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Atheroma plaque, metabolic syndrome and inflammation in patients with psoriasisBackground: Chronic inflammation plays an important role in the development of cardiovascular risk factors. Although the prevalence of comorbidities and cardiovascular events has been described in patients with psoriasis, few studies have examined subclinical atherosclerosis in psoriasis patients. Objective: Our objective was to investigate the prevalence of atheroma plaques in patients with severe psoriasis compared with control subjects and to analyze the association with metabolic syndrome, homocysteine levels and inflammatory parameters. Patients and Methods: This case-control study included 133 patients, 72 with psoriasis and 61 controls consecutively admitted to the outpatient clinic in Dermatology Departments (Granada, Spain.) Results: Carotid atheroma plaques were observed in 34.7% of the psoriatic patients versus 8.2% of the controls (p=0.001) and metabolic syndrome was diagnosed in 40.3% of the psoriatic patients versus 13.1% of the controls (p<0.001). Significantly higher mean values of insulin, aldosterone, homocysteine and acute phase parameters (fibrinogen, D-dimer, C reactive protein and erythrocyte sedimentation rate) were found in psoriatic patients. Binary logistic regression showed a strong association between psoriasis and atheroma plaque and metabolic syndrome after controlling for confounding variables. Limitations: The absence of longitudinal quantification of metabolic syndrome parameters and intima-media thickness in psoriatic patients. Conclusion: The chronic inflammation and hyperhomocysteinemia found in psoriatic patients may explain the association with atheroma plaque and metabolic syndrome. Cardiovascular screening by metabolic syndrome criteria assessment and carotid ultrasound in psoriasis may be useful to detect individuals at risk and start preventive treatment against the development of cardiovascular disease.

Renal cell carcinoma is the most common form of malignant renal tumour and is extremely lethal. About 25% of the patients develop metastasis at the time of diagnosis, and in many cases during the course of the disease, affecting the lung, lymphatic ganglions, liver, and bone, with skin metastases being quite rare.A 73-year-old patient, who had undergone surgery for adenocarcinoma in the left kidney 10 years previously, visited the dermatological service due to the appearance of recent, rapidly-developing lesion at the back of his neck. It was decided to remove it surgically. The histological study confirmed clear cell carcinoma that was probably of renal origin. A computed tomography scan was performed on the thorax and abdomen, and lesions were observed that were compatible with metastasis in the right kidney and left lung. Treatment with a multikinase angiogenesis inhibitor (sunitib) was started.Due to the late development of the skin metastases and those in other regions that worsen the prognosis, these patients must be subjected to long-term clinical observation. Urologist should pay attention to cutaneous lesion appearing in these patients as in many times they look like benign lesion.

Vitamin D deficiency is associated with higher cardiovascular risk and metabolic syndrome (MeS) criteria. The main objective of this study was to analyse the association of 25-hydroxyvitamin D (25-OHD) serum levels with MeS (National Cholesterol Education Program-Adult Treatment Panel-III criteria) in 46 Spanish patients with psoriasis, but without arthritis and systemic treatment, and 46 control subjects, matched by sex and age. The patients with psoriasis showed significantly lower level of 25-OHD than controls (30.5 vs. 38.3 ng/ml; p = 0.0001). Patients with MeS had significantly lower serum levels of 25-OHD than those without MeS (24.1 ± 7.5 vs. 32.8 ± 8.9, p = 0.007), and a negative correlation was found between 25-OHD and waist circumference, diastolic blood pressure, fasting glucose, and triglyceridaemia. In the control group no significant correlation between 25-OHD and MeS was found. Al-though the sample was small, our results suggest a potential protective role for 25-OHD in the metabolic profile of patients with psoriasis without arthritis.

• The results were analyzed by analysis of variance and Pearson's correlation coefficient. RESULTS• Patients with relapsed calcium renal lithiasis present a greater BMD loss than those in the O or A groups.• Densitometry: T-score femur − 0.2 group O, − 0.5 group A, − 1.2 group B ( P = 0.001); T-score column − 0.6 group O, − 0.6 group A, − 1.3 group B ( P = 0.05).• A statistically significant negative correlation exists between values of β -crosslaps and T-score femur ( R = − 0.251; P = 0.009) and T-score column ( R = − 0.324; P = 0.001); thus, a higher concentration of β -crosslaps was accompanied by a lower value of the T-score and a greater loss of BMD.• A positive relationship is observed between β -crosslaps and osteocalcin ( R = 0.611; P < 0.001) and between calciuria and cocient β -crosslaps/osteocalcin ( R = 0.303; P = 0.001). CONCLUSIONS• A statistically significant relationship is shown between the loss of BMD and relapsed calcium renal lithiasis.• Determination of bone remodelling markers (i.e. osteocalcin and β -crosslaps) facilitates the diagnosis of osteopaenia/ osteoporosis in these patients. KEYWORDScalcium lithiasis, bone density, bone remodelling markers, bone densitometry What's known on the subject? and What does the study add? Hypercalciuria is related with bone mineral density loss.This study demonstrates the relationship between recurrent calcium nephrolithiasis and bone mineral density loss and their correlation with bone markers.Study Type -Aetiology (case control) Level of Evidence 3b OBJECTIVES• To show that a relationship exists between the loss of bone mineral density (BMD) and calcium renal lithiasis and that bone remodelling markers correlate with changes in BMD.• It is possible that many cases hypercalciuria are related to the increase of bone turnover and the predominance of bone resorption phenomena. PATIENTS AND METHODS• The present study comprised a transversal investigation in three groups: group O, without lithiasis; group A, with a single episode of lithiasis; and group B, with relapsed calcium renal lithiasis.• An analysis was made of body mass index; abdominal X-ray and/or urography and renal ultrasonography; osteocalcin and β -crosslaps bone markers; calcium and citrate concentrations in the urine; and femur and spinal column bone densitometry.