Psoriasis and comorbid diseases : Implications for management - 18/04/17

Doi : 10.1016/j.jaad.2016.07.065

Junko Takeshita, MD, PhD, MSCE ^a,^b,^⁎ , Sungat Grewal, BS ^a, Sinéad M. Langan, MB, BCh, BAO, MRCP, MSc, PhD ^c, Nehal N. Mehta, MD, MSCE ^d, Alexis Ogdie, MD, MSCE ^b,^e, Abby S. Van Voorhees, MD ^f, Joel M. Gelfand, MD, MSCE ^a,^b
^a Department of Dermatology, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania
^b Department of Epidemiology and Biostatistics, Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania
^e Division of Rheumatology, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania
^c London School of Hygiene and Tropical Medicine and St. John's Institute of Dermatology, London, United Kingdom
^d National Heart, Lung and Blood Institute, Bethesda, Maryland
^f Department of Dermatology, Eastern Virginia Medical School, Norfolk, Virginia

^∗Correspondence to: Junko Takeshita, MD, PhD, MSCE, Department of Dermatology, University of Pennsylvania, 3400 Civic Center Boulevard, Perelman Center for Advanced Medicine, 7th Floor, South Tower, Office 728, Philadelphia, PA 19104.Department of DermatologyUniversity of Pennsylvania3400 Civic Center Boulevard, Perelman Center for Advanced Medicine, 7th Floor, South Tower, Office 728PhiladelphiaPA19104

Abstract

As summarized in the first article in this continuing medical education series, the currently available epidemiologic data suggest that psoriasis may be a risk factor for cardiometabolic disease. Emerging data also suggest associations between psoriasis and other comorbidities beyond psoriatic arthritis, including chronic kidney disease, inflammatory bowel disease, hepatic disease, certain malignancies, infections, and mood disorders. Recognizing the comorbid disease burden of psoriasis is essential for ensuring comprehensive care of patients with psoriasis. The clinical implications of the comorbid diseases that are associated with psoriasis and recommendations for clinical management are reviewed in this article.

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Key words : cardiovascular disease, chronic kidney disease, comorbidities, Crohn's disease, depression, infection, lymphoma, metabolic syndrome, nonalcoholic fatty liver disease, psoriasis, psoriatic arthritis, screening, vaccination

Abbreviations used : BMI, BSA, CD, CDC, CIRT, CTCL, CV, CVD, FDA, IBD, IL, MACE, NAFLD, NMSC, PASI, PUVA, RA, RCT, TB, TNF, UC

Plan

Cardiometabolic disease

Major adverse cardiovascular events

Gastrointestinal disease

Inflammatory bowel disease

Hepatic disease

Chronic kidney disease

	Supported in part by National Institute of Arthritis and Musculoskeletal and Skin Diseases grants K24AR064310 (Dr Gelfand), T32AR00746532 (Ms Grewal), K23AR063764 (Dr Ogdie), and K23AR068433 (Dr Takeshita), a Dermatology Foundation Career Development Award (Dr Takeshita), the Intramural Research Program at the National Institutes of Health grant ZIAHL006193-02 (Mehta), and a National Institute for Health Research Clinician Scientist Fellowship (grant NIHR/CS/010/014 to Dr Langan). The findings and conclusions in this report are those of the authors and do not necessarily represent the views of the UK Department of Health.
	Dr Takeshita has received a research grant (to the Trustees of the University of Pennsylvania) from Pfizer Inc and payment for continuing medical education work related to psoriasis. Dr Mehta is a full-time employee of the US Government. Dr Ogdie receives research grants from AbbVie (to the Group for Research and Assessment of Psoriasis and Psoriatic Arthritis [GRAPPA]), Celgene (to GRAPPA), and Pfizer Inc (to the Trustees of the University of Pennsylvania and GRAPPA), and has served as a consultant for Novartis, receiving honoraria. Dr Van Voorhees has served as a consultant for AbbVie, Amgen, Aqua, AstraZeneca, Celgene, Corrona, Dermira, Janssen, Leo, Novartis, and Pfizer, receiving honoraria; received a research grant from AbbVie; and has other relationship with Merck. Dr Gelfand has served as a consultant for AbbVie, AstraZeneca, Celgene Corp, Coherus, Eli Lilly, Janssen Biologics (formerly Centocor), Sanofi, Merck, Novartis Corp, Endo, and Pfizer Inc, receiving honoraria; receives research grants (to the Trustees of the University of Pennsylvania) from AbbVie, Amgen, Eli Lilly, Janssen, Novartis Corp, Regeneron, and Pfizer Inc; and received payment for continuing medical education work related to psoriasis. Dr Gelfand is a co–patent holder of resiquimod for treatment of cutaneous T-cell lymphoma. No other potential conflicts of interest were declared by the authors.
	Date of release: March 2017
	Expiration date: March 2020