Dermatology. 2008;216(2):152-5. Epub 2008 Jan 23
Association between psoriasis and the metabolic syndrome. A cross-sectional study.
Cohen AD, Sherf M, Vidavsky L, Vardy DA, Shapiro J, Meyerovitch J.
Research and Health Planning Department, Health Planning and Policy Division, Clalit Health Services, Omer/Tel Aviv, Israel. email@example.com
BACKGROUND: Previous reports have shown an association between inflammatory diseases such as systemic lupus erythematosus or rheumatoid arthritis and the metabolic syndrome. Recent data demonstrate that psoriasis is an inflammatory disease, suggesting that psoriasis may be one of the components of the metabolic syndrome. OBJECTIVE: To assess the association between psoriasis and the metabolic syndrome. METHODS: A cross-sectional study was performed utilizing the database of the Clalit Health Services. Case patients were defined as patients with a diagnosis of psoriasis vulgaris. Controls were randomly selected from the list of Clalit Health Services enrollees. The proportions of components of the metabolic syndrome (ischemic heart disease, hypertension, diabetes, obesity and dyslipidemia) were compared between case and control patients by univariate analyses. chi(2) tests were used to compare categorical parameters between the groups. Logistic and linear regression models served to measure the association between psoriasis and the metabolic syndrome. RESULTS: The study included 16,851 patients with psoriasis and 48,681 controls. In the case group, there were 8,449 men (50.1%) and 8,402 women (49.9%), with a mean age of 42.7 years (SD = 20.3, range = 2-111). Diabetes mellitus was present in 13.8% of the patients with psoriasis as compared to 7.3% of the controls (p < 0.001). Hypertension occurred in 27.5% of the patients with psoriasis and in 14.4% of the controls (p < 0.001). Obesity was present in 8.4% of the patients with psoriasis as opposed to 3.6% of the controls (p < 0.001). Ischemic heart disease was observed in 14.2% of the patients with psoriasis as compared to 7.1% of the controls (p < 0.001). Multivariate models adjusting for age, gender and smoking status of the patients demonstrated that psoriasis was associated with the metabolic syndrome (OR = 1.3, 95% CI = 1.1-1.4), ischemic heart disease (OR = 1.1, 95% CI = 1.0-1.2), diabetes mellitus (OR = 1.2, 95% CI = 1.0-1.3), hypertension (OR = 1.3, 95% CI = 1.2-1.5) and obesity (OR = 1.7, 95% CI = 1.5-1.9). LIMITATIONS: The study is designed as a case-control study, thus an association alone was proven and not causality. CONCLUSION: Our findings demonstrate a possible association between psoriasis and the metabolic syndrome. Appropriate treatment of the metabolic syndrome may be an important part of the management of patients with psoriasis. (c) 2008 S. Karger AG, Basel.
J Int Med Res. 2006 Nov-Dec;34(6):632-9.
Echocardiographic and clinical abnormalities in patients with psoriasis.
Biyik I, Narin A, Bozok MA, Ergene O.
Department of Cardiology, Usak State Hospital, Usak, Turkey. firstname.lastname@example.org
We investigated the incidence and severity of echocardiographic and clinical abnormalities in patients with psoriasis and their relationship to the severity, duration and type of psoriasis and other related factors. A total of 216 psoriasis patients and 216 control subjects were included in this study. Left and right heart dimensions, wall thicknesses, wall motion abnormalities, valvular disturbances, and systolic and diastolic functions were examined using two-dimensional and Doppler echocardiographic techniques. Left ventricular hypertrophy, left ventricular diastolic dysfunction, left ventricular wall motion abnormalities and valvular pathologies, especially mitral and tricuspid valve prolapse, were significantly more frequent in patients with psoriasis. Systolic and diastolic blood pressures were significantly higher in psoriasis patients. Significant correlations were found between: (i) psoriasis vulgaris and tricuspid valve prolapse; (ii) palmo-plantar psoriasis and valvular pathologies; and (iii) disease duration and left ventricular diastolic dysfunction and systolic and diastolic blood pressures. Physicians should be aware that cardiovascular abnormalities are common in patients with psoriasis.
Semin Arthritis Rheum. 2006 Apr;35(5):333-9.
Lack of echocardiographic and Doppler abnormalities in psoriatic arthritis patients without clinically evident cardiovascular disease or classic atherosclerosis risk factors.
Gonzalez-Juanatey C, Amigo-Diaz E, Miranda-Filloy JA, Testa A, Revuelta J, Garcia-Porrua C, Martin J, Llorca J, Gonzalez-Gay MA.
Staff Physicians, Cardiology Division, Hospital Xeral-Calde, Lugo, Spain.
OBJECTIVE: To assess the prevalence of echocardiographic and Doppler abnormalities in psoriatic arthritis (PsA) patients without clinically evident cardiovascular manifestations or classic atherosclerosis risk factors. METHODS: Fifty PsA patients were recruited from Hospital Xeral-Calde, Lugo, Spain. Patients seen during the period of recruitment that had classic cardiovascular risk factors or had suffered cardiovascular or cerebrovascular events were excluded. Fifty healthy matched controls were also studied. Echocardiographic and Doppler studies were performed in all cases and controls. RESULTS: In PsA patients the frequency of aortic and tricuspid (10%) and mitral regurgitation (16%) was not different from that seen in matched controls (10, 4, and 12%). Also, the pulmonary artery systolic pressure was normal in the group of PsA patients (23.4+/-3.9 mm Hg). The prevalence of diastolic dysfunction, in all cases due to impaired relaxation, was similar in PsA patients (28%) and controls (24%) (P=0.65). In addition, no significant echocardiographic and Doppler differences were observed when PsA patients with polyarticular pattern were compared with the remaining PsA patients. CONCLUSIONS: The present study shows that actively treated PsA patients without cardiovascular risk factors or clinically evident cardiovascular disease do not exhibit silent subclinical echocardiographic abnormalities.
Br J Dermatol. 2007 Feb;156(2):271-6.
Psoriasis: a possible risk factor for development of coronary artery calcification.
Ludwig RJ, Herzog C, Rostock A, Ochsendorf FR, Zollner TM, Thaci D, Kaufmann R, Vogl TJ, Boehncke WH.
Department of Dermatology and Department of Radiology, Johann Wolfgang Goethe-University, Theodor-Stern-Kai 7, D-60590 Frankfurt am Main, Germany.
BACKGROUND: Psoriasis is a chronic inflammatory skin disorder affecting about 2% of white-skinned individuals. Epidemiological data on the prevalence and degree of coronary artery calcification (CAC) as an indicator for cardiovascular diseases in patients with psoriasis are contradictory. OBJECTIVES: To study the prevalence and degree of CAC as an indicator for cardiovascular diseases in 32 patients with psoriasis matched for age, sex and risk factors to an equally sized control population. METHODS: Noncontrast-enhanced 16-row spiral computed tomography was performed in patients and controls. RESULTS: We found a significantly increased prevalence (59.4% vs. 28.1%, P = 0.015) and severity (CAC score according to Agatston 3.7 vs. 0.0, P = 0.019) of CAC in patients with psoriasis. Multiple linear regression calculations identified psoriasis as a likely independent risk factor for CAC. CONCLUSIONS: Our results point towards the potentially systemic nature of the inflammatory processes underlying the pathogenesis of psoriasis, which may therefore be considered a potentially severe systemic disease.
Br J Dermatol. 2007 Jul;157(1):68-73. Epub 2007 Jun 6.
Prevalence of metabolic syndrome in patients with psoriasis: a hospital-based case-control study.
Gisondi P, Tessari G, Conti A, Piaserico S, Schianchi S, Peserico A, Giannetti A, Girolomoni G.
Section of Dermatology, Department of Biomedical and Surgical Science, University of Verona, Verona, Italy. email@example.com
BACKGROUND: Psoriasis is a chronic inflammatory disease associated with an increased cardiovascular risk. Metabolic syndrome is a significant predictor of cardiovascular events. OBJECTIVE: To investigate the prevalence of metabolic syndrome in patients with psoriasis. METHODS: We performed a hospital-based case-control study on 338 adult patients with chronic plaque psoriasis and 334 patients with skin diseases other than psoriasis. RESULTS: Metabolic syndrome was significantly more common in psoriatic patients than in controls (30.1% vs. 20.6%, odds ratio 1.65, 95% confidence interval 1.16-2.35; P = 0.005) after the age of 40 years. Psoriatic patients also had a higher prevalence of hypertriglyceridaemia and abdominal obesity, whereas hyperglycaemia, arterial hypertension and high-density lipoprotein cholesterol plasma levels were similar. Although psoriasis patients were more frequently smokers, the association of psoriasis with metabolic syndrome was independent from smoking. There was no correlation between severity of psoriasis and prevalence of metabolic syndrome. Psoriatic patients with metabolic syndrome were older and had a longer disease duration compared with psoriatic patients without metabolic syndrome. CONCLUSION: Psoriatic patients have a higher prevalence of metabolic syndrome, which can favour cardiovascular events. We suggest psoriatic patients should be encouraged to correct aggressively their modifiable cardiovascular risk factors.
Acta Derm Venereol. 2007;87(6):506-9.
Psoriasis and the metabolic syndrome.
Cohen AD, Gilutz H, Henkin Y, Zahger D, Shapiro J, Bonneh DY, Vardy DA.
Clalit Health Services, Ben-Gurion University, Beer-Sheva, Isreal. firstname.lastname@example.org
Previous reports have shown a possible association between psoriasis and obesity, ischaemic heart disease, hypertension or diabetes mellitus. However, most of these studies were uncontrolled and were based on small sample sizes. We therefore investigated the association between psoriasis and the metabolic syndrome in a case control study. Case patients were defined as patients with a diagnosis of psoriasis vulgaris. Control patients were subjects who underwent hernioplasty or appendectomy. We used data mining techniques utilizing the database of the southern district of Clalit Health Services. The proportions of patients with diseases that belong to the metabolic syndrome were compared between case and control patients by univariate analyses. chi2 tests were used to compare categorical parameters between the groups. Logistic regression models were used to measure the association between psoriasis and the metabolic syndrome. A total of 340 patients with psoriasis and 6643 controls were included in the study. The mean age of case patients was 47.7 years (SD 10.7 years). There were 50.3% men and 49.7% women. Ischaemic heart disease was present in 23.5% of the patients with psoriasis, compared with 17.2% of the controls (p=0.003). Diabetes mellitus was present in 27.9% of the patients with psoriasis, compared with 19.5% of the controls (p <0.001). Hypertension was present in 44.4% of the patients with psoriasis, compared with 37.2% of the controls (p=0.007). Obesity was present in 29.4% of the patients with psoriasis, compared with 23.5% of the controls (p=0.012). Dyslipidaemia was present in 50.9% of the patients with psoriasis, compared with 44.2% of the controls (p=0.015). The association between psoriasis and the metabolic syndrome was pronounced after the age of 50 years and in men. Multivariate models adjusting for age and gender demonstrated that psoriasis was associated with an increased risk for ischaemic heart disease (odds ratio (OR) 1.4 95% confidence interval (CI) 1.0-1.8), diabetes mellitus (OR 1.5 95% CI 1.2-2.0), hypertension (OR 1.3 95% CI 1.0-1.7), obesity (OR 1.3 95% CI 1.0-1.7) and dyslipidaemia (OR 1.2 95% CI 1.0-1.6). Our findings demonstrate a possible association between psoriasis and the metabolic syndrome. Further studies are needed to establish this observation.
J Am Acad Dermatol. 2007 Aug;57(2):347-54. Epub 2007 Apr 12.
J Am Acad Dermatol. 2008 Feb;58(2):352.
Heart disease in psoriasis.
Kremers HM, McEvoy MT, Dann FJ, Gabriel SE.
Division of Epidemiology, Department of Health Sciences Research, Mayo Clinic, Rochester, MN 55905, USA. email@example.com
Psoriasis has been traditionally viewed as an inflammatory skin disorder of unknown origin. Recent advances in the immunopathogenesis and genetics of psoriasis have broadened our understanding of psoriasis. Psoriasis is now considered a systemic inflammatory condition analogous to other inflammatory immune disorders. Patients with other immune disorders, such as systemic lupus erythematosus or rheumatoid arthritis, are known to be at increased risk of heart disease. Similarly, patients with psoriasis may carry an excess risk of heart disease, which would represent an important previously unrecognized cause of morbidity and mortality. This review summarizes the current evidence for an increased cardiovascular risk in patients with psoriasis and outlines deficits in our knowledge in this area.
Clin Dermatol. 2007 Nov-Dec;25(6):529-34.
Comorbidities in psoriasis.
Department of Dermatology, Schleswig-Holstein University Clinic, 24105 Kiel, Germany. firstname.lastname@example.org
Epidemiological studies have shown that, in psoriasis patients, associated disorders may occur more frequently than expected. Such comorbidities include psoriatic arthritis, psoriatic pustular diseases, Crohn disease, and signs of metabolic syndrome, which leads to atherosclerosis with coronary heart disease. Although the disorders represent separate entities, they appear to follow overlapping pathogenic pathways. Comorbidities often become clinically manifest years after onset of psoriasis and are frequently seen in severe disease. Persistent low-grade inflammation with secretion of proinflammatory cytokines (eg, tumor necrosis factor alpha) favors the development of insulin resistance and metabolic syndrome. In addition, biochemical and immunologic observations point toward an inflammatory immune mechanism that uses tools of the innate defense armamentarium.
Arch Dermatol. 2007 Dec;143(12):1493-9.
The risk of mortality in patients with psoriasis: results from a population-based study.
Gelfand JM, Troxel AB, Lewis JD, Kurd SK, Shin DB, Wang X, Margolis DJ, Strom BL.
MSCE, Department of Dermatology, University of Pennsylvania School of Medicine, 2 Maloney Bldg, 3600 Spruce St, Philadelphia, PA 19104, USA. Joel.Gelfand@uphs.upenn.edu
OBJECTIVE: To determine the risk of mortality in patients with psoriasis. DESIGN: Cohort study. SETTING: General practitioners participating in the General Practice Research Database in the United Kingdom, 1987-2002. PATIENTS: Mild psoriasis, defined as any patient with a diagnostic code of psoriasis but no history of systemic therapy; severe psoriasis, any patient with a diagnostic code of psoriasis and a history of systemic therapy consistent with severe psoriasis. The unexposed (control) population was composed of patients with no history of a psoriasis diagnostic code. Control patients were selected in a 5:1 ratio from the same practice and date in practice as the patients with psoriasis. MAIN OUTCOME MEASURE: Hazard ratio (HR) of time to death using Cox proportional hazards models adjusted for age and sex. RESULTS: There was no overall effect of mild psoriasis on mortality (HR, 1.0; 95% confidence interval [CI], 0.97-1.02), whereas patients with severe psoriasis demonstrated an increased overall mortality risk (HR, 1.5; 95% CI, 1.3-1.7). The association of severe psoriasis with mortality persisted after adjustment for risk factors for mortality (HR, 1.4; 95% CI, 1.3-1.6) and after exclusion of patients with inflammatory arthropathy (HR, 1.5; 95% CI, 1.3-1.8). Male and female patients with severe psoriasis died 3.5 (95% CI, 1.2-5.8) and 4.4 (95% CI, 2.2-6.6) years younger, respectively, than patients without psoriasis (P < .001). CONCLUSION: Severe but not mild psoriasis is associated with an increased risk of death.
Arch Med Res. 2007 Jan;38(1):64-9. Epub 2006 Nov 3.
Heart rate and arrhythmia in patients with psoriasis vulgaris.
Markuszeski L, Bissinger A, Janusz I, Narbutt J, Jedrzejowska AS, Zalewska A.
Department of Interventional Cardiology, Cardiodiabetology and Cardiac Rehabilitation University Hospital No. 2, Lodz, Poland.
BACKGROUND: Psoriasis is a chronic inflammatory disease involving 1-3% of the human population worldwide. Many systemic diseases including cardiovascular disturbances have been described in psoriatic patients. However, there is a scarcity of data on heart rate, heart rate variability, arrhythmia and conduction abnormalities in this group of patients. METHODS: The study comprised 32 patients with chronic psoriasis vulgaris and negative personal history of heart problems. Severity of the disease was evaluated by Psoriasis Area and Severity Index (PASI). Twenty-four-h continuous electrocardiographic monitoring (24-h Holter ECG) was performed in all patients. RESULTS: Heart rate was significantly higher both during the day and at night in patients with psoriasis vulgaris than in the control group (p < 0.0001). There was a positive correlation between the increased heat rate, both during the day and at night, in psoriatic patients and severity of the disease expressed as PASI. Single supraventricular beats were significantly more frequently observed in psoriatic patients vs. the control group (p < 0.0001). CONCLUSIONS: An active inflammatory process observed in psoriasis seems to exert its influence on increased heart rate and supraventricular beats development. However, to confirm the above findings, further studies on larger groups of psoriatic patients, presenting different types of the disease are mandatory.
J Rheumatol. 2006 Nov;33(11):2167-72. Epub 2006 Sep 1.
J Rheumatol. 2006 Nov;33(11):2105-7.
Cardiovascular disease and risk factors in patients with rheumatoid arthritis, psoriatic arthritis, and ankylosing spondylitis.
Han C, Robinson DW Jr, Hackett MV, Paramore LC, Fraeman KH, Bala MV.
Centocor Inc., Malvern, PA 19335, USA. email@example.com
OBJECTIVE: To compare the prevalence of cardiovascular diseases and their risk factors between patients with rheumatoid arthritis (RA), psoriatic arthritis (PsA), and ankylosing spondylitis (AS) and control subjects. METHODS: Data for patients continuously enrolled in an integrated outcomes database between January 1, 2001, and December 31, 2002, with International Classification of Diseases, 9th Revision codes of 714.x (RA), 696.0 (PsA), or 720.0 (AS) were evaluated in this cross-sectional comparative study. Control groups were established for each patient group (1:4 ratio) by matching on the basis of age, sex, geographic region, and length of time in plan. Age- and sex-adjusted prevalence of cardiovascular comorbidities and risk factors were calculated; the prevalence ratio of the comorbidities and risk factors for the patient groups compared with the control population were estimated. Use of selected cardiovascular medications was also compared between patient and control groups. RESULTS: The RA, PsA, and AS cohorts comprised 28,208, 3066, and 1843 patients, respectively. The prevalence ratio of ischemic heart disease (1.5, 1.3, 1.2), atherosclerosis (1.9, 1.4, 1.5), peripheral vascular disease (2.4, 1.6, 1.6), congestive heart failure (2.0, 1.5, 1.8), cerebrovascular disease (1.6, 1.3, 1.7), type II diabetes (1.4, 1.5, 1.2), hyperlipidemia (1.2, 1.2, 1.2), and hypertension (1.3, 1.3, 1.3) were higher in patients than controls. For RA, PsA, and AS, use of angiotensin-converting enzyme inhibitors, calcium channel blockers, diuretics, nitrates/vasodilators, anticoagulants, and antihyperlipidemia agents was significantly higher in patients than controls. CONCLUSION: Cardiovascular diseases and their risk factors were more common in patients with RA, PsA, and AS than in matched controls.
Curr Opin Rheumatol. 2006 Mar;18(2):135-40.
The cardiovascular manifestations of rheumatic diseases.
Goodson NJ, Solomon DH.
Department of Rheumatology, Division of Infection and Immunity, University Hospital Aintree, Liverpool, UK.
PURPOSE OF REVIEW: To review the cardiovascular manifestations of several more common rheumatic conditions in the light of the recent reported literature. RECENT FINDINGS: Evidence that chronic inflammation is associated with the occurrence of cardiac events in people both with and without chronic inflammatory joint disease is emerging. Both atherosclerosis and rheumatic diseases, however, have a complicated cause, and it is likely that inflammation contributes to other environmental and host risk factors in these patients. Treatments used to suppress inflammation in many rheumatic conditions have the potential to reduce cardiovascular disease morbidity as well as improve musculoskeletal function. SUMMARY: Cardiovascular morbidity and mortality have been found to be increased in association with many of the rheumatic diseases. In particular, coronary heart disease seems to be associated with inflammatory rheumatic conditions. Whilst it is likely that chronic systemic inflammation promotes accelerated atherosclerosis in these patients, the mechanisms by which this occurs are complex and the effects of treatment and other cardiovascular risk factors need to be considered.
JAMA. 2006 Oct 11;296(14):1735-41
JAMA. 2007 Jan 24;297(4):361-2; author reply 362-3.
JAMA. 2007 Jan 24;297(4):361; author reply 362-3.
JAMA. 2007 Jan 24;297(4):362; author reply 362-3.
Risk of myocardial infarction in patients with psoriasis.
Gelfand JM, Neimann AL, Shin DB, Wang X, Margolis DJ, Troxel AB.
Department of Dermatology and Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania, Philadelphia, PA 19104, USA. firstname.lastname@example.org
CONTEXT: Psoriasis is the most common T-helper cell type 1 (T(H)1) immunological disease. Evidence has linked T(H)1 diseases to myocardial infarction (MI). Psoriasis has been associated with cardiovascular diseases, but has only been investigated in hospital-based studies that did not control for major cardiovascular risk factors. OBJECTIVE: To determine if within a population-based cohort psoriasis is an independent risk factor for MI when controlling for major cardiovascular risk factors. DESIGN, SETTING, AND PATIENTS: A prospective, population-based cohort study in the United Kingdom of patients with psoriasis aged 20 to 90 years, comparing outcomes among patients with and without a diagnosis of psoriasis. Data were collected by general practitioners as part of the patient's medical record and stored in the General Practice Research Database between 1987 and 2002, with a mean follow-up of 5.4 years. Adjustments were made for hypertension, diabetes, history of myocardial infarction, hyperlipidemia, age, sex, smoking, and body mass index. Patients with psoriasis were classified as severe if they ever received a systemic therapy. Up to 5 controls without psoriasis were randomly selected from the same practices and start dates as the patients with psoriasis. A total of 556,995 control patients and patients with mild (n = 127,139) and severe psoriasis (n = 3837) were identified. MAIN OUTCOME MEASURE: Incident MI. RESULTS: There were 11,194 MIs (2.0%) within the control population and 2319 (1.8%) and 112 (2.9%) MIs within the mild and severe psoriasis groups, respectively. The incidences per 1000 person-years for control patients and patients with mild and severe psoriasis were 3.58 (95% confidence interval [CI], 3.52-3.65), 4.04 (95% CI, 3.88-4.21), and 5.13 (95% CI, 4.22-6.17), respectively. Patients with psoriasis had an increased adjusted relative risk (RR) for MI that varied by age. For example, for a 30-year-old patient with mild or severe psoriasis, the adjusted RR of having an MI is 1.29 (95% CI, 1.14-1.46) and 3.10 (95% CI, 1.98-4.86), respectively. For a 60-year-old patient with mild or severe psoriasis, the adjusted RR of having an MI is 1.08 (95% CI, 1.03-1.13) and 1.36 (95% CI, 1.13-1.64), respectively. CONCLUSIONS: Psoriasis may confer an independent risk of MI. The RR was greatest in young patients with severe psoriasis.
J Am Acad Dermatol. 2006 Nov;55(5):829-35. Epub 2006 Sep 25.
Prevalence of cardiovascular risk factors in patients with psoriasis.
Neimann AL, Shin DB, Wang X, Margolis DJ, Troxel AB, Gelfand JM.
Dermatology, Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania, Philadelphia, Pennsylvania 19104, USA.
BACKGROUND: Previous studies suggest that patients hospitalized for psoriasis have an increased frequency of a variety of cardiovascular comorbidities. Limited population-based data exist on this association, and few studies have determined which factors are independently associated with psoriasis. OBJECTIVE: We sought to determine whether the prevalence of the major cardiovascular risk factors was higher in mild and severe psoriasis than in patients without psoriasis. METHODS: We conducted a population-based study in the United Kingdom using the General Practice Research Database. Patients were classified as having severe psoriasis if they received a code for psoriasis as well as systemic therapy. Patients were defined as having mild psoriasis if they ever received a psoriasis code but no systemic therapy. Control subjects were selected from the same practices and start dates as psoriasis patients. Patients were classified as having risk factors if they received codes for diabetes, hypertension, hyperlipidemia, obesity, or smoking. Analyses were performed by using conditional logistic regression, and adjustments were made considering age, gender, person-years, and all cardiovascular risk factors. RESULTS: We identified 127,706 patients with mild psoriasis and 3854 with severe psoriasis. Respective prevalence rates of risk factors in those with severe psoriasis, mild psoriasis, and in controls were as follows: diabetes (7.1%, 4.4%, 3.3%), hypertension (20%, 14.7%, 11.9%), hyperlipidemia (6%, 4.7%, 3.3%), obesity (20.7%, 15.8%, 13.2%), and smoking (30.1%, 28%, 21.3%). Patients with mild psoriasis had a higher adjusted odds of diabetes (odds ratio [OR], 1.13; 95% confidence interval [CI], 1.08-1.18]), hypertension (OR, 1.03; 95% CI, 1.01-1.06), hyperlipidemia (OR, 1.16; 95% CI, 1.12-1.21), obesity (OR, 1.27; 95% CI, 1.24-1.31), and smoking (OR, 1.31; 95% CI, 1.29-1.34) than controls. Patients with severe psoriasis had a higher adjusted odds of diabetes (OR, 1.62; 95% CI, 1.3-2.01), obesity (OR, 1.79; 95% CI, 1.55-2.05), and smoking (OR, 1.31; 95% CI, 1.17-1.47) than controls. Additionally, diabetes (OR, 1.39; 95% CI, 1.22-1.58) and obesity (OR, 1.47; 95% CI, 1.32-1.63) were more prevalent in those with severe psoriasis than with mild psoriasis. LIMITATIONS: The study was cross-sectional and therefore the directionality of the associations could not be determined. CONCLUSION: Multiple cardiovascular risk factors are associated with psoriasis. Cardiovascular risk factors that are key components of the metabolic syndrome are more strongly associated with severe psoriasis than with mild psoriasis.
J Eur Acad Dermatol Venereol. 2003 Jul;17(4):414-7.
Echocardiographic findings in subjects with psoriatic arthropathy.
Saricaoglu H, Güllülü S, Bülbül Baskan E, Cordan J, Tunali S.
Uludad University Medical Faculty, Department of Dermatology, Bursa, Turkey. email@example.com
BACKGROUND: Psoriatic arthropathy (PA) is a seronegative arthropathy with a 5-20% prevalence among psoriatics. In recent years, cardiovascular abnormalities have been shown in patients with seronegative arthropathies. OBJECTIVE/AIM: Since echocardiography is a non-invasive method to evidence cardiac abnormalities, we planned a study to evaluate heart involvement in subjects with psoriatic athropathy using this method. METHODS: A total of 21 subjects (15 women, six men) aged from 34 to 71 years were involved in this study. After PA diagnosis was confirmed by skeletal scintigraphic survey, patients were evaluated by Doppler echocardiogram for cardiovascular disturbances and the results were compared with those for a sex- and age-matched control group. RESULTS: The left ventricle end-diastolic and end-systolic diameters of the PA group were statistically different from those of the control group (P < 0.05), but no difference was observed in ejection fraction and the mitral E/A ratios. The presence of diastolic dysfunction was significantly related to the presence of arthropathy and the duration of psoriasis (P < 0.05). CONCLUSION: We conclude that mild diastolic dysfunction may accompany PA but our data should be confirmed by further studies.
J Med Assoc Thai. 1998 Feb;81(2):141-5.
Methotrexate induced pericarditis and pericardial effusion in psoriatic patient.
Palungwachira P, Palungwachira P, Laohathai P.
Family Medicine Department, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand.
We describe a 62-year-old woman with Psoriasis who presented as Methotrexate-induced pericarditis and pericardial effusion. Aspiration of the pericardium was required and the patient made a satisfactory recovery. At six-months follow-up, she remained well, psoriasis plaques was controlled by topical crude coal tar and topical corticosteroid. These complications are extremely rare, but have been described as isolated phenomena associated with methotrexate therapy.
Br J Dermatol. 1998 Feb;138(2):329-33.
Psoriatic arthritis associated with dilated cardiomyopathy and Takayasu's arteritis.
Fukuhara K, Urano Y, Akaike M, Ahsan K, Arase S.
Department of Dermatology, School of Medicine, University of Tokushima, Japan.
A 40-year-old Japanese man with psoriatic arthritis (PA) involving the spine, sacroiliac and peripheral joints presented with dyspnoea and ankle oedema. Blood pressure was 180/110 and 114/80 mmHg in the right and left upper arms, respectively. Examinations showed left ventricular dilatation and diffuse hypokinesis of the left ventricle, with no involvement of the coronary arteries. Aortography detected total occlusion of the left subclavian artery and stenosis of the origin at the right renal artery. Dilated cardiomyopathy and Takayasu's arteritis associated with PA was diagnosed. A few cases of PA have been reported in association with cardiovascular diseases, but the association of these three diseases has not been documented in the literature to date. Dermatologists need to be aware of cardiovascular manifestations in patients with PA, because cardiovascular diseases are not rare in other seronegative spondyloarthropathies.
Ann Rheum Dis. 1991 Apr;50(4):227-30.
Echocardiographic diastolic abnormalities of the left ventricle in inflammatory joint disease.
Rowe IF, Gibson DG, Keat AC, Brewerton DA.
Department of Rheumatology, Westminster Hospital, London, UK.
Echocardiographic early diastolic abnormalities have been shown recently in 50% of men with ankylosing spondylitis. Similar techniques were used to investigate subjects with rheumatoid arthritis and psoriatic arthritis with or without spondylitis. These subjects had no clinical, radiographic, or electrocardiographic evidence of cardiac or respiratory disease. Echocardiographic abnormalities seen resembled those of ankylosing spondylitis in that the interval between minimum left ventricular dimension and mitral valve opening was prolonged in 12 of 22 subjects with rheumatoid arthritis and in seven of 11 subjects with psoriatic arthritis. Isovolumic relaxation time was significantly prolonged in four subjects with rheumatoid arthritis and one with psoriatic arthritis. Unlike ankylosing spondylitis, however, there was consistent reduction in peak rate of left ventricular dimension increase in subjects with rheumatoid arthritis and psoriatic arthritis. In addition, the dimension increase during atrial systole was greater than normal in nine subjects with rheumatoid arthritis and two with psoriatic arthritis. The most likely cause of these abnormalities is increased connective tissue deposition in the myocardium.
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