Skip to main content

Advertisement

SpringerLink
Log in

Association between psoriasis, psoriatic arthritis and gastrointestinal disease

An exploratory nationwide inpatient sample analysis

  • original article
  • Published:
Wiener klinische Wochenschrift Aims and scope Submit manuscript

Summary

Background

Psoriasis is associated with cardiovascular disease, inflammatory bowel disease (IBD), metabolic syndrome, and psychiatric disease. Furthermore, psoriasis is associated with immune dysregulation and systemic inflammation.

Objective

To determine the association of psoriasis and psoriatic arthritis with IBD and the association of the combination of psoriasis or psoriatic arthritis with IBD and other gastrointestinal illnesses.

Methods

Discharge data from the 2000–2014 Nationwide Inpatient Sample, Healthcare Cost and Utilization Project (HCUP), which approximates a 20% stratified sample of all US hospitalizations, were analyzed. Multivariable logistic regression was used to examine the association between psoriasis and psoriatic arthritis with IBD and 23 gastrointestinal illnesses adjusting for sociodemographic characteristics.

Results

Psoriasis was associated with IBD (Crohn’s disease adjusted odds ratio (aOR) = 2.13, 95% confidence interval (CI) [2.0–2.3], p < 0.001). When adjusting for sociodemographics and IBD, psoriasis was associated with 21 of 23 gastrointestinal diseases examined, most notably celiac disease, autoimmune hepatitis, and non-alcoholic fatty liver disease. Psoriatic arthritis was also associated with IBD (Crohn’s disease, aOR = 1.95, 95% CI [1.7–2.2], and ulcerative colitis, aOR = 2.66, 95% CI [2.4–2.9]).

Conclusion

Psoriasis and psoriatic arthritis inpatients have an associated increase in IBD and numerous other gastrointestinal illnesses.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

References

  1. Stern RS, Nijsten T, Feldman SR, Margolis DJ, Rolstad T, (eds.). Psoriasis is common, carries a substantial burden even when not extensive, and is associated with widespread treatment dissatisfaction. Journal of Investigative Dermatology Symposium Proceedings; 2004 Mar;9(2):136–9. https://doi.org/10.1046/j.1087-0024.2003.09102.x.

  2. Gelfand JM, Weinstein R, Porter SB, Neimann AL, Berlin JA, Margolis DJ. Prevalence and treatment of psoriasis in the United Kingdom: a population-based study. Arch Dermatol. 2005;141(12):1537–41.

    Article  PubMed  Google Scholar 

  3. Kurd SK, Gelfand JM. The prevalence of previously diagnosed and undiagnosed psoriasis in US adults: results from NHANES 2003–2004. J Am Acad Dermatol. 2009;60(2):218–24.

    Article  PubMed  Google Scholar 

  4. Smith A, Kassab J, Payne R, Beer W. Bimodality in age of onset of psoriasis, in both patients and their relatives. Dermatology. 1993;186(3):181–6.

    Article  CAS  PubMed  Google Scholar 

  5. Farber EM, Nall L, Strefling A. Psoriasis: a disease of the total skin. J Am Acad Dermatol. 1985;12(1):150–6.

    Article  CAS  PubMed  Google Scholar 

  6. Friedman S, Rubin PH, Bodian C, Goldstein E, Harpaz N, Present DH. Screening and surveillance colonoscopy in chronic Crohn’s colitis. Gastroenterology. 2001;120(4):820–6.

    Article  CAS  PubMed  Google Scholar 

  7. Loftus EV Jr, Silverstein MD, Sandborn WJ, Tremaine WJ, Harmsen WS, Zinsmeister AR. Crohn’s disease in Olmsted County, Minnesota, 1940–1993: incidence, prevalence, and survival. Gastroenterology. 1998;114(6):1161–8.

    Article  PubMed  Google Scholar 

  8. Loftus E, Silverstein M, Sandborn W, Tremaine W, Harmsen W, Zinsmeister A. Ulcerative colitis in Olmsted County, Minnesota, 1940–1993: incidence, prevalence, and survival. Gut. 2000;46(3):336–43.

    Article  PubMed  PubMed Central  Google Scholar 

  9. Skroza N, Proietti I, Pampena R, La Viola G, Bernardini N, Nicolucci F, et al. Correlations between psoriasis and inflammatory bowel diseases. Biomed Res Int. 2013; https://doi.org/10.1155/2013/983902.

    Article  PubMed  PubMed Central  Google Scholar 

  10. Sánchez FO, Reddy MPL, Sakuraba K, Ståhle M, Alarcón-Riquelme ME. IFN-regulatory factor 5 gene variants interact with the class I MHC locus in the Swedish psoriasis population. J Investig Dermatol. 2008;128(7):1704–9.

    Article  PubMed  Google Scholar 

  11. Eppinga H, Sperna Weiland CJ, Thio HB, van der Woude CJ, Nijsten TE, Peppelenbosch MP, et al. Similar depletion of protective faecalibacterium prausnitzii in psoriasis and inflammatory bowel disease, but not in hHidradenitis sSuppurativa. J Crohns Colitis. 2016;10(9):1067–75. https://doi.org/10.1093/ecco-jcc/jjw070.

    Article  PubMed  Google Scholar 

  12. Cottone M, Sapienza C, Macaluso FS, Cannizzaro M. Psoriasis and inflammatory bowel disease. Dig Dis. 2019;37(6):451–7. https://doi.org/10.1159/000500116.

    Article  PubMed  Google Scholar 

  13. Vavricka SR, Brun L, Ballabeni P, Pittet V, Vavricka BMP, Zeitz J, et al. Frequency and risk factors for extraintestinal manifestations in the Swiss inflammatory bowel disease cohort. Am J Gastroenterol. 2011;106(1):110–9.

    Article  PubMed  Google Scholar 

  14. Cohen A, Dreiher J, Birkenfeld S. Psoriasis associated with ulcerative colitis and Crohn’s disease. J Eur Acad Dermatol Venereol. 2009;23(5):561–5. https://doi.org/10.1111/j.1468-3083.2008.03031.x.

    Article  CAS  PubMed  Google Scholar 

  15. Makredes M, Robinson D Jr, Bala M, Kimball AB. The burden of autoimmune disease: a comparison of prevalence ratios in patients with psoriatic arthritis and psoriasis. J Am Acad Dermatol. 2009;61(3):405–10.

    Article  PubMed  Google Scholar 

  16. Bernstein CN, Wajda A, Blanchard JF. The clustering of other chronic inflammatory diseases in inflammatory bowel disease: a population-based study. Gastroenterology. 2005;129(3):827–36.

    Article  PubMed  Google Scholar 

  17. Persson PG, Leijonmarck CE, Bernell O, Hellers G, Ahlbom A. Risk indicators for inflammatory bowel disease. Int J Epidemiol. 1993;22(2):268–72.

    Article  CAS  PubMed  Google Scholar 

  18. Agency for Healthcare Research and Quality. HCUP databases. Healthcare cost and utilization project (HCUP). 2019. www.hcup-us.ahrq.gov/nisoverview.jsp. Accessed 1 March 2020.

  19. Whalen D, Houchens R, Elixhauser A. 2002 HCUP nationwide inpatient sample (NIS) comparison report. HCUP method series report# 2007-03. Rockville: US Agency for Healthcare Research and Quality; 2007.

    Google Scholar 

  20. Icen M, Crowson CS, McEvoy MT, Gabriel SE, Maradit Kremers H. Potential misclassification of patients with psoriasis in electronic databases. J Am Acad Dermatol. 2008;59(6):981–5. https://doi.org/10.1016/j.jaad.2008.08.034.

    Article  PubMed  PubMed Central  Google Scholar 

  21. Asgari MM, Wu JJ, Gelfand JM, Salman C, Curtis JR, Harrold LR, et al. Validity of diagnostic codes and prevalence of psoriasis and psoriatic arthritis in a managed care population, 1996–2009. Pharmacoepidemiol Drug Saf. 2013;22(8):842–9. https://doi.org/10.1002/pds.3447.

    Article  PubMed  PubMed Central  Google Scholar 

  22. Peery AF, Dellon ES, Lund J, Crockett SD, McGowan CE, Bulsiewicz WJ, et al. Burden of gastrointestinal disease in the United States: 2012 update. Gastroenterology. 2012;143(5):1179–1187.e3. https://doi.org/10.1053/j.gastro.2012.08.002.

    Article  PubMed  Google Scholar 

  23. Fu Y, Lee CH, Chi CC. Association of psoriasis with inflammatory bowel disease: a systematic review and meta-analysis. JAMA Dermatol. 2018;154(12):1417–23. https://doi.org/10.1001/jamadermatol.2018.3631.

    Article  PubMed  PubMed Central  Google Scholar 

  24. Ren Z, Hsu DY, Brieva J, Silverberg NB, Langan SM, Silverberg JI. Hospitalization, inpatient burden and comorbidities associated with bullous pemphigoid in the U.S.A. Br J Dermatol. 2017;176(1):87–99. https://doi.org/10.1111/bjd.14821.

    Article  CAS  PubMed  Google Scholar 

  25. Hsu D, Brieva J, Silverberg JI. Costs of care for hospitalization for pemphigus in the United States. JAMA Dermatol. 2016;152(6):645–54. https://doi.org/10.1001/jamadermatol.2015.5240.

    Article  PubMed  Google Scholar 

  26. Hsu DY, Gordon K, Silverberg JI. Serious infections in hospitalized patients with psoriasis in the United States. J Am Acad Dermatol. 2016;75(2):287–96. https://doi.org/10.1016/j.jaad.2016.04.005.

    Article  PubMed  Google Scholar 

  27. Wallace BC, Dahabreh IJ, Trikalinos TA, Lau J, Trow P, Schmid CH. Closing the gap between methodologists and end-users: R as a computational back-end. J Stat Softw. 2012;49(5):1–15.

    Article  Google Scholar 

  28. Poikolainen K, Reunala T, Karvonen J. Smoking, alcohol and life events related to psoriasis among women. Br J Dermatol. 1994;130(4):473–7.

    Article  CAS  PubMed  Google Scholar 

  29. Poikolainen K, Reunala T, Karvonen J, Lauharanta J, Kärkkäinen P. Alcohol intake: a risk factor for psoriasis in young and middle aged men? BMJ. 1990;300(6727):780–3.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  30. Chen Y‑J, Wu C‑Y, Chen T‑J, Shen J‑L, Chu S‑Y, Wang C‑B, et al. The risk of cancer in patients with psoriasis: a population-based cohort study in Taiwan. J Am Acad Dermatol. 2011;65(1):84–91.

    Article  PubMed  Google Scholar 

  31. Boffetta P, Gridley G, Lindelöf B. Cancer risk in a population-based cohort of patients hospitalized for psoriasis in Sweden. J Investig Dermatol. 2001;117(6):1531–7.

    Article  CAS  PubMed  Google Scholar 

  32. Miele L, Vallone S, Cefalo C, La Torre G, Di Stasi C, Vecchio FM, et al. Prevalence, characteristics and severity of non-alcoholic fatty liver disease in patients with chronic plaque psoriasis. J Hepatol. 2009;51(4):778–86.

    Article  CAS  PubMed  Google Scholar 

  33. Frentz G, Olsen J. Malignant tumours and psoriasis: a follow-up study. Br J Dermatol. 1999;140(2):237–42.

    Article  CAS  PubMed  Google Scholar 

  34. Hannuksela-Svahn A, Pukkala E, Läärä E, Poikolainen K, Karvonen J. Psoriasis, its treatment, and cancer in a cohort of Finnish patients. J Investig Dermatol. 2000;114(3):587–90.

    Article  CAS  PubMed  Google Scholar 

  35. Stern RS, Lange R. Cardiovascular disease, cancer, and cause of death in patients with psoriasis: 10 years prospective experience in a cohort of 1,380 patients. J Investig Dermatol. 1988;91(3):197–201. https://doi.org/10.1111/1523-1747.ep12464847.

    Article  CAS  PubMed  Google Scholar 

  36. Ahmad T, Marshall SE, Jewell D. Genetics of inflammatory bowel disease: the role of the HLA complex. World J Gastroenterol. 2006;12(23):3628.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  37. Capon F, Di Meglio P, Szaub J, Prescott NJ, Dunster C, Baumber L, et al. Sequence variants in the genes for the interleukin-23 receptor (IL23R) and its ligand (IL12B) confer protection against psoriasis. Hum Genet. 2007;122(2):201–6.

    Article  CAS  PubMed  Google Scholar 

  38. Maddur MS, Miossec P, Kaveri SV, Bayry J. Th17 cells: biology, pathogenesis of autoimmune and inflammatory diseases, and therapeutic strategies. Am J Pathol. 2012;181(1):8–18. https://doi.org/10.1016/j.ajpath.2012.03.044.

    Article  CAS  PubMed  Google Scholar 

  39. Chiricozzi A, Krueger JG. IL-17 targeted therapies for psoriasis. Expert Opin Investig Drugs. 2013;22(8):993–1005.

    Article  CAS  PubMed  Google Scholar 

  40. Fujino S, Andoh A, Bamba S, Ogawa A, Hata K, Araki Y, et al. Increased expression of interleukin 17 in inflammatory bowel disease. Gut. 2003;52(1):65–70.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  41. Scher JU, Ubeda C, Artacho A, Attur M, Isaac S, Reddy SM, et al. Decreased bacterial diversity characterizes the altered gut microbiota in patients with psoriatic arthritis, resembling dysbiosis in inflammatory bowel disease. Arthritis Rheumatol. 2015;67(1):128–39.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  42. Icen M, Crowson CS, McEvoy MT, Dann FJ, Gabriel SE, Maradit Kremers H. Trends in incidence of adult-onset psoriasis over three decades: a population-based study. J Am Acad Dermatol. 2009;60(3):394–401. https://doi.org/10.1016/j.jaad.2008.10.062.

    Article  PubMed  PubMed Central  Google Scholar 

  43. Kappelman MD, Moore KR, Allen JK, Cook SF. Recent trends in the prevalence of Crohn’s disease and ulcerative colitis in a commercially insured US population. Dig Dis Sci. 2013;58(2):519–25.

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Dermatology, West Virginia University, 64 Medical Center Drive, PO Box 9100, 26506, Morgantown, WV, USA

    Ahmed Yousaf BA, Rahul Raiker BS & Zachary Zinn MD

  2. Department of Health Policy, Management & Leadership, West Virginia University, Morgantown, WV, USA

    Stephen M. Davis PhD

  3. Department of Emergency Medicine, West Virginia University, Morgantown, WV, USA

    Stephen M. Davis PhD

  4. Department of Medicine, Section of Gastroenterology and Hepatology, West Virginia University, Morgantown, WV, USA

    Swapna Gayam MD

Authors
  1. Ahmed Yousaf BA
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Rahul Raiker BS
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Stephen M. Davis PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Swapna Gayam MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Zachary Zinn MD
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Zachary Zinn MD.

Ethics declarations

Conflict of interest

A. Yousaf, R. Raiker, S.M. Davis, S. Gayam and Z. Zinn declare that they have no competing interests.

Ethical standards

Ethics approval: approved by the West Virginia University institutional review board, protocol # 2002899647.

Additional information

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Caption Electronic Supplementary Material

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Yousaf, A., Raiker, R., Davis, S.M. et al. Association between psoriasis, psoriatic arthritis and gastrointestinal disease. Wien Klin Wochenschr 133, 586–593 (2021). https://doi.org/10.1007/s00508-020-01740-8

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00508-020-01740-8

Keywords

Search

Navigation