Characteristics of patients with psoriasis and Type 2 diabetes in a central China case-control study

ARTICLE

ejd.2012.1680

Auteur(s) : Xue-Chao Xu, Ai-Ping Feng feng-aiping@medmail.com.cn

Department of Dermatology, Affiliated Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China

Psoriasis is considered as a systemic disease due to the increase in incidence of cardiovascular events and prevalent cases of T2DM, which is the leading cause of end-stage renal disease, preventable amputations, blindness and cardiovascular disease [1, 2]. The etiology of psoriasis may involve the immune system, interaction of multiple genes and environmental factors [3].

We examined the frequency of T2DM in patients with psoriasis and whether psoriatics having T2DM have different characteristics compared to patients with psoriasis alone and controls with T2DM, in central China.

400 patients (38.1 ± 23.2 years, range=15-78) and 1,000 controls (38.8 ± 21.5 years, range=17-79,), attending the Affiliated Union Hospital and Zhongshan Hospital in Wuhan between 2005-2011, were included in this study. Descriptive characteristics of the study population are recorded in table 1 and 2. Patients with psoriasis were defined as having severe and mild disorders according to whether they received systemic therapy or phototherapy [4]. All statistical analyses were performed using SPSS Version 13.0.

Table 1 Clinical characteristics of psoriatics.

Table 2 Descriptive characteristics of psoriatic patients and controls.

¹with T2DM; ²without T2DM. BMI: body mass index

The prevalence of T2DM was remarkably greater in psoriasis patients than in control subjects (18% vs 8.6%; P<0.001). The mean age of the patient group with T2DM (52.7 ± 12.6 years) was higher than that of the patients without T2DM (34.5 ± 9.5 years) (P<0.05), and the same as mean duration (12.1 ± 6.5 years vs 6.9 ± 3.8 years; P<0.05). Our results indicate that patients with psoriasis and T2DM were more severely affected, more obese, had a greater frequency of hypertension and dyslipidemia and they were more inclined to have smoking and alcohol consumption habits than their counterparts without T2DM (P<0.05) (table 3). The results of multivariate models controlling for age and gender are demonstrated in table 3.

Table 3 Regression models analysis in patients with psoriasis and controls.

¹ with T2DM; ² without T2DM. OR : odds ratio. CI : confidence interval. Model controlling for age and gender.

In the present study we showed that the prevalence of T2DM was greater in psoriasis patients than in controls, which was in accordance with others [1, 2]. This study also indicated, for the first time, that psoriatics with T2DM were more likely to have metabolic syndromes (MBS) than those with psoriasis alone and controls with T2DM. Maybe because psoriasis and T2DM are closely associated with metabolic syndromes [1], we could find these associations between these groups.

The pathological mechanisms of psoriasis involve many aspects shared with other diseases, such as T2DM. Inflammatory factors (e.g. TNF-α) play an important role in the common inflammatory mechanisms of psoriasis and T2DM [3, 5]. Moreover, selected susceptibility gene CDKAL1 has been showed to be associated with psoriasis as well as T2DM [3]. Besides, the inflammation involved in the above diseases may cause insulin resistance [2], which maybe one of the important mechanisms in psoriasis and MBS. Boehncke et al. [6] observed a significant correlation between psoriasis and elevated levels of serum resistin – a cytokine known to be increased in insulin resistance. They also affirmed that insulin resistance is a consequence of chronic inflammation and a possible pathogenetic cause for comorbidities, including T2DM, known to be associated with psoriasis.

In summary, metabolic syndromes including T2DM in psoriatics impair patients’ quality of life to an extent and are associated with high costs. So future studies will be needed to determine which intervention and management techniques best improve outcomes for psoriasis patients with MBS, and how to reasonably remedy psoriasis.

Disclosure

Financial support: none. Conflict of interest: none.

References

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2. Boehncke WH, Boehncke S, Tobin AM et al. The ‘psoriatic march’: a concept of how severe psoriasis may drive cardiovascular comorbidity. Exp Dermatol 2011; 20(4):303-7.

3. Nestle FO, Kaplan DH, Barker J. Psoriasis. N Engl J Med 2009 ; 361 : 496-509.

4. Gelfand JM, Wang X, Qing L et al. Epidemiology and treatment patterns of psoriasis in the General Practice Research Database (GPRD). Pharmacoepidemiol Drug Saf 2005; 14(Suppl.):S23.

5. Wellen KE, Hotamisligil G.S. Inflammation, stress, and diabetes. J Clin Invest 2005 ; 15 : 1111-1119.

6. Boehncke S, Thaci D, Beschmann H, et al. Psoriasis patients show signs of insulin resistance. Br J Dermatol 2007; 157(6): 1249-51.