Comorbidities Associated with Psoriasis
Research has shown that patients with psoriasis can be at a higher risk for a number of major systemic comorbidities.80 Medical comorbidities that can be associated with psoriasis patients include84, 93:
- Other autoimmune disease, such as inflammatory bowel disorders (eg, Crohn's disease)
- Cardiovascular disease
- Diabetes and other components of metabolic syndrome, stemming from a high incidence of obesity
Psychiatric/psychological comorbidities associated with psoriasis patients, include84:
- Psychological and emotional burden of psoriasis
- Potential for alcohol abuse
Of particular importance, as many as 40% of individuals with psoriasis will go on to develop psoriatic arthritis (PsA), a seronegative spondyloarthropathy that typically affects the peripheral joints 57. PsA is a distinct, complex disease that is in need of early recognition and clinical assessment.82, 94
For psoriasis patients who develop PsA, an average of 12 years passes before the onset of PsA symptoms.57 Even after symptom onset, the average time to diagnosis of PsA is 5 years.95 In fact, evidence suggests that 1 in 4 patients with psoriasis may also have psoriatic arthritis but don't know it.82, 83, †
As physicians who care for the large majority of patients with psoriasis, dermatologists play an important role in identifying the morbidity of all aspects of psoriatic disease, including the early diagnosis of PsA, so patients will have the best chance of receiving effective treatment.
Based on non-interventional, cross sectional studies conducted in Spain (n=375) and Ireland (n=100)
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Pertaining to, characterized by, causing, resulting from, or becoming affected by inflammation.
A key enzyme involved in the cytokine production of inflammatory cells. PDE4 is an intracellular enzyme that promotes inflammation by degrading intracellular levels of cyclic adenosine monophosphate (cAMP), a naturally occurring second messenger that helps maintain immune homeostasis by modulating the production of pro‑ and anti‑inflammatory mediators.
A common dermatologic condition characterized by the eruption of circumscribed, discrete and confluent, reddish, silvery‑scaled maculopapules; the lesions occur predominantly on the elbows, knees, scalp, and trunk, and microscopically show characteristic parakeratosis and elongation of rete ridges with shortening of epidermal keratinocyte transit time due to decreased cyclic guanosine monophosphate
- 57 Gottlieb A, Korman NJ, Gordon KB, et al. Guidelines of care for the management of psoriasis and psoriatic arthritis: Section 2. Psoriatic arthritis: overview and guidelines of care for treatment with an emphasis on the biologics. J Am Acad Dermatol. 2008;58:851‑864.
- 80 Husted JA, Thavaneswaran A, Chandran V, Gladman DD. Incremental effects of comorbidity on quality of life in patients with psoriatic arthritis. The Journal of rheumatology. Aug 2013;40(8):1349-1356.
- 82 Haroon M, Kirby B, FitzGerald O. High prevalence of psoriatic arthritis in patients with severe psoriasis with suboptimal performance of screening questionnairesss. Ann Rheum Dis. 2013;72:736-740.
- 83 Zarco P, López-Estebaránz JL, Fernandez-Sueiro JL, García-Calvo C. Prevalence of psoriatic arthritis in psoriatic patients attending dermatologists’ units in Spain: PREVAL study. Presented at the 3rd World Psoriasis and Psoriatic Arthritis Conference; June 27-July 1, 2012; Stockholm, Sweden.
- 84 Menter A, Korman NJ, Elmets CA, et al. Guidelines of care for the management of psoriasis and psoriatic arthritis: section 6. Guidelines of care for the treatment of psoriasis and psoriatic arthritis: case-based presentations and evidence-based conclusions. J Am Acad Dermatol. 2011;65(1):137-174
- 93 Husted JA, Thavaneswaran A, Chandran V, Gladman DD. Incremental effects of comorbidity on quality of life in patients with psoriatic arthritis. J Rheumatol. 2013;40(8):1349-1356.
- 94 Moll JM, Wright V. Psoriatic arthritis. Semin Arthritis Rheum. 1973;3(1):55-78.
- 95 Lebwohl MG, Bachelez H, Barker J, et al. Patient perspectives in the management of psoriasis: results from the population-based Multinational Assessment of Psoriasis and Psoriatic Arthritis Survey. J Am Acad Dermatol. 2013. doi: 10.1016/j.jaad.2013.12.018.