Psoriasis comorbidities: complications and benefits of immunobiological treatment

Abstract

During the last decade, different studies have converged to evidence the high prevalence of comorbidities in subjects with psoriasis. Although a causal relation has not been fully elucidated, genetic relation, inflammatory pathways and/or common environmental factors appear to be underlying the development of psoriasis and the metabolic comorbidities. The concept of psoriasis as a systemic disease directed the attention of the scientific community in order to investigate the extent to which therapeutic interventions influence the onset and evolution of the most prevalent comorbidities in patients with psoriasis. This study presents scientific evidence of the influence of immunobiological treatments for psoriasis available in Brazil (infliximab, adalimumab, etanercept and ustekinumab) on the main comorbidities related to psoriasis. It highlights the importance of the inflammatory burden on the clinical outcome of patients, not only on disease activity, but also on the comorbidities. In this sense, systemic treatments, whether immunobiologicals or classic, can play a critical role to effectively control the inflammatory burden in psoriatic patients.

Hyperproliferation is the main driver of metabolomic changes in psoriasis lesional skin

“…Psoriasis is a chronic inflammatory skin disease that affects 1-2% of the population and has a profound impact on the quality of life of those affected by this condition 1,2 . There are a number of comorbidities associated with psoriasis: metabolic syndrome and its components (central obesity, atherogenic dyslipidemia, systemic arterial hypertension, insulin resistance), cardiovascular disease (CVD) and non-alcoholic steatohepatitis 3,4 .…”

“…Five of the psoriasis patients had psoriatic joint involvement and 7 had nail involvement. The comorbidities the psoriasis patients had were following: food allergies (1 patient), drug allergies (1), dust mite allergies (2), urticaria (no active rash at the time of biopsy) (2), diabetes (2), thyroid disease (1), rheumatoid arthritis (1) and hypertension (4). Nine of the 20 patients had positive family history of psoriasis.…”

Evaluation of Psoriasis Patients

“…Genetic susceptibility, inflammatory pathways and common environmental factors (tobacco smoking, alcohol consumption, psychological stress and low physical activity) are responsible for the development of psoriasis and metabolic comorbidities. These disorders share similar pathophysiological phenomena: chronic inflammation with high production of pro-inflammatory cytokines (especially TNF-alpha, IFN-gamma, IL-1, IL-2, IL-6, IL-8 and IL-17) that induces angiogenesis, adipogenesis, oxidative stress, insulin signaling, lipid metabolism and immune cell traffic [72,73]. Metabolic aspects of chronic inflammation Th-1/Th-17 in psoriasis would have a role of predisposition and reciprocal aggravation on other conditions, such as obesity, diabetes and atherosclerosis [74].…”

Medical Management of Chronic Plaque Psoriasis in the Modern Age

“…In the next step, these cells will raise the production of psoriatic cytokines such as IL-17 within the site of injury, hence increasing the keratinocytes' turnover and eventually piloting towards the cutaneous symptoms of psoriasis [18][19][20][21]. Also, the proinflammatory substances may extend into the bloodstream with a significant influence on insulin signalling, angiogenesis, lipogenesis or adipogenesis, which will ultimately lead to comorbidities such as obesity and dyslipidaemia, hypertension, depression and type 2 diabetes mellitus [3,22]. Grasping the mechanisms of psoriasis is the utmost step in offering the best available therapy.…”