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Diseases associated to psoriasis
G. Girolomoni
Department of Medicine, Section of Dermatology and Venereology, University of Verona

Chronic plaque psoriasis is frequently associated with cardio-metabolic disorders including myocardial infarction, stroke, hypertension, diabetes, obesity, dyslipidemia, metabolic syndrome and non-alcoholic fatty liver disease (NAFLD). Common genetic traits, unhealthy life style behaviours as well as common inflammatory mechanisms, such as elevated levels of multifunctional cytokines (i.e. TNF-ª) may underlie the association of psoriasis and cardio-metabolic co-morbidities. In particular, psoriasis and psoriatic arthritis are associated with increased atherothrombotic diseases such as myocardial infarction and deep venous thrombosis, and ultimately reduced life span. Both disease-specific and non-disease specific risk factors are likely to fuel each other in deleterious vicious circles. Disease specific risk factors are a direct consequence of psoriasis inflammation and include hyperhomocysteinemia, elevated C-reactive protein, elevated blood inflammatory cytokines and platelet activation. Non-disease specific risk factors comprise insulin resistance/diabetes, obesity, dyslipidemia, hypertension, metabolic syndrome and smoking habit. The presence of co-morbidities has important implications in the global approach to patients with psoriasis, and impact the therapy choice. Traditional systemic anti-psoriatic agents could negatively affect cardio-metabolic co-morbidities (eg, methotrexate on NALFD, ciclosporin on hypertension and diabetes), and may have important interactions with drugs commonly used by psoriasis patients (eg, methotrexate and NSAIDs, ciclosporin and statins). In contrast, biological agents do not have negative interactions with cardio-metabolic co-morbidities. Finally, patients with moderate to severe psoriasis should be treated promptly and effectively, should also be encouraged to drastically correct their modifiable cardiovascular risk factors, in particular obesity, alcohol consumption and smoking habit.

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8.Gisondi P, Del Giglio M, Di Francesco V, Zamboni M, Girolomoni G. Weight loss improves the response of obese patients with moderate-to-severe chronic plaque psoriasis to low-dose cyclosporine therapy: a randomized, controlled, investigator-blinded, clinical trial. Am J Clin Nutr 88:1242-1247, 2008.
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