National Psoriasis Foundation

 

Study: Risk of serious medical events increases with psoriasis severity

Lifestyle improvements and treating your disease critical to reducing risk of comorbidities

There's a definite link between the severity of a person's psoriasis and the odds that person may develop another serious medical condition, according to a study published in JAMA Dermatology.

The study found a link between increasing severity of psoriasis and several other diseases, including:

  • Chronic pulmonary disease
  • Diabetes
  • Mild liver disease
  • Myocardial infarction and peripheral vascular disease (cardiovascular disease)
  • Peptic ulcer disease
  • Renal disease
  • Other rheumatological diseases

"The takeaway point is that increasing severity of skin psoriasis is a marker that other serious medical conditions may be present," said Dr. Joel Gelfand, associate professor of dermatology and epidemiology at the University of Pennsylvania.

People with psoriasis, especially if the disease is moderate to severe, or getting worse, should seek comprehensive medical care to lower the risk of future health problems, Gelfand said.

How the study was done

The research is part of the Incident Health Outcomes and Psoriasis Events (iHOPE) Study. The investigators surveyed general practitioners caring for 9,035 psoriasis patients - 52 percent with mild disease, 36 percent with moderate disease, and 12 percent with severe disease, or with psoriasis affecting more than 10 percent of their body.

Previous studies have identified a link between cardiovascular disease and diabetes with psoriasis. This study showed that additional diseases associated with diabetes, such as damage to the retinas of the eye and to the peripheral nervous system (the part of the nervous system that includes the hands and feet), also are linked to the severity of psoriasis. Both diseases share a common pathway – TH-1 cytokines – or molecules in the immune system known to promote inflammation and insulin resistance.

The study showed that people with mild psoriasis were 14 percent more likely to have diabetes, while those with moderate psoriasis were 22 percent more likely to have diabetes and those with severe psoriasis were 32 percent more likely. People with mild psoriasis were only 5 percent more likely to develop peripheral vascular disease, or inflammation in the vascular system beyond the heart, but that risk increased significantly if the psoriasis was worse. People with severe psoriasis were 85 percent more likely to have peripheral vascular disease.

What patients can do

The study raises many questions, but the overall message is that lifestyle choices can make a difference for people with psoriatic diseases, said Dr. Mark Lebwohl.

For example, it's long been reported that people with psoriasis smoke more than people who don't have psoriasis. Smoking is a large risk factor for chronic pulmonary disease.

Many of the other diseases linked to psoriasis are linked to obesity, and several of the diseases indicated in the study are already linked to obesity, too, like diabetes and hypertension.

Exercising, eating right, quitting smoking and treating psoriasis can help prevent comorbidities, Lebwohl said. Registries show that patients who treat their psoriasis have a lower risk of developing vascular inflammation, by about 50 percent or more for those using biologic treatments that block tumor necrosis factor-alpha, Lebwohl said. National Psoriasis Foundation awarded a $50,000 Discovery Grant to Case Western University researcher Nicole Ward to further examine this link and if aggressively treating psoriasis reduces the risk of developing cardiovascular disease.

"Everything (the study) found is something that clinicians have been seeing in practice for years," Lebwohl said.

August 8, 2013

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