Psoriasis Severity Increases Risk for Several Major Medical Comorbidities

Patients with psoriasis have a higher prevalence of overall medical comorbidity and of specific comorbid diseases, and the comorbidity burden increases significantly with increasing psoriasis severity, according to a recent population-based, cross-sectional study.

Although there is an abundance of literature available on psoriasis comorbidity, as noted by the authors, less is known about the degree to which psoriasis severity may affect the prevalence of comorbid diseases. In this study, senior study author Joel M. Gelfand, MD, MSCE, associate professor of dermatology and epidemiology, Department of Dermatology and the Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania Perelman School of Medicine, Philadelphia, and colleagues examined the prevalence of major medical comorbidity included in the Charlson comorbidity index for individuals with mild, moderate, or severe psoriasis vs. those without psoriasis.

“This is the most comprehensive study on the topic to date,” said Gelfand. He noted that major advances include the fact that their work is broadly representative of patients with psoriasis. “Importantly—for the first time—we show how simple categorizations of psoriasis severity based on body surface area (BSA) affected directly correlates with the likelihood of having several major medical comorbidities,” he said.

“Physicians should be aware of these associations in providing comprehensive care to patients with psoriasis, especially those presenting with more severe disease,” the authors concluded.

Researchers compared 9035 patients (aged 25-64 years) with psoriasis with 90,350 age- and practice-matched patients without psoriasis. Mild, moderate, and severe psoriasis were classified by objective measures of BSA involvement; among the patients with psoriasis, 51.8% of cases were mild (limited disease with ≤2% BSA affected; n=4523), 35.8% were moderate (scattered disease with 3-10% BSA affected; n=3122), and 12.4% were severe (extensive disease with >10% BSA affected; n=1081).

The authors reported that the mean Charlson comorbidity index was increasingly higher in individuals with mild, moderate, or severe psoriasis. In addition, psoriasis overall was found to be associated with a higher prevalence of chronic pulmonary disease, diabetes mellitus, diabetes with systemic complications, mild liver disease, myocardial infarction, peptic ulcer disease, peripheral vascular disease, renal disease, and rheumatologic disease, and trend analysis revealed significant associations between psoriasis severity and each of the above comorbid diseases.

These findings are important in that “they allow patients and their care givers to determine how these results apply to them based on their extent of skin involvement with psoriasis,” said Gelfand. “A critical next step is to determine if treatment of psoriasis lowers the risk of associated medical disorders.”

The VIP (Vascular Inflammation in Psoriasis) trial and the VIP-Extension study, for example, are currently being conducted to determine whether tumor necrosis factor inhibitors and phototherapy improve lipid metabolism and alleviate vascular inflammation in individuals with moderate to severe psoriasis.

The full text of this study is available in JAMA Dermatology.

-Meredith Edwards White

Reference:

Yeung H, Takeshita J, Mehta NN, et al. Psoriasis severity and the prevalence of major medical comorbidity: a population-based study. JAMA Dermatol. 2013 Aug 7. doi: 10.1001/jamadermatol.2013.5015. [Epub ahead of print]