Comorbidities of Psoriatic Disease
New York, NY—Psoriatic disease is now understood to be a systemic condition with a link to cardiometabolic risk as well as other comorbidities, including some types of cancers. But it is still unknown how treatment impacts those risks, according to information presented during IAS by Joel M. Gelfand, MD, MSCE, University of Pennsylvania Health System.
Topical agents are usually used to treat mild disease, minimal disability, or effects on health-related quality of life. Topical agents, ultraviolet therapies, oral medications, and injectable biologics are used for moderate-to-severe disease. Still, Dr Gelfand pointed out, half of patients who are intensively treated continue to have very active disease, Moreover, 75% with severe disease remain poorly controlled.
Besides well-established comorbidities, emerging comorbidities include sleep ap- nea, nonalcoholic steatohepatitis, chronic obstructive pulmonary disease, chronic and end-stage renal disease, and peptic ulcer disease.
Up to 30% of new cases of psoriatic disease are attributable to obesity. Risk factors include family history, smok- ing, excess alcohol intake, streptococcal pharyngitis, and HIV. Patients with severe psoriatic disease are 65% more likely to die of infection, highlighting the importance of vaccinations.
Moderate-to-severe psoriatic disease is also a risk factor for chronic renal disease, representing nearly a 2-fold risk, and a more than a 4-fold risk of dialysis. Patients with severe psoriatic disease are also 41% more likely to die of cancer.
The more severe psoriatic disease is, the greater the levels of systemic inflammation, and the greater the risk of cardiometabolic disease. Diabetes and lipid disorder screening should be done in patients with psoriatic disease, particularly in those whose disease is severe. Cardiovascular (CV) risk factors are generally under-screened and undermanaged, Dr Gelfand noted.
Independent of traditional CV risk factors, psoriatic disease is associated with a reduction in HDL efflux, an increase in LDL particle concentration, and a decrease in particle size, which has been confirmed by 8 meta-analyses. Psoriatic disease is also linked to increased vascular inflammation independent of traditional risk factors, and equivalent to 10 years of aging. The 10-year risk of a major CV event attributable to psoriatic disease is 6%, and the risk of CV disease in patients with severe disease is similar to the risk conferred by diabetes.
It is still not definitively known if psoriatic disease should be treated aggressively to lower the risk of CV disease using treatments such as methotrexate and TNF inhibitors. However, observational data suggests that it should. A protec- tive effect of phototherapy, apremilast, and ustekinumab on CV events has also not yet been proven.—Mary Mihalovic
