Understanding Psoriasis Comorbidities

Psoriatic arthritis is an inflammatory arthritis associated with psoriasis. Currently, there is no diagnostic test for psoriatic arthritis. This may result in delayed diagnosis and treatment and complicates efforts to estimate prevalence and incidence rates. Delayed diagnosis of psoriatic arthritis is associated with poor outcomes, including functional impairment and permanent disability.

• 9 – 33% of individuals with psoriasis develop psoriatic arthritis
• Annual incidence of psoriatic arthritis is estimated to be 1.7 – 2.7 per 100 individuals with psoriasis
• Several validated screening tools exist that can be used in primary care and dermatology clinics
• 10 – 15% of individuals with psoriasis have undiagnosed psoriatic arthritis
• Individuals with Medicaid who have psoriatic arthritis report a considerably lower rate of utilizing rheumatologic care compared to individuals with commercial insurance and Medicare (11.6%, 67.9%, 54.8%)
• Early detection and treatment is vital to reducing long-term joint damage and disability. Diagnostic delay of 6 months can lead to permanent joint damage and disability.
• Psoriasis severity is associated with an increased risk of developing psoriatic arthritis. For every 1% increase in BSA there is a 2% increased risk of developing psoriatic arthritis.
• Depression and obesity have been identified as risk factors for developing psoriatic arthritis. The presence of obesity is associated with a 64% increase in and depression with a 68% increase in risk of developing psoriatic arthritis.
• Age is a risk factor for developing PsA, compared to individuals 18 – 29 years of age:
• - Individuals 30 – 39 years of age have a 32% increase likelihood of developing PsA
• - Individuals 40 – 49 years of age have a 54 % increase likelihood of developing PsA
• - Individuals 50 – 59 years of age have a 36% increase likelihood of developing PsA4

The American College of Cardiology recognizes psoriasis as an independent risk factor for CVD. Systemic inflammation – a key feature of psoriasis – promotes atherosclerosis as well as complications from atherosclerosis contributing to heart attack.

Compared to the general population, individuals with psoriasis experience:

• 46% increase risk of CVD mortality
• 17% increase risk of Myocardial Infarction (MI)
• 19% increase risk of stroke

The risk of CVD mortality, MI, and stroke increase with severity of psoriasis:

Compared to the general population individuals with mild psoriasis experience:

• 29% increase risk of MI
• 12% increase risk of stroke

Individuals with severe psoriasis experience:

• 37 – 39% increase risk of CVD mortality
• 70 – 200% increase risk of MI
• 56 – 59% increase risk of stroke

• Psoriasis is associated with a 43 – 58% increased risk of hypertension compared to the general public
• 9.1% of individuals with psoriasis have undiagnosed hypertension (SBP ≥ 140 mm or DBP ≥ 90mm)
• Severity of psoriasis is associated with adequately controlling hypertension. As severity of psoriasis increases so does the likelihood of uncontrolled hypertension.
• Only 59.6% of individuals with psoriasis achieved treatment goal of SBP < 140mm and DBP < 90mm
• 21.8% of individuals with psoriasis were not treating their hypertension
• Rates of hyperlipidemia among individuals with psoriasis range from 20.7% to 48.6%
• The American College of Cardiology recognizes psoriasis as a risk-enhancing factor in the development of atherosclerotic cardiovascular disease (ASCVD) and recommends statin use for individuals aged 40 and over with psoriasis
• 40% of individuals with psoriasis who have hyperlipidemia are not using lipid lowering medications
• Only 35% of individuals with psoriasis who have hyperlipidemia received a statin to manage their cholesterol. Statin usage among individuals with psoriasis is lower than the rate among the general population (44.5%)
• 50% of individuals with psoriasis who have hyperlipidemia were not at treatment goal (LDL < 100 mg/dL)

Obesity

Systemic inflammation has been linked with increase body fat and visceral adipose tissue.

• Obesity is associated with poorer outcomes among individuals with psoriasis, including poorer treatment response.
• Individuals with psoriasis have a 41 – 66% higher likelihood of having obesity compared to the general population
• The likelihood of having obesity increases with severity of psoriasis:

Compared to individuals without psoriasis:

- Individuals with mild psoriasis have a 45% increased likelihood of obesity

- Individuals with severe psoriasis have a 123% increased likelihood of obesity

• Individuals with psoriasis are less likely to engage in moderate to vigorous physical activity than those without psoriasis. On average, individuals with psoriasis spent 31% less time engaged in leisure time moderate to vigorous physical activities than those with psoriasis.
• A lower proportion of individuals with psoriasis engage in exercise to lose weight compared to those without psoriasis (48.0% v 62.4%), despite having similar rates of desiring to lose weight. Additionally, among individuals with psoriasis who exercised in order to lose weight only 16.1% engaged in vigorous physical activity compared to 28% of individuals without psoriasis.
• Skin sensitivity and feeling self-conscious or embarrassed about their skin are barriers to physical activity for individuals with psoriasis.

Diabetes

Inflammation in adipose tissue, liver, and pancreas is linked with diabetes and metabolic syndrome.

• Psoriasis severity is associated with an increased risk of type-2 diabetes. For each 10% increase in BSA affected by psoriasis, the risk of type-2 diabetes increases by 20%.
• 36.7% of individuals with psoriasis achieved ADA diabetes treatment goal of HbA1c of less than 7%
• 19% of individuals with psoriasis who have a diagnosis of diabetes are not treating their diabetes