Psoriasis Associated With Higher Risk of Organ-Based Comorbidities

Compared with the general population, patients with psoriasis face a higher risk of single- and multiple organ-based comorbidities, says a new analysis published in Anais Brasileiros de Dermatologia.

The analysis included 15 observational studies comprising 200,000 patients with psoriasis and nearly 10 million individuals from the general population. Overall, patients with psoriasis had a 20% greater risk of organ-based comorbidities (pooled relative risk [pRR], 1.20; 95% CI: 1.11-1.31). Patients with moderate or severe disease were more likely to have an increased risk of comorbidities.

“The pathogenesis of psoriasis is believed to be the result of the interaction of genetic, environmental, and immune factors,” wrote the researcher of the study. “Psoriasis has been considered to be a systemic disease that may increase risks of cardiovascular disease, metabolic syndrome, and other comorbidities. The comorbidity mechanism of psoriasis may be related to the release of pro-inflammatory molecules during chronic inflammation. More and more evidence suggest that severe or relapsing psoriasis tends to be a systemic inflammation disease.”

According to the researcher, the findings help further characterize psoriasis as a systemic inflammatory disease.

First looking at single organ-based comorbidities, the study found that compared with the general population, patients with psoriasis had increased risks of cardiovascular events, cerebrovascular disease, and liver disease:

• Cardiovascular events: 20% greater risk (pRR, 1.20; 95% CI: 1.11-1.30)
• Cerebrovascular disease: 56% greater risk (pRR, 1.56; 95% CI: 1.20-2.04)
• Liver disease: 75% greater risk (pRR, 1.75; 95% CI: 1.33-2.29)

There were no significant differences in the risks of renal and pulmonary diseases between the patients with psoriasis and the general population.

Based on previous reports indicating that patients with psoriasis experience 2 or more comorbidities, the researcher also analyzed the risk of multiple organ-based comorbidities and found that compared with the general population, there were higher risks of the following:

• Coexisting renal and cardiovascular events: 9% greater risk (pRR 1.09; 95% CI, 1.01-1.18)
• Coexisting renal and cerebrovascular events: 28% greater risk (pRR 1.28; 95% CI, 0.99-1.66)
• Coexisting renal and liver diseases: 46% greater risk (pRR 1.46; 95% CI, 1.10-1.94)
• Coexisting cardiovascular and liver diseases: 41% greater risk (pRR 1.41; 95% CI, 1.11-1.80)

The researcher noted that some analyses included in the study lacked “high statistical power” due to the small number of studies included.

“The present study can provide a reference for effective clinical treatments. Lately, biological antibody therapy plays a promising role in the control of psoriatic morbidity and mortality,” wrote the author of the study, noting that the cytokines driving the pathogenesis of each organ may be the same or completely different. “If molecular mechanisms and dysregulated target cytokines in involved organs are different, then the choice of biological antibody should be totally different. No biological antibody is a panacea, and clinicians should try to provide patients with more individualized treatment plans according to organ-based comorbidities that psoriasis involved.”

According to the researcher, the pathogenesis of psoriasis and associated comorbidities may be mediated through several cytokines, including interleukin-17, IL-23, and tumor necrosis factor-ɑ.

Reference

Tang X. The risk of organ-based comorbidities in psoriasis: a systematic review and meta-analysis. An Bras Dermatol. Published online July 15, 2022. doi:10.1016/j.abd.2021.10.007