Behet Disease Associated With Increased Risk For Psoriasis And Psoriatic Arthritis
Behçet disease is a rare disorder in the United States with unknown etiology, and typically has a higher incidence in the areas between the Eastern Mediterranean Basin and the Middle East. Behçet disease shares characteristics with psoriasis in that they are both chronic, relapsing inflammatory skin diseases accompanied by joint involvement as well as other systemic manifestations. Despite these similarities, it is unknown whether Behçet disease and psoriasis are related.
Researchers conducted the current analysis to examine the link between Behçet disease and psoriasis/PsA in a large cohort of patients in the National Health Insurance Service of Korea database between 2002 and 2015.
The following cohort definitions were used to select patients for the study from the database, which included 1,113,656 registered individuals:
- Behçet disease cohort : patients with Behçet disease with at least 2 consecutive visits within 6 months and a documented pathergy test.
- Psoriasis cohort : patients with psoriasis with at least 2 consecutive visits within 6 months and with a prescription of topical treatment, UV therapy, or oral medication for at least 3 consecutive months.
- PsA cohort : patients with PsA with at least 2 consecutive visits, with each visit being at least 6 months apart with antibody testing or HLA-B27 typing or receiving treatment with disease-modifying antirheumatic drugs/biologics.
Psoriasis And Type 2 Diabetes
Epidemiological studies have suggested that the association between psoriasis and type 2 diabetes is dependent on severity of psoriasis.22 Imiquimod is a Tolllike receptor7/8 ligand, and its application to mouse skin induces both psoriasislike skin lesions and systemic inflammation, such as production of cytokines.23
Ikumi et al. showed that skin severity, blood glucose level, and hemoglobin A1c were highly correlated with psoriasis, mainly via interleukin 17, in patients with type 2 diabetes. They also found similar hyperglycemia, glucose intolerance, and IL17 production in a mouse model using IMQ, but showed no abnormalities in pancreatic islet or liver function at an early stage, indicating improvement with the use of IL17 antibody.24 Antibody preparations may be useful in the treatment of psoriatic patients with type 2 diabetes.24
The biguanide hypoglycemic drug metformin is the firstline drug for type 2 diabetes, and psoriasis was reportedly improved by controlling blood glucose with longterm metformin use.25 Management of type 2 diabetes is thus considered very important in the treatment of psoriasis.
Psoriasis Association With Other Autoimmune Diseases
Association of psoriasis with other autoimmune diseases is an ongoing research area. Previous studies have shown that there is a higher frequency of autoimmune diseases among psoriasis patients than observed in the general population potentially stemming from cytokine pathways dysregulation., Based on a retrospective study using MEDLINE data from January 1, 1980 to June 1, 2011, the major autoimmune disorders associated with psoriasis include RA, celiac disease, IBD, especially CD, multiple sclerosis, SLE, and autoimmune thyroid disease. However, anecdotal reports of other autoimmune diseases associated with psoriasis include Sjögrens syndrome and alopecia areata. In addition, a new meta-analysis of a single mutation of CD226, Gly307Ser has suggested that this modification is associated with an increased risk of developing various autoimmune disorders including psoriasis.
Recommended Reading: Vitamin D Cream For Psoriasis
Goals For Treating Systemic Inflammation In Psoriasis
Studies in other immunemediated inflammatory diseases , including Crohn disease and rheumatoid arthritis , have demonstrated the significant benefits of early treatment with approved biologics to improve outcomes and suggest that similar approaches may be helpful in controlling systemic inflammation and optimizing longterm outcomes in psoriasis.15 Notably, several of the same biological agents are approved for the treatment of moderatetosevere psoriasis and RA and/or Crohn disease owing to the centrality of their targets in disease pathogenesis.
As practitioners more readily recognize psoriasis as a systemic disease and place more emphasis on controlling systemic inflammation, treatment goals can be separated into two distinct categories based on the feasibility of achieving desired outcomes. The first and most practically implementable goal is potentially preventing damage associated with systemic inflammation while simultaneously potentially preventing the progression of psoriasis and its comorbidities. The second, perhaps loftier and more forwardthinking, goal is potentially reversing existing inflammatory damage and signs and symptoms of comorbidities.
Reduction Of Cvd Risk By Biologics
A case of psoriasis in which coronary artery stenosis was improved by the use of antiinterleukin 17 antibody. Coronary stenosis with noncalcified plaque in the left anterior descending artery and severe stenoses with interruption in the right posterior descending artery before treatment. High magnification of the boxed section: attenuation of contrast effect in both left anterior descending artery and posterior descending artery before treatment. Improvement of coronary stenosis in both left anterior descending artery and posterior descending artery after treatment. High magnification of the boxed section: attenuation in both left anterior descending artery and posterior descending artery is improved after treatment
Tumor necrosis factor inhibitors and IL17 antibodies have been reported to improve coronary plaque with treatment, but no direct effect of IL23 antibody has been reported.
The antiinflammatory effects of IL23 antibody on aortic vascular inflammation in psoriatic patients are currently being tested.74
Don’t Miss: Is L Lysine Good For Psoriasis
Goal : Prevent Damage Associated With Inflammation And Prevent Future Damage/comorbidities
Numerous biomarkers of inflammation have been identified.26 Some of the most commonly utilized markers of inflammatory damage and cardiovascular risk in active psoriasis include Creactive protein and erythrocyte sedimentation rate .26 CRP levels are positively correlated with disease severity as measured by the Psoriasis Area and Severity Index .27, 28 CRP is also an independent predictor of CVD risk and is implicated in the development of atherosclerotic lesions because it reduces expression of nitric oxide synthase and prostacyclin synthase, binds lowdensity lipoprotein cholesterol stimulating its uptake by macrophages and upregulates expression of adhesion molecules on endothelial cells.29 As levels of CRP decrease, cardiovascular risk lowers.29 However, there is evidence that questions the clinical usefulness of CRP for evaluating cardiovascular risk among individuals with inflammatory conditions such as psoriasis, indicating a need for alternative CVD risk biomarkers in patients with underlying inflammatory conditions.30, 31
What Is The Connection Between Celiac Disease And Psoriasis
A 2019 study showed an association between psoriasis and celiac disease. The study found that the risk of new-onset psoriasis was high in those with celiac disease. They describe the link found between celiac disease and psoriasis to be significant. It was recommended that those with psoriasis and bowel issues to be screened for celiac disease.
Psoriasis is a separate condition from dermatitis herpetiformis , which is a severe, chronic skin rash associated with celiac disease. Learn more about DH.
You May Like: Best Remedy For Scalp Psoriasis
Systemic Treatment Of Psoriasis Could Ameliorate Cardiovascular Comorbidities
New psoriasis treatment paradigms have gone beyond the belief of psoriasis as a disease limited to the skin. Borrowing the experience from the studies of other immune-mediated inflammatory diseases, such as Crohn’s disease and rheumatoid arthritis, the goals of treating systemic inflammation in psoriasis are two: to prevent and even to reverse comorbidities .
Chronic Obstructive Pulmonary Disease
The inflammation associated with psoriasis can affect the lungs and raise the risk for chronic obstructive pulmonary disease . COPD is a group of lung conditions or diseases that block airflow and make breathing difficult.
A study published in January 2012 in the Journal of the European Academy of Dermatology and Venereology concluded that psoriasis patients were at a greater risk of developing COPD. And while a review published in August 2016 in the Journal of Dermatological Treatment provides evidence supporting the increased risk of COPD in people with psoriasis, the underlying reasons for the connection remains unclear.
People with psoriasis should avoid COPD risk factors, such as smoking and lung irritants like air pollution, chemical fumes, and dust. Doctors should test at-risk patients early for reduced lung function.
Read Also: How To Loosen Scalp Psoriasis
What Type Of Psoriasis Treatment Will I Need
Several treatment options can relieve psoriasis. Creams or ointments may be enough to improve the rash in small areas of skin. If the rash affects larger areas, or you also have joint pain, you may need other treatments. Joint pain may be a sign that you have arthritis.
Your provider will decide on a treatment plan based on:
- Severity of the rash.
- Vitamin A or retinoid creams.
Conditions Associated With Psoriasis
Most cases of psoriasis can be controlled, and most people who have psoriasis live regular lives.
Sometimes, having a chronic illness may increase the risk of developing other chronic conditions. Psoriasis, for example, has been associated with a higher risk of developing other conditions, or comorbidities.
It is important to let your family physician, specialist, or nurse practitioner know about any concerns you may have and be sure to discuss prevention and screening for associated conditions with them.
- Psoriatic arthritis , the inflammation of joints and connective tissue, may develop in up to 30% of patients with psoriasis. Together, psoriasis and psoriatic arthritis are known as psoriatic disease.
- PsA has the potential to cause a significant impact on day-to-day function.
- It is important to get PsA diagnosed early to prevent further damage to the joints.
- For more information click here.
- Inflammatory bowel disease is a broad term describing chronic inflammation of the digestive tract and includes forms such as Crohns disease and ulcerative colitis.
- Like psoriasis, IBD is also linked to a maladaptive immune system response as the cause of bowel inflammation.
- Patients with psoriasis may be at three times higher risk of developing IBD compared to the general population.
You May Like: Is Garlic Good For Psoriasis
Monocytes Macrophages And Myeloid
Monocytes are known precursors for DCs and macrophages and as such, they have been described to be important cellular contributors to psoriatic pathology. It has been suggested that psoriatic monocytes engulf low density lipoprotein leading to overproduction of inflammatory cytokines. Additionally, psoriatic monocytes have also been described to possess increased phagocytic capabilities due to an imbalance in the ratio of cAMP/cGMP found in lesional skin. More recently an increase in CD14+ CD16+ intermediate monocytes termed Mon2 has been described in a cohort of human psoriatic patients., Interestingly, Mon2 monocytes also have been shown to be linked to an increased risk of CVD and to be predictive of myocardial infarction and death.
Myeloid-derived suppressor cells
Psoriasis And Metabolic Syndrome
Metabolic syndrome is a condition in which risk factors for lifestylerelated diseases such as obesity, hypertension, glucose intolerance, and dyslipidemia accumulate in a patient.7
In 1999, the WHO proposed the concept of metabolic syndrome and diagnostic criteria, based on the combination of these risk factors for atherosclerosis from the perspective of insulin resistance. In addition, hypertriglyceridemia of 150 mg/dL or more and/or low highdensity lipoprotein cholesterol of less than 40 mg/dL, systolic blood pressure of 130 mmHg or more and/or diastolic blood pressure of 85 mmHg or more, and fasting hyperglycemia of 110 mg/dL or more.8, 9 In Europe, the USA, and Japan, psoriatic patients are considered to be at high risk of metabolic syndrome.10, 11
Recommended Reading: Show Me Pictures Of Plaque Psoriasis
Cerebrovascular Disease In Psoriasis
Cerebrovascular accidents are one of the common vascular disorders among psoriatic patients.42
When ischemia occurs in the brain, activation of microglia is characterized by inflammatory cytokines and neuroprotective mediators .75
Other cells, such as macrophages, infiltrate the brain in the early stages of infarction, and neutrophils and lymphocytes bind in the late stages.76 IL23 secreted by macrophages promotes the proliferation of Th17 and T cells to produce IL17, which contributes to poststroke brain injury.77
The effect of blocking IL23/IL17 has also been studied in stroke models. IL23deficient animals exhibited significantly lower levels of T cells, followed by decreased secretion of IL17 and reduced infarct size.78 Similar results were seen after inhibition of the IL12/ IL23p40 subunit.79 IL23p19 suppression reduced inflammationinduced levels of IL23 and IL17, as well as upregulation of the regulatory T cell transcription factor FoxP3. Blockade of the p19 subunit may be associated with delayed cerebral ischemia and reduced infarct and neurological dysfunction.80 On the other hand, the involvement of psoriasis in cerebral infarction from thrombus due to abnormal wall motion after MI or from thrombus due to atrial fibrillation is unknown.
Psoriatic Juvenile Idiopathic Arthritis
Psoriatic juvenile idiopathic arthritis
This table lists symptoms that people with this disease may have. For most diseases, symptoms will vary from person to person. People with the same disease may not have all the symptoms listed. This information comes from a database called the Human Phenotype Ontology . The HPO collects information on symptoms that have been described in medical resources. The HPO is updated regularly. Use the HPO ID to access more in-depth information about a symptom.
|80%-99% of people have these symptoms|
|30%-79% of people have these symptoms|
|5%-29% of people have these symptoms|
|Abnormal shoulder morphology|
|1%-4% of people have these symptoms|
|Abnormality of the temporomandibular joint||Abnormality of the jaw joint Deformity of the jaw joint Malformation of jaw joint|
You May Like: Is Exfoliating Good For Psoriasis
Psoriasis: A Systemic Inflammatory Disease
Historically, psoriasis was considered a disease that was limited to the skin and was typically treated with topical agents or phototherapy. Although such therapies can provide effective relief of localized skin symptoms, they do little to affect underlying disease causes.16 With recent advances in understanding the inflammatory nature of psoriasis, research efforts have focused on elucidating the roles of specific proinflammatory cytokines that contribute to disease pathogenesis, with the goal of developing new targeted therapies.4, 17, 18
Psoriasis develops when activated plasmacytoid dendritic cells produce the proinflammatory cytokine IFN, which activates myeloid dendritic cells in conjunction with IFN, TNF, IL1 and IL6.19 These activated myeloid dendritic cells produce IL12 and IL23, which correspondingly activate T helper 1 and Th17 cells.19 Once initiated, this cycle of inflammation continues chronically, as activated Th1 cells produce TNF and Th17 cells produce IL17A, IL17F and IL22.19 These cytokines further activate keratinocytes that produce a variety of cytokines, chemokines and antimicrobial peptides that promote an ongoing proinflammatory response .19
Psoriasis. Comorbidities and key inflammatory cytokines. IFN, interferon IL, interleukin TNF, tumour necrosis factor.
What Is Cdc Doing About Psoriasis
In 2010, CDC worked with experts in psoriasis, psoriatic arthritis, and public health to develop a public health perspective that considers how these conditions affect the entire population. The resulting report is Developing and Addressing the Public Health Agenda for Psoriasis and Psoriatic Arthritis pdf icon. You can read a short article about the agendaexternal icon in The American Journal of Preventive Medicine.
CDCs National Health and Nutrition Examination Survey , an intermittent source of national psoriasis data, has included questions about psoriasis as late as the 2013-2014 cycle. A recent analysis of NHANES data estimates that 7.4 million adults had psoriasis in 2013external icon.
- Psoriasis causes patches of thick red skin and silvery scales. Patches are typically found on the elbows, knees, scalp, lower back, face, palms, and soles of feet, but can affect other places . The most common type of psoriasis is called plaque psoriasis.
- Psoriatic arthritis is an inflammatory type of arthritis that eventually occurs in 10% to 20% of people with psoriasis. It is different from more common types of arthritis and is thought to be related to the underlying problem of psoriasis.
- Psoriasis and psoriatic arthritis are sometimes considered together as psoriatic disease.
Who is at risk for psoriasis?
Anyone can get psoriasis. It occurs mostly in adults, but children can also get it. Men and women seem to have equal risk.
Can I get psoriasis from someone who has it?
Don’t Miss: What Part Of The Body Does Psoriasis Affect
Psoriasis And Nonalcoholic Fatty Liver Disease
Nonalcoholic fatty liver disease is a process in which fat is deposited in the liver in the absence of significant alcohol consumption or the use of drugssuch as steroids, methotrexate, tamoxifen, or amiodaronethat facilitate steatosis.32
Nonalcoholic fatty liver disease and metabolic syndrome have similar pathogenic mechanisms, but the two pathologies are distinguished by histological differences in the liver.33
Mortality is higher in patients with NAFLD than in the general population, regardless of which of these histological variants is present the cause of death is usually cardiovascular disease .34
Gisondi et al. reported that a higher rate of ultrasounddiagnosed NAFLD in a series of 130 consecutive patients with psoriasis than in 260 healthy controls matched for age, sex, and BMI.35 The pathogenic links between psoriasis and NAFLD are chronic inflammation and peripheral insulin resistance, which is a common finding in diseases associated with psoriasis. On the other hand, the involvement of IL17 in both psoriasis and NAFLD has been revealed. T cells in adipose tissue synthesize IL17, which can regulate lipogenesis and glucose metabolism. Thelper 17 cells and IL17 may accelerate the progression from simple steatohepatitis to severe steatohepatitis.36
What If Those Psoriasis Treatments Dont Work
If psoriasis doesnt improve, your healthcare provider may recommend these treatments:
- Light therapy: UV light at specific wavelengths can decrease skin inflammation and help slow skin cell production.
- PUVA: This treatment combines a medication called psoralen with exposure to a special form of UV light.
- Methotrexate: Providers sometimes recommend this medication for severe cases. It may cause liver disease. If you take it, your provider will monitor you with blood tests. You may need periodic liver biopsies to check your liver health.
- Retinoids: These vitamin A-related drugs can cause side effects, including birth defects.
- Cyclosporine: This medicine can help severe psoriasis. But it may cause high blood pressure and kidney damage.
- Immune therapies: Newer immune therapy medications work by blocking the bodys immune system so it cant jumpstart an autoimmune disease such as psoriasis.
You May Like: Does Vitamin E Oil Help Scalp Psoriasis