Infections and the risk of psoriatic arthritis among psoriasis patients: a systematic review
- 961 Downloads
Psoriasis and psoriatic arthritis (PsA) are related inflammatory diseases with some shared genetic and environmental risk factors. It has been suggested that environmental factors, including infections, can trigger the development of PsA among psoriasis patients. The aim of this review was to systematically examine available data evaluating the effect of infections on the risk of developing PsA. A systematic search of the Cochrane Library, PubMed, Scopus, and Web of Science was conducted on March 16 2017, in accordance with the PRISMA statement. The following search terms were used along with “psoriatic arthritis”: “infections”, “risk”, “bacteria”, and “virus”. Abstracts were reviewed and publications meeting the following criteria included: (1) Observational studies on psoriasis and PsA patients, including case–control, cohort, or ecologic studies and (2) presenting original data on the association between infections and PsA. The protocol for this systematic review was registered on PROSPERO (ID: 79432). Twenty-seven original studies presenting data on infections among PsA patients were included. Eight studies showed a statistically significant association between infections and PsA. In addition, seven studies reported mixed result with some statistically significant associations and five studies did not find statistically significant associations. This included studies of bacterial as well as viral pathogens and those of infections in general. The remaining seven studies lacked data to determine statistical significance. Out of all included studies, the total number of included patients was 933 PsA patients and 1611 controls. While the studies summarized did not all provide evidence supporting an association between infections and PsA certain trends emerged. The available data are inconsistent and further studies are needed to verify or refute this purported association. In particular, laryngeal infections and infections involving streptococci should be studied more carefully.
KeywordsPsoriatic arthritis Infections Risk And psoriasis
TJL was the guarantor of the review. Both authors contributed to the development of the search strategy and inclusion criteria. TÞ performed the search of the databases and removed the duplications. Both authors screened the publications in terms of content. When uncertainty arose about whether a publication should be included or not, it was discussed by both authors. TJL provided expertise in rheumatology. Both authors contributed to the work of clarifying the included studies. Both authors read, provided feedback, and approved the final manuscript.
This work was supported by the Icelandic Research Fund (RANNIS #120433021). The Icelandic Research Fund was not involved in any aspects of the study nor will it have input on the interpretation or publication of the study results.
Compliance with ethical standards
Conflict of interest
The authors confirm that there is no known conflict of interest associated with this publication and there has been no significant financial support for this work that could have influenced its outcome. Authors report grants from The Icelandic Research Fund (RANNIS # 120433021) during the conduct of the study. The Icelandic Research Fund was not involved in any aspects of the study nor had input on the interpretation or publication of the study results.
- 10.Gudjonsson JE, Karason A, Runarsdottir EH, Antonsdottir AA, Hauksson VB, Jonsson HH, Gulcher J, Stefansson K, Valdimarsson H (2006) Distinct clinical differences between HLA-Cw*0602 positive and negative psoriasis patients—an analysis of 1019 HLA-C- and HLA-B-typed patients. J Invest Dermatol 126(4):740–745. https://doi.org/10.1038/sj.jid.5700118 CrossRefPubMedGoogle Scholar
- 18.Muto M, Date Y, Ichimiya M, Moriwaki Y, Mori K, Kamikawaji N, Kimura A, Sasazuki T, Asagami C (1996) Significance of antibodies to streptococcal M protein in psoriatic arthritis and their association with HLA-A*0207. Tissue Antigens 48(6):645–650. https://doi.org/10.1111/j.1399-0039.1996.tb02687.x CrossRefPubMedGoogle Scholar
- 21.Wang QM, Vasey FB, Mahfood JP, Valeriano J, Kanik KS, Anderson BE, Bridgeford PH (1999) V2 regions of 16S ribosomal RNA used as a molecular marker for the species identification of streptococci in peripheral blood and synovial fluid from patients with psoriatic arthritis. Arthritis Rheum 42(10):2055–2059. https://doi.org/10.1002/1529-0131(199910)42:10<2055::aid-anr5>3.0.co;2-a CrossRefGoogle Scholar
- 27.Silveira LH, Gutierrez F, Scopelitis E, Cuellar ML, Citera G, Espinoza LR (1993) Chlamydia-induced reactive arthritis Rheumatic. Dis Clin N Am 19(2):351–362Google Scholar
- 29.Stinco G, Fabris M, Pasini E, Pontarini E, Patriarca MM, Piccirillo F, De Vita S, Dolcetti R (2012) Detection of DNA of Chlamydophila psittaci in subjects with psoriasis: a casual or a causal link? Br J Dermatol 167(4):926–928. https://doi.org/10.1111/j.1365-2133.2012.11043.x CrossRefPubMedGoogle Scholar
- 32.Scher JU, Sczesnak A, Longman RS, Segata N, Ubeda C, Bielski C, Rostron T, Cerundolo V, Pamer EG, Abramson SB, Huttenhower C, Littman DR (2013) Expansion of intestinal Prevotella copri correlates with enhanced susceptibility to arthritis. eLife. https://doi.org/10.7554/eLife.01202.001 CrossRefPubMedPubMedCentralGoogle Scholar
- 41.Mehraein Y, Lennerz C, Ehlhardt S, Remberger K, Jak A, Zang KD (2004) Latent Epstein-Barr virus (EBV) infection and cytomegalovirus (CMV) infection in synovial tissue of autoimmune chronic arthritis determined by RNA- and DNA-in situ hybridization. Mod Pathol 17(7):781–789. https://doi.org/10.1038/modpathol.3800119 CrossRefPubMedGoogle Scholar
- 42.Mehraein Y, Lennerz C, Ehlhardt S, Venzke T, Ojak A, Remberger K, Zang KD (2003) Detection of parvovirus B19 capsid proteins in lymphocytic cells in synovial tissue of autoimmune chronic arthritis. Mod Pathol 16(8):811–817. https://doi.org/10.1097/01.mp.0000083145.68333.9b CrossRefPubMedGoogle Scholar
- 43.Brzewski PŁ, Spałkowska M, Podbielska M, Chmielewska J, Wołek M, Malec K, Wojas-Pelc A (2013) The role of focal infections in the pathogenesis of psoriasis and chronic urticaria. Postepy Dermatologii i Alergologii 30(2):77–84. https://doi.org/10.5114/pdia.2013.34155 CrossRefPubMedPubMedCentralGoogle Scholar
- 48.Thorleifsdottir RH, Eysteinsdottir JH, Olafsson JH, Sigurdsson MI, Johnston A, Valdimarsson H, Sigurgeirsson B (2016) Throat infections are associated with exacerbation in a substantial proportion of patients with chronic plaque psoriasis. Acta Derm Venereol 96(6):788–791. https://doi.org/10.2340/00015555-2408 CrossRefPubMedPubMedCentralGoogle Scholar
- 49.Thorleifsdottir RH, Sigurdardottir SL, Sigurgeirsson B, Olafsson JH, Sigurdsson MI, Petersen H, Gudjonsson JE, Johnston A, Valdimarsson H (2017) Patient-reported outcomes and clinical response in patients with moderate-to-severe plaque psoriasis treated with tonsillectomy: a randomized controlled Trial. Acta Derm Venereol 97(3):340–345. https://doi.org/10.2340/00015555-2562 CrossRefPubMedGoogle Scholar
- 50.Carrasco S, Neves FS, Fonseca MH, Goncalves CR, Saad CG, Sampaio-Barros PD, Goldenstein-Schainberg C (2011) Toll-like receptor (TLR) 2 is upregulated on peripheral blood monocytes of patients with psoriatic arthritis: a role for a gram-positive inflammatory trigger? Clin Exp Rheumatol 29(6):958–962PubMedGoogle Scholar
- 51.Yen YF, Jen IA, Chen M, Lan YC, Lee CY, Chuang PH, Lee Y, Arthur Chen YM (2017) HIV Infection Increases the Risk of Incident Psoriasis: A Nationwide Population-Based Cohort Study in Taiwan. J Acquir Immune Defic Syndr 75(5):493–499. https://doi.org/10.1097/qai.0000000000001431 CrossRefPubMedGoogle Scholar
- 53.Menon B, Gullick NJ, Walter GJ, Rajasekhar M, Garrood T, Evans HG, Taams LS, Kirkham BW (2014) Interleukin-17 + CD8 + T cells are enriched in the joints of patients with psoriatic arthritis and correlate with disease activity and joint damage progression. Arthritis Rheumatol 66(5):1272–1281. https://doi.org/10.1002/art.38376 CrossRefPubMedPubMedCentralGoogle Scholar