Patients had high prevalence of cardiovascular comorbidities, and high cardiovascular risk according to the Framingham risk score. Cardiovascular disease, obesity, diabetes, hypertension, dyslipidemia, metabolic syndrome, nonalcoholic fatty liver disease, cancer, anxiety and depression, and inflammatory bowel disease have been found at a higher prevalence in psoriasis patients compared to the general population. The relationship between psoriasis and other diseases has drawn increasing interest in recent years. Psoriatic arthritis (PsA) is an inflammatory arthritis associated with psoriasis. Cardiovascular mortality risk ratio versus the general population was available in the study by Wong et al.
Other studies have compared patients with psoriatic arthritis versus psoriasis in terms of comorbidity and cardiovascular risks. One study showed that the risk of cardiovascular mortality, myocardial infarction and stroke was 1. Psoriasis and psoriatic arthritis diseases illustrate that immune-mediated activated crossroads of inflammation beyond enhanced cardiovascular risk factors are the result of an interplay between different proatherogenic mediators derived from metabolic, vascular and autoimmune joint and skin inflamed target tissue. In 1995, Hansson and others established that atherosclerosis has many features of a chronic inflammatory process, giving rise to the immune-mediated hypothesis behind atherogenesis 2. Patients with psoriasis may also have an increased risk of major adverse cardiovascular events (MACE) beyond that attributable to measured cardiovascular risk factors. We stratified our analysis by mild versus severe psoriasis and included adjusted risk estimates accounting for comorbidities. Variable levels of covariate adjustment were performed (Tables 1 and 2), with all studies adjusting for age and sex, but only some studies including full adjustment for other medical comorbidities.
Patients with rheumatoid arthritis (RA), psoriatic arthritis (PsA), and psoriasis (PsO) are at increased risk of comorbidities such as cardiovascular diseases (CVD; likely related to accelerated atherosclerosis and systemic inflammation), osteoporosis, depression, infections, and cancer1,2. The 8 comorbidity topics that obtained the highest level of agreement in the Delphi vote (including CVD risk and outcomes, smoking, weight, malignancies, infections, osteoporosis, and depression) were then reformulated into searchable terms, according to the Population, Intervention, Comparison, Outcome method7. Regarding PsA, no studies were found that have compared the rate of symptoms of depression in patients with PsA to healthy controls. HIV infection and AIDS – although other comorbid skin conditions may mimic psoriasis. A number of studies have suggested that people with psoriasis may have an increased risk of cardiovascular disease, lymphoma and non-melanoma skin cancer. An assessment of any patient with psoriasis should include disease severity, the impact of disease on physical, psychological and social well-being, whether they have psoriatic arthritis, and the presence of any comorbidities. Current guidelines therefore suggest that potent steroids can be used in the short term to gain control of chronic plaque psoriasis in a primary care setting but that long-term use should be avoided. Psoriasis has been associated with an increased risk of a variety of concomitant conditions (Table 1). Patients with psoriatic arthritis (PsA) are often prescribed NSAIDs, which are associated with deterioration of kidney function3 as well as acute renal failure.
Psoriatic Arthritis: How It Stacks Up To Rheumatoid Arthritis And Psoriasis
Comorbidities in Pso include psoriatic arthritis (PsA), reduced quality of life, malignancy, depression, but also a constellation of associated conditions that enhance the cardiovascular (CV) risk. Cardiovascular Risk Factors and Comorbidities in Psoriasis and Psoriatic Arthritis. In fact, in terms of CV risk, several studies have demonstrated a higher risk in patients with Pso but data on CV disease more specifically in PsA are limited. Conversely, a study by Husted et al. compared CV morbidity in PsA vs. Physicians should evaluate patients with psoriasis for comorbidities, including psychological conditions. Nail disease (psoriatic onychodystrophy) occurs in 80 to 90 percent of patients with psoriasis over the lifetime. No studies have directly compared individual topical corticosteroids, but systematic reviews concluded that more potent agents produce greater improvement in psoriasis symptoms. Data Sources: A PubMed search was completed in Clinical Queries using the key terms psoriasis, arthritis, etiology, and treatment. 8-12 It is well established that psoriasis patients are at increased risk for head and neck cancer, solid tumors (liver, pancreas, lung, breast, kidney), and non-melanoma skin cancer. 8 While some therapies decrease the risk of comorbidities, others may exacerbate them or increase the risk, making the data less straightforward. There have been very few trials comparing the efficacy and safety of biologic therapy versus traditional systemic therapy for the treatment of psoriasis. Still, Ward said, research has shown that the longer a patient has psoriasis, the greater the risk for developing cardiovascular diseases, diabetes and other comorbidities. Still, Ward said, research has shown that the longer a patient has psoriasis, the greater the risk for developing cardiovascular diseases, diabetes and other comorbidities. The study also found that patients with severe psoriasis defined as more than 10 percent of body surface area coverage are more likely to have diabetes compared to those with mild to moderate disease. In addition, psoriatic arthritis occurs more frequently in patients with severe psoriasis, and patients usually have psoriasis first. 3Section of Inflammation and Cardiometabolic Diseases, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland 4Division of Cardiology, University of Pennsylvania Perelman School of Medicine, Philadelphia 5Division of Rheumatology, University of Pennsylvania Perelman School of Medicine, Philadelphia. The presence of comorbid conditions in psoriasis patients has important implications for clinical management. A satellite symposium held at the Royal College of Physicians, London, United Kingdom, in December 2005 investigated the associations between psoriasis, comorbid diseases and concomitant therapy and their significance for long-term patient treatment. Other inflammatory diseases, such as rheumatoid arthritis (RA) and CD, are thought to involve similar pathogenetic mechanisms.
Evidence-based Recommendations For The Management Of Comorbidities In Rheumatoid Arthritis, Psoriasis, And Psoriatic Arthritis: Expert Opinion Of The Canadian Dermatology-rheumatology Comorbidity Initiative
Important comorbidities are psoriatic arthritis, metabolic syndrome, Crohn’s disease, depression, and cancer. Patients with severe psoriasis may be at an increased risk for myocardial infarction and this subgroup of patients tends to have a reduced life expectancy. Background: Few studies report estimates of cardiovascular disease (CVD) or major adverse cardiovasc. Adverse Cardiovascular Events in Patients With Psoriatic Arthritis Compared to Patients Without Psoriatic Arthritis. Psoriatic arthritis (PsA) and psoriasis have been associated with an increased prevalence of cardiovascular disease (CVD); however, few published studies have examined the risk of incident CVD in patients with PsA, whereas only 1 recent analysis presented data on major adverse cardiovascular events (MACE). Another study reported that the 10-year cumulative incidence of cardiovascular events was 17 among 126 patients with PsA with no history of CVD. Psoriasis is a long-lasting autoimmune disease characterized by patches of abnormal skin. Psoriasis is associated with an increased risk of psoriatic arthritis, lymphomas, cardiovascular disease, Crohn’s disease, and depression. However, modern studies have failed to demonstrate any link between the two conditions. Others include hot water, scratching psoriasis skin lesions, skin dryness, excessive alcohol consumption, cigarette smoking, and obesity. Psoriatic arthritis is a chronic inflammatory arthritis that develops in at least 5 of patients with psoriasis. See Psoriasis: Manifestations, Management Options, and Mimics, a Critical Images slideshow, to help recognize the major psoriasis subtypes and distinguish them from other skin lesions. Magnetic resonance imaging studies. Hip and knee joint replacements have been successful.
Psoriasis is associated with the metabolic syndrome and cardiovascular (CV) disease. Psoriasis patients are not only more likely to have CV risk factors but severe psoriasis may serve as an independent risk factor for CV mortality. Psoriatic skin lesions are the result of inflammation in the dermis and hyperproliferation with abnormal differentiation of the epidermis. (used in other inflammatory diseases such as inflammatory bowel disease, rheumatoid arthritis and ankylosing spondylitis).