Skip to main content

Advertisement

SpringerLink
Log in

Metabolic disorders in patients with psoriasis and psoriatic arthritis

  • Published:
Current Rheumatology Reports Aims and scope Submit manuscript

Abstract

Psoriasis is one of the common complex disorders in Western world, affecting 2% to 3% of the population. Recent studies indicate that psoriasis is associated with an increased risk of comorbidity and mortality compared to the general population. It appears that patients with psoriasis have a higher prevalence of metabolic disorders such as diabetes, hypertension, obesity, and hyperlipidemia, as well as a higher frequency of cigarette smoking. These concomitant diseases can complicate the treatment of psoriasis. Even though the etiology of these associations is elusive, physicians should be aware of them and take active steps to reduce the risk profiles of patients with psoriasis and psoriatic arthritis, in order to lessen mortality and comorbidity.

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

Similar content being viewed by others

References and Recommended Reading

  1. Raychaudhuri SP, Farber EM: The prevalence of psoriasis in the world. J Eur Acad Dermatol Venereol 2001, 15:16–17.

    Article  PubMed  CAS  Google Scholar 

  2. Gladman DD, Antoni C, Mease P, et al.: Psoriatic arthritis: epidemiology, clinical features, course, and outcome. Ann Rheum Dis 2005, 64(Suppl 2):ii14–17.

    Article  PubMed  Google Scholar 

  3. Capon F, Trembath RC, Barker JN: An update on the genetics of psoriasis. Dermatol Clin 2004, 22:339–347, vii.

    Article  PubMed  CAS  Google Scholar 

  4. Nair RP, Stuart PE, Nistor I, et al.: Sequence and haplotype analysis supports HLA-C as the psoriasis susceptibility 1 gene. Am J Hum Genet 2006, 78:827–851.

    Article  PubMed  CAS  Google Scholar 

  5. Mallon E, Bunce M, Savoie H, et al.: HLA-C and guttate psoriasis. Br J Dermatol 2000, 143:1177–1182.

    Article  PubMed  CAS  Google Scholar 

  6. Lindegard B: Diseases associated with psoriasis in a general population of 159,200 middle-aged, urban, native Swedes. Dermatologica 1986, 172:298–304.

    Article  PubMed  CAS  Google Scholar 

  7. Henseler T, Christophers E: Disease concomitance in psoriasis. J Am Acad Dermatol 1995, 32:982–986.

    Article  PubMed  CAS  Google Scholar 

  8. Lopez AD, Mathers CD, Ezzati M, et al.: Global and regional burden of disease and risk factors, 2001: systematic analysis of population health data. Lancet 2006, 367:1747–1757.

    Article  PubMed  Google Scholar 

  9. Arnett DK, McGovern PG, Jacobs JrDR, et al.: Fifteen-year trends in cardiovascular risk factors (1980-1982 through 1995–1997): the Minnesota Heart Survey. Am J Epidemiol 2002, 156:929–935.

    Article  PubMed  Google Scholar 

  10. Willerson JT, Ridker PM: Inflammation as a cardiovascular risk factor. Circulation 2004, 109:II2-II10.

    PubMed  Google Scholar 

  11. Mitra B, Panja M: High sensitive C-reactive protein: a novel biochemical markers and its role in coronary artery disease. J Assoc Physicians India 2005, 53:25–32.

    PubMed  CAS  Google Scholar 

  12. Sesso HD, Buring JE, Rifai N, et al.: C-reactive protein and the risk of developing hypertension. JAMA 2003, 290:2945–2951.

    Article  PubMed  CAS  Google Scholar 

  13. Li JJ, Fang CH: C-reactive protein is not only an inflammatory marker but also a direct cause of cardiovascular diseases. Med Hypotheses 2004, 62:499–506.

    Article  PubMed  CAS  Google Scholar 

  14. Vanizor Kural B, Orem A, Cimsit G, et al.: Evaluation of the atherogenic tendency of lipids and lipoprotein content and their relationships with oxidant-antioxidant system in patients with psoriasis. Clin Chim Acta 2003, 328:71–82.

    Article  Google Scholar 

  15. Rocha-Pereira P, Santos-Silva A, Rebelo I, et al.: The inflammatory response in mild and in severe psoriasis Creactive protein and alpha2-macroglobulin plasma activity in medium-severe and severe psoriasis. Br J Dermatol 2004, 150:917–928.

    Article  PubMed  CAS  Google Scholar 

  16. Helliwell PS, Marchesoni A, Peters M, et al.: Cytidine deaminase activity, C reactive protein, histidine, and erythrocyte sedimentation rate as measures of disease activity in psoriatic arthritis. Ann Rheum Dis 1991, 50:362–365.

    Article  PubMed  CAS  Google Scholar 

  17. Spadaro A, Taccari E, Riccieri V, et al.: Interleukin-6 and soluble interleukin-2-receptor in psoriatic arthritis: correlations with clinical and laboratory parameters. Clin Exp Rheumatol 1996, 14:413–416.

    PubMed  CAS  Google Scholar 

  18. Yasumoto S, Imayama A, Hori Y: Increased serum level of interleukin-6 in patients with psoriatic arthritis and thrombocytosis. J Dermatol 1995, 22:718–722.

    PubMed  CAS  Google Scholar 

  19. Kane D, Roth J, Frosch M, et al.: Increased perivascular synovial membrane expression of myeloid-related proteins in psoriatic arthritis. Arthritis Rheum 2003, 48:1676–1685.

    Article  PubMed  CAS  Google Scholar 

  20. Tzoulaki I, Murray GD, Lee AJ, et al.: C-reactive protein, interleukin-6, and soluble adhesion molecules as predictors of progressive peripheral atherosclerosis in the general population: Edinburgh Artery Study. Circulation 2005, 112:976–983.

    Article  PubMed  CAS  Google Scholar 

  21. Manson JE, Bassuk SS: Obesity in the United States: a fresh look at its high toll. JAMA 2003, 289:229–230.

    Article  PubMed  Google Scholar 

  22. Herron MD, Hinckley M, Hoffman MS, et al.: Impact of obesity and smoking on psoriasis presentation and management. Arch Dermatol 2005, 141:1527–1534. This study is of great importance for investigators interested in clinical psoriasis research. It is a comprehensive study of the impact of obesity and smoking on psoriasis. The authors provide evidence indicating that smoking may have a role in the disease onset, while obesity seems to be a consequence of psoriasis. The.ndings encourage physicians to highlight the importance of diet, exercise, and smoking cessation to patients with psoriasis.

    Article  PubMed  Google Scholar 

  23. Naldi L, Chatenoud L, Linder D, et al.: Cigarette smoking, body mass index, and stressful life events as risk factors for psoriasis: results from an Italian case-control study. J Invest Dermatol 2005, 125:61–67. This work demonstrates that smoking and obesity are linked to psoriasis at disease onset. In contrast to Herron et al. [22], these authors suggest that obesity is a risk factor for the onset of psoriasis.

    Article  PubMed  CAS  Google Scholar 

  24. Hamminga EA, van der Lely AJ, Neumann HA, et al.: Chronic inflammation in psoriasis and obesity: Implications for therapy. Med Hypotheses 2006, 67:768–773. Here, authors hypothesize that losing weight may improve psoriasis by reducing concentrations of cytokine network, such as TNF-β, IL-6, and leptin, and by improving insulin sensitivity.

    Article  PubMed  CAS  Google Scholar 

  25. Mallbris L, Granath F, Hamsten A, et al.: Psoriasis is associated with lipid abnormalities at the onset of skin disease. J Am Acad Dermatol 2006, 54:614–621. This is the.rst study that provides a baseline characterization of lipid profile in psoriasis at disease onset. The authors demonstrate an atherogenic lipid profile at the onset of psoriasis. The study design allows a high specificity and reliable assessment of established confounding factors and eliminates factors such as obesity, hypertension, cigarette smoking, physical activity, and disease severity as possible explanations to the.ndings.

    Article  PubMed  Google Scholar 

  26. Reddy SM, Reed G, Anandarajah A, et al.: Comparative analysis of disease activity, radiographic features and bone density in psoriatic and rheumatoid arthritis. Arthritis Rheum 2005, 52:S641.

    Google Scholar 

  27. Ferretti G, Simonetti O, Offidani AM, et al.: Changes of plasma lipids and erythrocyte membrane.uidity in psoriatic children. Pediatr Res 1993, 33:506–509.

    Article  PubMed  CAS  Google Scholar 

  28. Lebwohl M, Ali S: Treatment of psoriasis. Part 2. Systemic therapies. J Am Acad Dermatol 2001, 45:649–661, quiz 662–664.

    Article  PubMed  CAS  Google Scholar 

  29. Jones SM, Harris CP, Lloyd J, et al.: Lipoproteins and their subfractions in psoriatic arthritis: identification of an atherogenic profile with active joint disease. Ann Rheum Dis 2000, 59:904–909.

    Article  PubMed  CAS  Google Scholar 

  30. Lazarevic MB, Vitic J, Mladenovic V, et al.: Dyslipoproteinemia in the course of active rheumatoid arthritis. Semin Arthritis Rheum 1992, 22:172–178.

    Article  PubMed  CAS  Google Scholar 

  31. Preece JF: Raised blood pressure and psoriasis. J R Coll Gen Pract 1977, 27:713–715.

    PubMed  CAS  Google Scholar 

  32. Ena P, Madeddu P, Glorioso N, et al.: High prevalence of cardiovascular diseases and enhanced activity of the reninangiotensin system in psoriatic patients. Acta Cardiol 1985, 40:199–205.

    PubMed  CAS  Google Scholar 

  33. Spadaro A, Taccari E, Mohtadi B, et al.: Life-table analysis of cyclosporin A treatment in psoriatic arthritis: comparison with other disease-modifying antirheumatic drugs. Clin Exp Rheumatol 1997, 15:609–614.

    PubMed  CAS  Google Scholar 

  34. Cersosimo E, Defronzo RA: Insulin resistance and endothelial dysfunction: the road map to cardiovascular diseases. Diabetes Metab Res Rev 2006, Epub ahead of print.

  35. Jucci A, Vignini M, Pelfini C, et al.: Psoriasis and insulin secretion. Preliminary results. Arch Dermatol Res 1977, 257:239–246.

    Article  PubMed  CAS  Google Scholar 

  36. Brenelli SL, Moraes AM, Monte-Alegre S, et al.: Insulin resistance in psoriasis. Braz J Med Biol Res 1995, 28:297–301.

    PubMed  CAS  Google Scholar 

  37. Reynoso-von Drateln C, Martinez-Abundis E, Balcazar-Munoz BR, et al.: Lipid profile, insulin secretion, and insulin sensitivity in psoriasis. J Am Acad Dermatol 2003, 48:882–885.

    Article  Google Scholar 

  38. Ucak S, Ekmekci TR, Basat O, et al.: Comparison of various insulin sensitivity indices in psoriatic patients and their relationship with type of psoriasis. J Eur Acad Dermatol Venereol 2006, 20:517–522.

    Article  PubMed  CAS  Google Scholar 

  39. Anan F, Takahashi N, Shinohara T, et al.: Smoking is associated with insulin resistance and cardiovascular autonomic dysfunction in type 2 diabetic patients. Eur J Clin Invest 2006, 36:459–465.

    Article  PubMed  CAS  Google Scholar 

  40. Yang RZ, Lee MJ, Hu H, et al.: Identification of omentin as a novel depot-specific adipokine in human adipose tissue: possible role in modulating insulin action. Am J Physiol Endocrinol Metab 2006, 290:E1253–1261.

    Article  PubMed  CAS  Google Scholar 

  41. Hagforsen E, Awder M, Lefvert AK, et al.: Palmoplantar pustulosis: an autoimmune disease precipitated by smoking? Acta Derm Venereol 2002, 82:341–346.

    Article  PubMed  Google Scholar 

  42. Smith JB, Fenske NA: Cutaneous manifestations and consequences of smoking. J Am Acad Dermatol 1996, 34:717–732, quiz 733–734.

    Article  PubMed  CAS  Google Scholar 

  43. Mills CM, Srivastava ED, Harvey IM, et al.: Smoking habits in psoriasis: a case control study. Br J Dermatol 1992, 127:18–21.

    Article  PubMed  CAS  Google Scholar 

  44. Poikolainen K, Reunala T, Karvonen J: Smoking, alcohol and life events related to psoriasis among women. Br J Dermatol 1994, 130:473–477.

    Article  PubMed  CAS  Google Scholar 

  45. Naldi L, Parazzini F, Brevi A, et al.: Family history, smoking habits, alcohol consumption and risk of psoriasis. Br J Dermatol 1992, 127:212–217.

    Article  PubMed  CAS  Google Scholar 

  46. Fortes C, Mastroeni S, Leffondre K, et al.: Relationship between smoking and the clinical severity of psoriasis. Arch Dermatol 2005, 141:1580–1584.

    Article  PubMed  Google Scholar 

  47. Peters MJ, van der Horst-Bruinsma IE, Dijkmans BA, et al.: Cardiovascular risk profile of patients with spondylarthropathies, particularly ankylosing spondylitis and psoriatic arthritis. Semin Arthritis Rheum 2004, 34:585–592.

    Article  PubMed  Google Scholar 

  48. Klareskog L, Stolt P, Lundberg K, et al.: A new model for an etiology of rheumatoid arthritis: smoking may trigger HLA-DR (shared epitope)-restricted immune reactions to autoantigens modified by citrullination. Arthritis Rheum 2006, 54:38–46, comment in 2006, 54:10–13.

    Article  PubMed  CAS  Google Scholar 

  49. Poikolainen K, Karvonen J, Pukkala E: Excess mortality related to alcohol and smoking among hospital-treated patients with psoriasis. Arch Dermatol 1999, 135:1490–1493.

    Article  PubMed  CAS  Google Scholar 

  50. Aicher A, Heeschen C, Mohaupt M, et al.: Nicotine strongly activates dendritic cell-mediated adaptive immunity: potential role for progression of atherosclerotic lesions. Circulation 2003, 107:604–611.

    Article  PubMed  CAS  Google Scholar 

  51. Sonnex TS, Carrington P, Norris P, et al.: Polymorphonuclear leukocyte random migration and chemotaxis in psoriatic and healthy adult smokers and non-smokers. Br J Dermatol 1988, 119:653–659.

    Article  PubMed  CAS  Google Scholar 

  52. Mallbris L, Akre O, Granath F, et al.: Increased risk for cardiovascular mortality in psoriasis inpatients but not in outpatients. Eur J Epidemiol 2004, 19:225–230.

    Article  PubMed  Google Scholar 

  53. Seishima M, Mori S, Noma A: Serum lipid and apolipoprotein levels in patients with psoriasis. Br J Dermatol 1994, 130:738–742.

    Article  PubMed  CAS  Google Scholar 

  54. Rocha-Pereira P, Santos-Silva A, Rebelo I, et al.: Dislipidemia and oxidative stress in mild and in severe psoriasis as a risk for cardiovascular disease. Clin Chim Acta 2001, 303:33–39.

    Article  PubMed  CAS  Google Scholar 

  55. Cheng SW, Ting AC, Wong J: Lipoprotein (a) and its relationship to risk factors and severity of atherosclerotic peripheral vascular disease. Eur J Vasc Endovasc Surg 1997, 14:17–23.

    Article  PubMed  CAS  Google Scholar 

  56. Alberti KG, Zimmet PZ: Definition, diagnosis and classification of diabetes mellitus and its complications. Part 1: diagnosis and classification of diabetes mellitus provisional report of a WHO consultation. Diabet Med 1998, 15:539–553.

    Article  PubMed  CAS  Google Scholar 

  57. Third Report of the National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel III).nal report. Circulation 2002, 106:3143/2-3421.

  58. Balkau B, Charles MA: Comment on the provisional report from the WHO consultation. European Group for the Study of Insulin Resistance (EGIR). Diabet Med 1999, 16:442–443.

    Article  PubMed  CAS  Google Scholar 

  59. International Diabetes Federation: The IDF consensus worldwide definition of metabolic syndrome. http://www. idf.org/webdata/docs/IDF_Metasyndrome_definition.pdf. Accessed July 25, 2006.

  60. Vahlquist C, Michaelsson G, Vessby B: Serum lipoproteins in middle-aged men with psoriasis. Acta Derm Venereol 1987, 67:12–15.

    PubMed  CAS  Google Scholar 

  61. Uyanik BS, Ari Z, Onur E, et al.: Serum lipids and apolipoproteins in patients with psoriasis. Clin Chem Lab Med 2002, 40:65–68.

    Article  PubMed  CAS  Google Scholar 

  62. Piskin S, Gurkok F, Ekuklu G, et al.: Serum lipid levels in psoriasis. Yonsei Med J 2003, 44:24–26.

    PubMed  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Medicine, Dermatology Unit, Karolinska Institutet, 17176, Stockholm, Sweden

    Lotus Mallbris MD, PhD

Authors
  1. Lotus Mallbris MD, PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Christopher T. Ritchlin MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Mona Ståhle MD, PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Lotus Mallbris MD, PhD.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Mallbris, L., Ritchlin, C.T. & Ståhle, M. Metabolic disorders in patients with psoriasis and psoriatic arthritis. Curr Rheumatol Rep 8, 355–363 (2006). https://doi.org/10.1007/s11926-006-0065-8

Download citation

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11926-006-0065-8

Keywords

Search

Navigation