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Psoriasis Patients at Increasing Risk for Range of Serious Medical Conditions, Relative to Severity of Skin Disease

PHILADELPHIA — Patients with mild, moderate and severe psoriasis had increasingly higher odds of having at least one major medical disease in addition to psoriasis, when compared to patients without psoriasis. Reporting findings in JAMA Dermatology, researchers from the Perelman School of Medicine at the University of Pennsylvania, concluded that the severity of disease, as measured by the percentage of body surface area affected by psoriasis, was strongly linked to an increased presence of other diseases affecting the lungs, heart, kidneys, liver and pancreas.

The research is part of the landmark Incident Health Outcomes and Psoriasis Events (iHOPE) Study. The investigators surveyed general practitioners caring for 9035 psoriasis patients - 52 percent with mild disease, 36 percent with moderate disease, and 12 percent with severe disease affecting more than 10 percent of their body surface area. Significant associations were found between psoriasis and a range of diseases, including chronic pulmonary disease (COPD), diabetes, mild liver disease, myocardial infarction and peripheral vascular disease, peptic ulcer disease, renal disease and other rheumatologic diseases.

"As we identify additional diseases linked to psoriasis, patients and physicians need to be aware of the increased odds of serious co-morbid illnesses, which is especially important in severe cases," said senior study author, Joel M. Gelfand, MD, MSCE, associate professor of Dermatology and Epidemiology. "The complications from diabetes and links to COPD, kidney disease and peptic ulcers we identified suggest new areas for research, while for the first time, demonstrating how increasing body surface area affected by psoriasis is directly associated with increasing risk of atherosclerotic disease."

Although thought of as a disease limited to skin and joints, earlier work from the interdisciplinary Penn team has demonstrated the systemic effects of this chronic inflammatory disease; particularly those related to diabetes, cardiovascular disease and mortality. A higher risk of diabetes was previously identified in psoriasis patients, and this study revealed that additional diabetes-associated systemic complications, such as retinopathy and neuropathy, were correlated with the severity of psoriasis as well. The diseases share a common pathway - TH-1 cytokines - known to promote inflammation and insulin resistance. By identifying these co-occuring diseases, researchers hope patients will receive comprehensive care with proper health screening, evaluation and management.

The investigators are currently conducting the Vascular Inflammation in Psoriasis Trial (NCT01553058) designed to determine if different treatment approaches to psoriasis are likely to lower the risk of cardiovascular disease.

Additional co-authors include lead author Howa Yeung, BS, Junko Takeshita, MD, PhD, David Margolis, MD, PhD, Daniel Shin, MS, Rosemary Attor, MS, and Andrea Troxel, ScD, from the Penn Dermatology department, Stephen Kimmel, MD, MSCE, from the division of Cardiology and Alexis Ogdie, MD, MSCE, from the division of Rheumatology, with Drs. Takeshita, Kimmel, Ogdie, Margolis, and Gelfand, Mr. Shin and Ms. Troxel also representing the Penn Center for Clinical Epidemiology and Biostatistics. Nehal Mehta, MD, MSCE, with Penn's division of Cardiovascular Medicine, contributed from the Section of Inflammation and Cardiometabolic Diseases at the National Heart, Lung and Blood Institute of the National Institutes of Health.

The study was supported by grants from the National Institutes of Health (T32-AR07465, T32-GM075766, R01-HL089744), a National Psoriasis Foundation Fellowship and an American College of Rheumatology Investigator Award.