Abstract
The coexistence of psoriasis with systemic lupus erythematosus (SLE) has been reported in limited case series, raising hypotheses about shared pathogenetic mechanisms. Nevertheless, important differences regarding treatment do exist. The aim of the present study was to determine the prevalence and characteristics of psoriasis in a defined cohort of lupus patients. Patients with psoriasis were retrieved from the University of Toronto Lupus Clinic from its inception in 1970 up to 2015. Charts were hand-searched to collect information concerning demographic, clinical, and therapeutic variables. Patients were matched with non-psoriasis lupus patients to identify the impact of supervening psoriasis on lupus activity, damage accrual, and venous thromboembolic (VTEs) and cardiovascular events (CVEs). Psoriasis was diagnosed in 63 patients (49 females, 14 males) for a prevalence of 3.46% (63/1823). The male-to-female ratio was significantly higher in non-psoriasis patients (0.286 vs. 0.138, p = 0.017). Plaque psoriasis was the most prominent type (55/63, 87.3%) whereas three patients had pustular disease; one had psoriatic arthritis. Nine patients (14.3%) were administered systemic treatment with methotrexate (n = 5), azathioprine (n = 1), ustekinumab (n = 3), and etanercept (n = 1). Psoriasis was definitely deteriorated by hydroxychloroquine in one patient. There was no significant impact of psoriasis on disease activity, damage accrual, VTEs, and CVEs. The prevalence of psoriasis was twice as high as that of the general Canadian population in this lupus cohort. Plaque psoriasis was the most prominent subtype, and topical treatment was adequate in the majority of patients. Supervening psoriasis had no significant impact on lupus activity and damage accrual.
Similar content being viewed by others
Change history
14 November 2018
Prof. Ari Polachek on of the author of the published version of this article missed to add his second affiliation which is the Department of Rheumatology, Tel Aviv Sourasky Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel. The new affiliation is now added and presented correctly in this article.
14 November 2018
Prof. Ari Polachek on of the author of the published version of this article missed to add his second affiliation which is the Department of Rheumatology, Tel Aviv Sourasky Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel. The new affiliation is now added and presented correctly in this article.
References
Farrell MS, Wallace SJ, Clarke SM, Tarafder MR, McLaughlin WA (2014) Implementation of the connective tissue screening questionnaire in northeast Pennsylvania to identify comorbidities of connective tissue diseases in subjects with systemic lupus erythematosus. J Prim Care Community Health 5:134–138
Aikawa NE, Jesus AA, Liphaus BL, Silva CA, Carneiro-Sampaio M, Viana VS et al (2012) Organ-specific autoantibodies and autoimmune diseases in juvenile systemic lupus erythematosus and juvenile dermatomyositis patients. Clin Exp Rheumatol 30:126–131
Astudillo L, Sailler L, Carreiro M, Dahan S, Ollier S, Arlet P (2003) Psoriasis and systemic lupus erythematosus: a rare association with specific therapeutic problems. Ann Med Interne 154:3–6
Millns JL, Muller SA (1980) The coexistence of psoriasis and lupus erythematosus. An analysis of 27 patients. Arch Dermatol 116:658–663
Hays SB, Camisa C, Luzar MJ (1984) The coexistence of systemic lupus erythematosus and psoriasis. J Am Acad Dermatol 10:619–622
Zalla MJ, Muller SA (1996) The coexistence of psoriasis with lupus erythematosus and other photosensitive disorders. Acta Derm Venereol Suppl (Stockh) 195:1–15
Alarcon-Segovia D, Alarcon-Riquelme ME, Cardiel MH, Caeiro F, Massardo L, Villa AR et al (2005) Familial aggregation of systemic lupus erythematosus, rheumatoid arthritis and other autoimmune diseases in 1177 lupus patients from the GLADEL cohort. Arthritis Rheum 52:1138–1147
Chandran V, Schentag CT, Brockbank JE, Pellett FJ, Shanmugarajah S, Toloza SM et al (2009) Familial aggregation of psoriatic arthritis. Ann Rheum Dis 68:664–667
Li Y, Cheng H, Zuo XB, Sheng YJ, Zhou FS, Tang XF et al (2013) Association analyses identifying two common susceptibility loci shared by psoriasis and systemic lupus erythematosus in the Chinese Han population. J Med Genet 50:812–818
Deng X, Su Y, Wu H, Wu R, Zhang P, Dai Y et al (2015) The role of microRNAs in autoimmune diseases with skin involvement. Scand J Immunol 81:153–165
Alarcon-Riquelme ME (2004) Role of RUNX in autoimmune diseases linking rheumatoid arthritis, psoriasis and lupus. Arthritis Res Ther 6:169–173
Konva C, Paz Z, Apostolides SA, Tsokos GC (2015) Update on the role of interleukin 17 in rheumatologic autoimmune diseases. Cytokine 75:207–215
Dowdy MJ, Nigra TP, Barth WF (1989) Subacute cutaneous lupus erythematosus during PUVA therapy for psoriasis: case report and review of the literature. Arthritis Rheum 32:343–346
Yanai H, Shuster D, Calabrese E, Mlynarsky L, Tumuluri S, Cohen RD (2013) The incidence and predictors of lupus-like reaction in patients with IBD treated with anti-TNF therapies. Inflamm Bowel Dis 19:2778–2786
Hochberg MC (1997) Updating the American College of Rheumatology revised criteria for the classification of systemic lupus erythematosus. Arthritis Rheum 40:1725
Taylor W, Gladman DD, Heliwell P, Marchesoni A, Mease P, Mielants H, CASPAR Study Group (2006) Classification criteria for psoriatic arthritis: development of new criteria from a large international study. Arthritis Rheum 54:2665–2673
Canadian Psoriasis Guidelines Committee (2009) Canadian guidelines for the management of plaque psoriasis, June. http://www.dermatology.ca/psoriasisguidelines
Avriel A, Zeller L, Flusser D, Abu Shakra M, Halevy S, Sukenik S (2007) Coexistence of psoriatic arthritis and systemic lupus erythematosus. Isr Med Assoc J 9:48–49
Haake H, Koneke J, Amann K, Vom Dahl J, Janssen U (2007) Development of systemic lupus erythematosus with focal proliferative nephritis during anti-TNF-alpha therapy for psoriatic arthritis. Med Klin (Munich) 102:852–857
Cervera R, Khamastha MA, Font J, Sebastiani GD, Gil A, Lavilla P et al. Systemic lupus erythematosus: clinical and immunological patterns of disease expression in a cohort of 1000 patients. The European Working Party on Systemic lupus Erythematosus. Medicine (Baltimore) 1993; 72: 113–124
Hoffman IE, Peene I, Cebecauer L, Isenberg D, Huizinga TW, Union A et al (2005) Presence of rheumatoid factor and antibodies to citrullinated peptides in systemic lupus erythematosus. Ann Rheum Dis 64:330–332
Grover C, Kashyap B, Daulatabad D, Dhawan A, Kaur IR (2016) Significance of anti-cyclic citrullinated peptide autoantibodies in immune-mediated inflammatory skin disorders with and without arthritis. Indian J Dermatol 61:510–514
Ziegelasch M, Van Delft MA, Wallin P, Skogh T, Magro-Checa C, Steup-Beekman GM et al (2016) Antibodies against carbamylated proteins and cyclic citrullinated peptides in systemic lupus erythematosus: results from two well-defined European cohorts. Arthritis Res Ther 18:289
Candia L, Marquez J, Gonzalez C, Santos AM, Londono J, Valle R et al (2006) Low frequency of anticyclic citrullinated peptide antibodies in psoriatic arthritis but not in cutaneous psoriasis. J Clin Rheumatol 12:226–229
Alenius GM, Berglin E, Rantapaa Dahlqvist S (2006) Antibodies against cyclic citrullinated peptide (CCP) in psoriatic patients with or without joint inflammation. Ann Rheum Dis 65:398–400
Payet J, Goulvestre C, Biale L, Avouac J, Wipff J, Job-Deslandre C et al (2014) Anticyclic citrullinated peptide antibodies in rheumatoid and non-rheumatoid rheumatic disorders: experience with 1162 patients. J Rheumatol 41:2395–2402
Ball EM, Tan AL, Fukuba E, McGonagle D, Grey A, Steiner G et al (2014) A study of erosive phenotypes in lupus arthritis using magnetic resonance imaging and anti-citrullinated protein antibody, anti-RA33 and RF autoantibody status. Rheumatology (Oxford) 53:1835–1843
Bolton GG (1989) Coexistent discoid lupus erythematosus and psoriasis: a therapeutic dilemma. J Miss State Med Assoc 30:181–182
Kontochristopoulos GJ, Giannadaki M, Doulaveri G, Christoforidou E, Zakopoulou N (2004) Psoriasis coexisting with subacute cutaneous lupus erythematosus. J Eur Acad Dermatol Venereol 18:385–386
Ueki H (2005) Koebner phenomenon in lupus erythematosus with special consideration of clinical findings. Autoimmun Rev 4:219–223
Kulick KB, Mogavero H Jr, Provost TT, Reichlin M (1983) Serologic studies in patients with lupus erythematosus and psoriasis. J Am Acad Dermatol 8:631–634
Cassano N, Buquicchio R, Ranieri V, Loconsole F, Vena GA (2008) Is there an association between antiphospholipid antibodies and psoriasis? J Biol Regul Homeost Agents 22:207–210
Prodanovich S, Kirsner RS, Kravetz JD, Ma F, Martinez L, Federman DG (2009) Association of psoriasis with coronary artery, cerebrovascular and peripheral vascular disease and mortality. Arch Dermatol 145:700–703
Ungprasert P, Sanguanken A, Upala S, Suksaranjit P (2014) Psoriasis and risk of venous thromboembolism: a systematic review and meta-analysis. QJM 107:793–797
Varada S, Gottlieb AB, Merola JF, Saraiya AR, Tintle SJ (2015) Treatment of coexistent psoriasis and lupus erythematosus. J Am Acad Dermatol 72:253–260
Winchester D, Duffin KC, Hansen C (2012) Response to ustekinumab in a patient with both severe psoriasis and hypertrophic cutaneous lupus. Lupus 21:1007–1010
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
All patients have provided written informed consent for studies being conducted in the University of Toronto Lupus Clinic and are approved by the University Health Network Research Ethics Board.
Disclosures
None.
Rights and permissions
About this article
Cite this article
Tselios, K., Yap, K.SY., Pakchotanon, R. et al. Psoriasis in systemic lupus erythematosus: a single-center experience. Clin Rheumatol 36, 879–884 (2017). https://doi.org/10.1007/s10067-017-3566-0
Received:
Revised:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s10067-017-3566-0