Extent of Psoriasis Tied to Risk of Comorbidities

August 15, 2013

By Anne Harding

NEW YORK (Reuters Health) Aug 15 - People with psoriasis have an increased risk of serious medical illness, and the more extensive their skin disease, the more severe the risk for other conditions, new research finds.

Those with the most extensive psoriasis - affecting more than 10% of the skin surface - are at nearly twice the risk of heart and blood vessel disease compared to people without psoriasis, according to Dr. Joel Gelfand at the University of Pennsylvania in Philadelphia and his colleagues.

The researchers also found an increased risk of chronic lung disease, diabetes, kidney disease, joint problems and other health conditions among psoriasis patients.

"People with psoriasis are prone to other major health and medical problems that need to be thought about holistically in caring for their disease," Dr. Gelfand told Reuters Health. "We can now for the first time explain how the degree of body surface area involved predicts the risk of other health problems, which can help them make informed decisions."

While several studies have linked psoriasis to heart disease, stroke, diabetes, and other health problems, it has not been clear whether psoriasis severity is related to the degree of risk for those other conditions, Gelfand and his team noted in a paper online August 7th in JAMA Dermatology.

Most investigations have used the type of psoriasis therapy as a marker for disease severity, they add, which may be inaccurate because not all patients with severe disease receive appropriate therapy, and the therapy itself could affect disease risk.

The researchers looked at UK data on 9,035 psoriasis patients whose illness severity was stratified by their skin surface involvement.

Just over half had mild disease, i.e., affecting less than 3% of their skin; 36% had moderate disease (up to 10% of skin area) and 12% had severe disease (more than 10% of skin affected).

The researchers then matched each patient to 10 controls.

Overall, the risk for any other type of serious illness was 11% higher for people with mild psoriasis than for their controls, 15% higher for patients with moderate psoriasis, and 35% higher for those with severe psoriasis.

Patients with moderate psoriasis were 22% more likely than controls to have diabetes, for example, while those with severe psoriasis had a 32% increased risk of diabetes.

Moderate psoriasis also conferred a 36% increased risk of diabetes with complications such as eye disease, while severe psoriasis conferred an 87% higher risk.

Moderate and severe psoriasis increased the risk of cardiovascular disease by 39% and 81%, respectively.

People with psoriasis are known to have more inflammation in their blood vessels, which probably accounts for some of their increased risk of other illnesses, Dr. Gelfand said.

Also, he noted, genes related to heart disease are active in the skin cells of psoriasis patients, so those cells make substances - such as the blood-pressure-boosting enzyme renin - that circulate throughout the blood.

It's not clear whether effective psoriasis treatment will reduce the risk of these illnesses, Dr. Gelfand said, but he and his colleagues are currently conducting a study to test whether patients undergoing treatment for psoriasis have less vascular inflammation.

For now, he added, the new findings show that people with psoriasis should take extra care to maintain their health. For patients with mild psoriasis, he said, the risk "of these other conditions is quite low when it comes down to it, but it's still a warning sign and a reminder that it's important to undergo preventative health examinations."

People with more severe psoriasis, he added, "need to take this information very seriously."

SOURCE: http://bit.ly/1behopi

JAMA Dermatol 2013.

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