these patients. The systemic inflammatory markers C-reactive protein (CRP) and interleukin- (IL-) 6, which have long been used to predict future CVD in the general population, are increased manyfold in patients with PS. Lipid abnormalities characterized by elevated triglycerides, low HDL cholesterol, and higher concentrations of LDL cholesterol and its oxidized form are also prevalent in patients. There is a need for additional laboratory markers for the assessment of cardiovascular status of patients with PS. Due to frequent comorbid overweight and obesity, biologically active compounds produced by adipocytes may have an impact on monitoring the status of the cardiovascular system of patients with PS. For this purpose, two adipokines, adiponectin and leptin, have been most extensively studied. The review focuses on some inflammatory and oxidative stress aspects in patients with PS through the analysis of the impact of prominent adipokines and oxidized low-density lipoprotein (oxLDL) to assess their eligibility for clinical practice as markers of CVD risk in patients with PS.
Collapse
|
46
|
Wang J, Suárez-Fariñas M, Estrada Y, Parker ML, Greenlees L, Stephens G, Krueger J, Guttman-Yassky E, Howell MD. Identification of unique proteomic signatures in allergic and non-allergic skin disease. Clin Exp Allergy 2017; 47:1456-1467. [DOI: 10.1111/cea.12979] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2017] [Accepted: 05/19/2017] [Indexed: 12/21/2022]
Affiliation(s)
- J. Wang
- MedImmune, LLC; Gaithersburg MD USA
| | - M. Suárez-Fariñas
- Department of Dermatology and the Laboratory for Inflammatory Skin Diseases; Icahn School of Medicine at Mount Sinai Medical Center; New York NY USA
- Department of Population Health Science and Policy; Icahn School of Medicine at Mount Sinai Medical Center; New York NY USA
- Icahn Institute for Genomics and Multiscale Biology at Mount Sinai; Icahn School of Medicine at Mount Sinai; New York NY USA
- Laboratory for Investigative Dermatology; Rockefeller University; New York NY USA
| | - Y. Estrada
- Department of Dermatology and the Laboratory for Inflammatory Skin Diseases; Icahn School of Medicine at Mount Sinai Medical Center; New York NY USA
| | | | | | | | - J. Krueger
- Laboratory for Investigative Dermatology; Rockefeller University; New York NY USA
| | - E. Guttman-Yassky
- Department of Dermatology and the Laboratory for Inflammatory Skin Diseases; Icahn School of Medicine at Mount Sinai Medical Center; New York NY USA
| | | |
Collapse
|
47
|
Farshchian M, Ansar A, Sobhan M, Hoseinpoor V. C-reactive protein serum level in patients with psoriasis before and after treatment with narrow-band ultraviolet B. An Bras Dermatol 2017; 91:580-583. [PMID: 27828628 PMCID: PMC5087213 DOI: 10.1590/abd1806-4841.20164655] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2015] [Accepted: 10/10/2015] [Indexed: 11/22/2022] Open
Abstract
Background: C-reactive protein is an inflammatory biomarker and its level increases in the serum of psoriatic patients. Its level is also associated with Psoriasis Area and Severity Index score. Objective: The aim of this study was to assess the decrement of serum C-reactive protein level with narrow-band ultraviolet B (NB-UVB) therapy. Methods: C-reactive protein serum levels in psoriasis patients were measured before and after treatment with NB-UVB and the data were analyzed in relation to the Psoriasis Area and Severity Index score improvement. Results: Baseline C-reactive protein levels among psoriatic patients were higher than normal. These levels decreased significantly after treatment (P<0.001). At the beginning of the study, patients with higher levels of C-reactive protein also had more extensive and severe skin involvement. The highest decrease in C-reactive protein was observed in patients who responded better to the treatment and achieved a higher Psoriasis Area and Severity Index 75%. There was an association between baseline Psoriasis Area and Severity Index scores and C-reactive protein levels. Conclusion: Patients with moderate to severe plaque-type psoriasis had active systemic inflammation, which was demonstrated by increased levels of C-reactive protein. Furthermore, skin disease severity was correlated with C-reactive protein levels. Phototherapy healed the psoriatic skin lesions and reduced inflammation, while decreasing C-reactive protein levels.
Collapse
Affiliation(s)
- Mahmoud Farshchian
- Psoriasis Research Center, Department of Dermatology, Farshchian Hospital, Hamadan University of Medical Sciences - Hamadan, Iran
| | - Akram Ansar
- Psoriasis Research Center, Department of Dermatology, Farshchian Hospital, Hamadan University of Medical Sciences - Hamadan, Iran
| | - Mohammadreza Sobhan
- Psoriasis Research Center, Department of Dermatology, Farshchian Hospital, Hamadan University of Medical Sciences - Hamadan, Iran
| | - Valiollah Hoseinpoor
- Psoriasis Research Center, Department of Dermatology, Farshchian Hospital, Hamadan University of Medical Sciences - Hamadan, Iran
| |
Collapse
|
48
|
Turina MC, Landewé R, Baeten D. Lessons to be learned from serum biomarkers in psoriasis and IBD – the potential role in SpA. Expert Rev Clin Immunol 2016; 13:333-344. [DOI: 10.1080/1744666x.2017.1244004] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Affiliation(s)
- Maureen C. Turina
- Department of Clinical Immunology and Rheumatology, Amsterdam Rheumatology and immunology Center, Academic Medical Center/University of Amsterdam, Amsterdam, The Netherlands
| | - Robert Landewé
- Department of Clinical Immunology and Rheumatology, Amsterdam Rheumatology and immunology Center, Academic Medical Center/University of Amsterdam, Amsterdam, The Netherlands
| | - Dominique Baeten
- Department of Clinical Immunology and Rheumatology, Amsterdam Rheumatology and immunology Center, Academic Medical Center/University of Amsterdam, Amsterdam, The Netherlands
| |
Collapse
|
49
|
Abstract
Psoriasis is a 'pacemaker' in dermatology. Substantial progress has been made regarding our understanding of its pathophysiology and genetic background, fuelling developments in cutaneous biology in general. Besides, the clinical perspective on psoriasis is currently changing, taking into consideration comorbidity and the systemic dimensions of this seemingly organ-specific inflammation. The availability of drugs exhibiting fewer contraindications and improved long-term safety opened a discussion around replacing a relatively limited (regarding both objectives and duration) 'therapeutic' by a much broader 'management' approach when it comes to treating psoriasis as a systemic disease. The question arises whether this 'upgrade' is warranted.
Collapse
Affiliation(s)
- Sandra Boehncke
- Department of Diabetology, Endocrinology, Hypertension and Nutrition, Geneva University Hospital, Geneva, Switzerland
| | | |
Collapse
|
50
|
Generali E, Scirè CA, Favalli EG, Selmi C. Biomarkers in psoriatic arthritis: a systematic literature review. Expert Rev Clin Immunol 2016; 12:651-60. [DOI: 10.1586/1744666x.2016.1147954] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
|