Skip to main content

Association of Multiple Sclerosis with Psoriasis: A Systematic Review and Meta-Analysis of Observational Studies

Abstract

Background

Previous studies have reported the occurrence of psoriasis together with multiple sclerosis (MS). Although similar predisposing genes and pathomechanisms have been hypothesized, the relationship between the two remains obscure.

Objective

The aim of this systematic review and meta-analysis was to investigate the association between psoriasis and MS.

Methods

We searched MEDLINE, Embase, and CENTRAL in July 2018 for case–control, cross-sectional, or cohort studies that examined either the odds or risk of psoriasis in subjects with multiple sclerosis. The risk of bias of included studies was assessed using the Newcastle–Ottawa Scale. A random-effects model meta-analysis was used to calculate the odds ratio (OR) for case–control/cross-sectional studies and hazard ratio (HR) for cohort studies.

Results

We included 10 publications that reported a total of 11 studies (5 case–control, 4 cross-sectional and 2 cohort studies). The case–control and cross-sectional studies included 18,456 MS patients and 870,149 controls, while the two cohort studies involved 25,187 MS patients and 227,225 controls in total. Three studies were rated with a high risk of bias in comparability, non-response rate, and selection of controls. MS was associated with increased odds (OR 1.29; 95% confidence interval [CI] 1.14–1.45) and risk for psoriasis (HR 1.92; 95% CI 1.32–2.80).

Conclusion

Patients with MS display both increased prevalence and incidence of psoriasis.

This is a preview of subscription content, access via your institution.

Fig. 1
Fig. 2
Fig. 3
Fig. 4

References

  1. Tullman MJ. Overview of the epidemiology, diagnosis, and disease progression associated with multiple sclerosis. Am J Manag Care. 2013;19(2 Suppl):S15–20.

    PubMed  Google Scholar 

  2. Kamm CP, Uitdehaag BM, Polman CH. Multiple sclerosis: current knowledge and future outlook. Eur Neurol. 2014;72(3–4):132–41. https://doi.org/10.1159/000360528.

    Article  CAS  PubMed  Google Scholar 

  3. Bogdanos DP, Smyk DS, Rigopoulou EI, Sakkas LI, Shoenfeld Y. Infectomics and autoinfectomics: a tool to study infectious-induced autoimmunity. Lupus. 2015;24(4–5):364–73. https://doi.org/10.1177/0961203314559088.

    Article  CAS  PubMed  Google Scholar 

  4. Procaccini C, De Rosa V, Pucino V, Formisano L, Matarese G. Animal models of multiple sclerosis. Eur J Pharmacol. 2015;759:182–91. https://doi.org/10.1016/j.ejphar.2015.03.042.

    Article  CAS  PubMed  Google Scholar 

  5. Gonsette RE. Self-tolerance in multiple sclerosis. Acta Neurol Belg. 2012;112(2):133–40. https://doi.org/10.1007/s13760-012-0061-x.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  6. LeVine SM. The role of reactive oxygen species in the pathogenesis of multiple sclerosis. Med Hypotheses. 1992;39(3):271–4.

    Article  CAS  PubMed  Google Scholar 

  7. Files DK, Jausurawong T, Katrajian R, Danoff R. Multiple sclerosis. Prim Care. 2015;42(2):159–75. https://doi.org/10.1016/j.pop.2015.01.007.

    Article  PubMed  Google Scholar 

  8. Parisi R, Symmons DP, Griffiths CE, Ashcroft DM. Global epidemiology of psoriasis: a systematic review of incidence and prevalence. J Invest Dermatol. 2013;133(2):377–85. https://doi.org/10.1038/jid.2012.339.

    Article  CAS  PubMed  Google Scholar 

  9. Reich K. The concept of psoriasis as a systemic inflammation: implications for disease management. J Eur Acad Dermatol Venereol. 2012;26(Suppl 2):3–11. https://doi.org/10.1111/j.1468-3083.2011.04410.x.

    Article  PubMed  Google Scholar 

  10. Weigle N, McBane S. Psoriasis. Am Fam Physician. 2013;87(9):626–33.

    PubMed  Google Scholar 

  11. Della Valle V, Maggioni M, Carrera C, Cattaneo A, Marzano AV, Damiani G. A mysterious abdominal pain during active psoriasis. Internal and emergency medicine. 2017. https://doi.org/10.1007/s11739-017-1765-y.

  12. Damiani G, Franchi C, Pigatto P, Altomare A, Pacifico A, Petrou S, et al. Outcomes assessment of hepatitis C virus-positive psoriatic patients treated using pegylated interferon in combination with ribavirin compared to new Direct-Acting Antiviral agents. World J Hepatol. 2018;10(2):329–36. https://doi.org/10.4254/wjh.v10.i2.329.

    Article  PubMed  PubMed Central  Google Scholar 

  13. Fiore M, Leone S, Maraolo AE, Berti E, Damiani G. Liver illness and psoriatic patients. Biomed Res Int. 2018;2018:12. https://doi.org/10.1155/2018/3140983.

    Article  CAS  Google Scholar 

  14. Tsai TF, Lee CH, Huang YH, Chi CC, Chang YT, Wong TW, et al. Taiwanese Dermatological Association consensus statement on management of psoriasis. Dermatol Sin. 2017;35(2):66–77. https://doi.org/10.1016/j.dsi.2017.01.002.

    Article  Google Scholar 

  15. Damiani G, Radaeli A, Olivini A, Calvara-Pinton P, Malerba M. Increased airway inflammation in patients with psoriasis. Br J Dermatol. 2016;175(4):797–9. https://doi.org/10.1111/bjd.14546.

    Article  CAS  PubMed  Google Scholar 

  16. Weidinger S, Willis-Owen SA, Kamatani Y, Baurecht H, Morar N, Liang L, et al. A genome-wide association study of atopic dermatitis identifies loci with overlapping effects on asthma and psoriasis. Hum Mol Genet. 2013;22(23):4841–56. https://doi.org/10.1093/hmg/ddt317.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  17. Malerba M, Damiani G, Radaeli A, Ragnoli B, Olivini A, Calzavara-Pinton PG. Narrowband ultraviolet B phototherapy in psoriasis reduces proinflammatory cytokine levels and improves vitiligo and neutrophilic asthma. Br J Dermatol. 2015;173(6):1544–5. https://doi.org/10.1111/bjd.13988.

    Article  CAS  PubMed  Google Scholar 

  18. Malerba M, Radaeli A, Olivini A, Damiani G, Ragnoli B, Montuschi P, et al. Exhaled nitric oxide as a biomarker in COPD and related comorbidities. Biomed Res Int. 2014;2014:271918. https://doi.org/10.1155/2014/271918.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  19. Shapiro J, Cohen AD, Weitzman D, Tal R, David M. Psoriasis and cardiovascular risk factors: a case-control study on inpatients comparing psoriasis to dermatitis. J Am Acad Dermatol. 2012;66(2):252–8. https://doi.org/10.1016/j.jaad.2010.11.046.

    Article  PubMed  Google Scholar 

  20. Chi CC, Wang J, Chen YF, Wang SH, Chen FL, Tung TH. Risk of incident chronic kidney disease and end-stage renal disease in patients with psoriasis: a nationwide population-based cohort study. J Dermatol Sci. 2015;78(3):232–8. https://doi.org/10.1016/j.jdermsci.2015.03.012.

    Article  PubMed  Google Scholar 

  21. Chi CC, Tung TH, Wang J, Lin YS, Chen YF, Hsu TK et al. Risk of uveitis among people with psoriasis: a nationwide cohort study. JAMA Ophthalmol. 2017. https://doi.org/10.1001/jamaophthalmol.2017.0569.

  22. Boehncke WH, Sterry W. Psoriasis–a systemic inflammatory disorder: clinic, pathogenesis and therapeutic perspectives. J Dtsch Dermatol Ges. 2009;7(11):946–52. https://doi.org/10.1111/j.1610-0387.2009.07083.x.

    Article  PubMed  Google Scholar 

  23. Augustin M, Radtke MA. Quality of life in psoriasis patients. Expert Rev Pharmacoecon Outcomes Res. 2014;14(4):559–68. https://doi.org/10.1586/14737167.2014.914437.

    Article  PubMed  Google Scholar 

  24. Rencz F, Gulacsi L, Remenyik E, Szegedi A, Hollo P, Karpati S, et al. Subjective expectations regarding life expectancy and health-related quality of life in moderate to severe psoriasis patients. Value Health. 2014;17(7):A611. https://doi.org/10.1016/j.jval.2014.08.2142.

    Article  CAS  PubMed  Google Scholar 

  25. Kwok T, Jing Loo W, Guenther L. Psoriasis and multiple sclerosis: is there a link? J Cutan Med Surg. 2010;14(4):151–5. https://doi.org/10.2310/7750.2010.09063.

    Article  PubMed  Google Scholar 

  26. Dobson R, Giovannoni G. Autoimmune disease in people with multiple sclerosis and their relatives: a systematic review and meta-analysis. J Neurol. 2013;260(5):1272–85. https://doi.org/10.1007/s00415-012-6790-1.

    Article  CAS  PubMed  Google Scholar 

  27. Opazo MC, Ortega-Rocha EM, Coronado-Arrazola I, Bonifaz LC, Boudin H, Neunlist M, et al. Intestinal microbiota influences non-intestinal related autoimmune diseases. Front Microbiol. 2018;9:432. https://doi.org/10.3389/fmicb.2018.00432.

    Article  PubMed  PubMed Central  Google Scholar 

  28. Wells G SB, O’Connell J, Robertson J, et al. The Newcastle-Ottawa Scale (NOS) for assessing the quality of nonrandomised studies in meta-analysis. 2011. Available from: http://www.ohri.ca/programs/clinical_epidemiology/oxford.asp.

  29. Review Manager (RevMan) [Computer program]. Version 5.3. Copenhagen: the nordic cochrane centre, The Cochrane Collaboration. 2014.

  30. Fellner A, Dano M, Regev K, Mosek A, Karni A. Multiple sclerosis is associated with psoriasis. A case-control study. J Neurol Sci. 2014;338(1–2):226–8. https://doi.org/10.1016/j.jns.2014.01.003.

    Article  PubMed  Google Scholar 

  31. Henderson RD, Bain CJ, Pender MP. The occurrence of autoimmune diseases in patients with multiple sclerosis and their families. J Clin Neurosci. 2000;7(5):434–7. https://doi.org/10.1054/jocn.2000.0693.

    Article  CAS  PubMed  Google Scholar 

  32. Langer-Gould A, Albers KB, Van Den Eeden SK, Nelson LM. Autoimmune diseases prior to the diagnosis of multiple sclerosis: a population-based case-control study. Mult Scler. 2010;16(7):855–61. https://doi.org/10.1177/1352458510369146.

    Article  CAS  PubMed  Google Scholar 

  33. Laroni A, Calabrese M, Perini P, Albergoni MP, Ranzato F, Tiberio M, et al. Multiple sclerosis and autoimmune diseases: epidemiology and HLA-DR association in North-east Italy. J Neurol. 2006;253(5):636–9. https://doi.org/10.1007/s00415-006-0084-4.

    Article  CAS  PubMed  Google Scholar 

  34. Midgard R, Gronning M, Riise T, Kvale G, Nyland H. Multiple sclerosis and chronic inflammatory diseases. A case-control study. Acta Neurol Scand. 1996;93(5):322–8.

    Article  CAS  PubMed  Google Scholar 

  35. Ramagopalan SV, Dyment DA, Valdar W, Herrera BM, Criscuoli M, Yee IM, et al. Autoimmune disease in families with multiple sclerosis: a population-based study. Lancet Neurol. 2007;6(7):604–10. https://doi.org/10.1016/s1474-4422(07)70132-1.

    Article  PubMed  Google Scholar 

  36. Marrie RA, Patten SB, Tremlett H, Wolfson C, Leung S, Fisk JD. Increased incidence and prevalence of psoriasis in multiple sclerosis. Mult Scler Relat Disord. 2017;13:81–6. https://doi.org/10.1016/j.msard.2017.02.012.

    Article  PubMed  Google Scholar 

  37. Edwards LJ, Constantinescu CS. A prospective study of conditions associated with multiple sclerosis in a cohort of 658 consecutive outpatients attending a multiple sclerosis clinic. Mult Scler. 2004;10(5):575–81. https://doi.org/10.1191/1352458504ms1087oa.

    Article  CAS  PubMed  Google Scholar 

  38. Guido N, Cices A, Ibler E, Huynh T, Majewski S, Sable K et al. Multiple sclerosis association with psoriasis: a large U.S. population, single centre, retrospective cross-sectional study. J Eur Acad Dermatol Venereol. 2017;31(9):e397–e8. https://doi.org/10.1111/jdv.14205.

  39. Roshanisefat H, Bahmanyar S, Hillert J, Olsson T, Montgomery S. Shared genetic factors may not explain the raised risk of comorbid inflammatory diseases in multiple sclerosis. Mult Scler. 2012;18(10):1430–6. https://doi.org/10.1177/1352458512438240.

    Article  CAS  PubMed  Google Scholar 

  40. Anagnostouli M, Anagnostoulis G, Katsavos S, Panagiotou M, Kararizou E, Davaki P. HLA-DRB1 15:01 and Epstein-Barr virus in a multiple sclerosis patient with psoriasis, nasopharyngeal and breast cancers. Lessons for possible hidden links for autoimmunity and cancer. J Neurol Sci. 2014;339(1–2):26–31. https://doi.org/10.1016/j.jns.2014.02.003.

  41. Alwan W, Nestle FO. Pathogenesis and treatment of psoriasis: exploiting pathophysiological pathways for precision medicine. Clin Exp Rheumatol. 2015;33(5 Suppl 93):S2–6.

    PubMed  Google Scholar 

  42. Wang X, Xu K, Chen S, Li Y, Li M. Role of interleukin-37 in inflammatory and autoimmune diseases. IJI. 2018;15(3):165–74. https://doi.org/10.22034/iji.2018.39386.

    Article  PubMed  Google Scholar 

  43. Yadav SK, Mindur JE, Ito K, Dhib-Jalbut S. Advances in the immunopathogenesis of multiple sclerosis. Curr Opin Neurol. 2015;28(3):206–19. https://doi.org/10.1097/wco.0000000000000205.

    Article  CAS  PubMed  Google Scholar 

  44. Kouris A, Pistiki A, Katoulis A, Georgitsi M, Giatrakou S, Papadavid E, et al. Proinflammatory cytokine responses in patients with psoriasis. Eur Cytokine Netw. 2014;25(4):63–8. https://doi.org/10.1684/ecn.2014.0358.

    CAS  Article  PubMed  Google Scholar 

  45. Tahvili S, Zandieh B, Amirghofran Z. The effect of dimethyl fumarate on gene expression and the level of cytokines related to different T helper cell subsets in peripheral blood mononuclear cells of patients with psoriasis. Int J Dermatol. 2015;54(7):e254–60. https://doi.org/10.1111/ijd.12834.

    Article  CAS  PubMed  Google Scholar 

  46. Wu Q, Wang Q, Mao G, Dowling CA, Lundy SK, Mao-Draayer Y. Dimethyl fumarate selectively reduces memory T cells and shifts the balance between Th1/Th17 and Th2 in multiple sclerosis patients. Journal of immunology (Baltimore, Md: 1950). 2017;198(8):3069–3080. https://doi.org/10.4049/jimmunol.1601532.

  47. Xu Z, Zhang F, Sun F, Gu K, Dong S, He D. Dimethyl fumarate for multiple sclerosis. Cochrane Database Syst Rev. 2015(4):Cd011076. https://doi.org/10.1002/14651858.cd011076.pub2.

  48. Mrowietz U, Barker J, Boehncke WH, Iversen L, Kirby B, Naldi L, et al. Clinical use of dimethyl fumarate in moderate-to-severe plaque-type psoriasis: a European expert consensus. J Eur Acad Dermatol Venereol. 2018;32(S3):3-14. https://doi.org/10.1111/jdv.15218.

    Article  PubMed  PubMed Central  Google Scholar 

  49. Heine G, Drozdenko G, Grun JR, Chang HD, Radbruch A, Worm M. Autocrine IL-10 promotes human B-cell differentiation into IgM- or IgG-secreting plasmablasts. Eur J Immunol. 2014;44(6):1615–21. https://doi.org/10.1002/eji.201343822.

    Article  CAS  PubMed  Google Scholar 

  50. Ghasemi N, Razavi S, Nikzad E. Multiple sclerosis: pathogenesis, symptoms. Diagnoses and cell-based therapy. Cell J. 2017;19(1):1–10.

    PubMed  Google Scholar 

  51. Ho P, Barton A, Worthington J, Plant D, Griffiths CEM, Young HS, et al. Investigating the role of the HLA-Cw*06 and HLA-DRB1 genes in susceptibility to psoriatic arthritis: comparison with psoriasis and undifferentiated inflammatory arthritis. Ann Rheum Dis. 2008;67(5):677–82. https://doi.org/10.1136/ard.2007.071399.

    Article  CAS  PubMed  Google Scholar 

  52. Hollenbach JA, Oksenberg JR. The immunogenetics of multiple sclerosis: a comprehensive review. J Autoimmun. 2015;64:13–25. https://doi.org/10.1016/j.jaut.2015.06.010.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  53. Javan MR, Shahraki S, Safa A, Zamani MR, Salmaninejad A, Aslani S. An interleukin 12 B single nucleotide polymorphism increases IL-12p40 production and is associated with increased disease susceptibility in patients with relapsing-remitting multiple sclerosis. Neurol Res. 2017;39(5):435–41. https://doi.org/10.1080/01616412.2017.1301623.

    Article  CAS  PubMed  Google Scholar 

  54. Cargill M, Schrodi SJ, Chang M, Garcia VE, Brandon R, Callis KP, et al. A large-scale genetic association study confirms IL12B and leads to the identification of IL23R as psoriasis-risk genes. Am J Hum Genet. 2007;80(2):273–90. https://doi.org/10.1086/511051.

    Article  CAS  PubMed  Google Scholar 

  55. Lucas RM, Byrne SN, Correale J, Ilschner S, Hart PH. Ultraviolet radiation, vitamin D and multiple sclerosis. Neurodegener Dis Manag. 2015;5(5):413–24. https://doi.org/10.2217/nmt.15.33.

    Article  PubMed  Google Scholar 

Download references

Acknowledgements

We would like to thank the Sunflower Statistical Consulting Company, Kaohsiung, Taiwan for statistical advice.

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Ching-Chi Chi.

Ethics declarations

Conflict of interest

Mr Liu, Dr Tung, Ms Lee, Drs Chang and Wang, and Prof. Chi declare no conflict of interest.

Funding sources

No funding was received for the conduct of this study.

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Liu, CY., Tung, TH., Lee, CY. et al. Association of Multiple Sclerosis with Psoriasis: A Systematic Review and Meta-Analysis of Observational Studies. Am J Clin Dermatol 20, 201–208 (2019). https://doi.org/10.1007/s40257-018-0399-9

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s40257-018-0399-9