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      Psoriasis: classical and emerging comorbidities *

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          Abstract

          Psoriasis is a chronic inflammatory systemic disease. Evidence shows an association of psoriasis with arthritis, depression, inflammatory bowel disease and cardiovascular diseases. Recently, several other comorbid conditions have been proposed as related to the chronic inflammatory status of psoriasis. The understanding of these conditions and their treatments will certainly lead to better management of the disease. The present article aims to synthesize the knowledge in the literature about the classical and emerging comorbidities related to psoriasis.

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          Pathogenesis and clinical features of psoriasis.

          Christopher EM Griffiths, Jonathan Barker (2007)
          Psoriasis, a papulosquamous skin disease, was originally thought of as a disorder primarily of epidermal keratinocytes, but is now recognised as one of the commonest immune-mediated disorders. Tumour necrosis factor alpha, dendritic cells, and T-cells all contribute substantially to its pathogenesis. In early-onset psoriasis (beginning before age 40 years), carriage of HLA-Cw6 and environmental triggers, such as beta-haemolytic streptococcal infections, are major determinants of disease expression. Moreover, at least nine chromosomal psoriasis susceptibility loci have been identified. Several clinical phenotypes of psoriasis are recognised, with chronic plaque (psoriasis vulgaris) accounting for 90% of cases. Comorbidities of psoriasis are attracting interest, and include impairment of quality of life and associated depressive illness, cardiovascular disease, and a seronegative arthritis known as psoriatic arthritis. A more complete understanding of underlying pathomechanisms is leading to new treatments, which will be discussed in the second part of this Series.
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            Psoriatic arthritis: epidemiology, clinical features, course, and outcome.

            D D Gladman, C Antoni, P. Mease … (2005)
            Psoriatic arthritis (PsA) has been defined as a unique inflammatory arthritis associated with psoriasis. Its exact prevalence is unknown, but estimates vary from 0.3% to 1% of the population. The clinical features described initially are recognised by most experienced clinicians, although they are most distinct in early disease. Initially, PsA typically presents as an oligoarticular and mild disease. However, with time PsA becomes polyarticular, and it is a severe disease in at least 20% of patients. Patients with PsA who present with polyarticular disease are at risk for disease progression. In addition to progression of clinical and radiological damage, health related quality of life is reduced among patients with PsA. It important to note that patients included in recent drug trials resemble patients followed prospectively in a clinic.
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              Non alcoholic fatty liver disease and metabolic syndrome.

              P Paschos, K Paletas (2008)
              Non-alcoholic fatty liver disease (NAFLD) is a clinicopathologic entity increasingly recognized as a major health burden in developed countries. It includes a spectrum of liver damage ranging from simple steatosis to nonalcoholic steatohepatitis (NASH), advanced fibrosis, and rarely, progression to cirrhosis. Recent studies emphasize the role of insulin resistance, oxidative stress and subsequent lipid peroxidation, proinflammatory cytokines, adipokines and mitochondrial dysfunction in the development and progression of NAFLD. Furthermore, accumulating evidence supports an association between NAFLD and metabolic syndrome. Although the data are mainly epidemiological, the pathogenesis of NAFLD and metabolic syndrome seems to have common pathophysiological mechanisms, with focus on insulin resistance as a key factor. This review summarizes the current knowledge on the epidemiology, pathophysiology and diagnosis of both NAFLD and metabolic syndrome and the findings that strongly support the association of nonalcoholic fatty liver disease as a possible component in the cluster of metabolic syndrome.
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                Author and article information

                Journal
                Journal ID (nlm-ta): An Bras Dermatol
                Journal ID (iso-abbrev): An Bras Dermatol
                Title: Anais Brasileiros de Dermatologia
                Publisher: Sociedade Brasileira de Dermatologia
                ISSN (Print): 0365-0596
                ISSN (Electronic): 1806-4841
                Publication date (Print and electronic): Jan-Feb 2015
                Publication date (Print): Jan-Feb 2015
                Volume: 90
                Issue: 1
                Pages: 9-20
                Affiliations
                [1 ]Federal University of Bahia (UFBA) – Salvador (BA), Brazil.
                [2 ]University of Toronto (UofT) – Toronto (ON), Canada.
                Author notes
                MAILING ADDRESS: Bruno de Oliveira Rocha, Rua Padre Feijó, 240, Ambulatório Magalhães Neto, 3º. Andar, Canela, 40110-170 - Salvador - BA, Brazil. E-mail: brunorocha.17@ 123456hotmail.com
                Article
                DOI: 10.1590/abd1806-4841.20153038
                PMC ID: 4323693
                PubMed ID: 25672294
                SO-VID: 0926b876-6892-4e7f-a555-21732f1af863
                Copyright © ©2015 by Anais Brasileiros de Dermatologia
                License:

                This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                Date received : 07 August 2013
                Date accepted : 28 August 2013
                Categories
                Subject: Continuing Medical Education

                Keywords: psoriatic arthritis,depression,crohn disease,fatty liver,lymphoma,obesity,psoriasis,uveitis
                Data availability:
                Keywords: psoriatic arthritis, depression, crohn disease, fatty liver, lymphoma, obesity, psoriasis, uveitis

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