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.
|
|
| Male |
Female |
| Number |
| 247 |
153 |
| Severity [n(%)] |
Mild |
80 (32.4) |
44 (28.8) |
| Severe |
167 (67.6) |
109 (71.2) |
| Types of psoriasis |
Vulgaris |
167 (67.6) |
96 (62.7) |
| Pustular |
15 (6.1) |
26 (17.0) |
| Arthritic |
18 (7.3) |
17 (11.1) |
| Erythrodermic |
58 (23.5) |
14 (9.2) |
Duration of
psoriasis(years) |
Range |
0.1-53 |
0.01-40 |
| Mean |
7.6 |
6.4 |
Table 2 Descriptive characteristics of psoriatic
patients and controls.
| Risk factors |
Psoriasis1
(n=72) |
Psoriasis2
(n=328) |
Controls1
(n=86 ) |
Controls2
(n=914) |
| Hypertension |
28 (38.9) |
64 (19.5) |
13 (15.1) |
81 (8.9) |
| Dyslipidemia |
33 (45.8) |
104 (31.9) |
23 (26.7) |
149 (16.3) |
| BMI>30 |
28 (38.9) |
90 (27.5) |
18 (20.9) |
121 (13.2) |
| Smoking |
23 (31.6) |
70 (21.3) |
15 (17.4) |
90 (9.8) |
| Alcohol consumption |
19 (25.8) |
57 (17.3) |
11 (12.8) |
72 (7.8) |
| Severity of psoriasis |
53 (73.7) |
189 (57.5) |
- |
- |
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.
|
| Psoriasis1 versus
psoriasis2 |
Psoriasis1 versus
controls1 |
Psoriasis2 versus
controls2 |
|
| χ2 |
p |
OR (95%CI) |
OR (95%CI) |
OR (95%CI) |
| Hypertension |
23.7 |
<0.001 |
12.6 (1.74-2.98) |
2.81 (1.24-3.95) |
2.65 (1.81-3.05) |
| Dyslipidemia |
10.2 |
<0.005 |
2.03 (1.02-2.67) |
2.25 (1.13-2.87) |
2.10 (1.02-2.75) |
| Obesity |
7.44 |
<0.01 |
1.74 (1.32-2.20) |
1.94 (1.52-2.37) |
1.83 (1.41-2.24) |
| Smoking |
6.52 |
<0.025 |
1.46 (1.17-1.64) |
1.61 (1.30-1.81) |
1.52 (1.23-1.84) |
| Alcohol consumption |
5.33 |
<0.025 |
1.20 (1.06-1.63) |
1.42 (1.22-1.73) |
1.29 (1.13-1.68) |
| Severity of psoriasis |
12.86 |
<0.005 |
1.75 (1.41-2.38) |
- |
- |
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
1. Boehncke WH, Boehncke S, Schon M.P. Managing comorbid
disease in patients with psoriasis. BMJ 2010 ; 340 :
b5666.
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.
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