There’s an interesting new study,1 reported in the popular press last week,2 to the effect that people treated for moderate to severe psoriasis with a class of drugs called ‘biologics’ show improvement in coronary artery inflammation, a condition that’s associated with psoriasis. Biologics are pharmaceutical products derived from biological sources.
There’s a connection between psoriasis and arterial inflammation, in other words.
Was anyone really surprised?
Actually, no. The data has been mounting for a long time, that psoriasis shares causal mechanisms and risk factors with a lot of other diseases, some of which might seem surprising, because they don’t appear as dermatology problems.
This latest study is just more confirmation that psoriasis, a common chronic inflammatory disease of the skin, is really a systemic disorder, and quite a complex one, with health implications far beyond the skin.
Psoriasis is not just another form of itchy rash, in other words, a bad dermatitis, that ought to be clearable with some sort of extra-strength cream.
We don’t know what all the shared causal mechanisms are yet, with the other conditions that are associated with psoriasis, but we do know what a lot of those conditions are.3
For instance, we’ve known for some time that psoriatic arthritis goes with psoriasis fairly frequently. We know that cardiometabolic disease is prevalent among people with bad psoriasis. We know there’s an increased risk of myocardial infarction, a kind of heart attack. We also know that obesity is an independent risk factor for psoriasis, and that there are high associations between psoriasis and high blood pressure and diabetes. Psoriasis may be associated with increased prevalence of irritable bowel syndrome, and certain liver and kidney disorders. There is even a statistical connection between psoriasis and certain cancer malignancies, notably lymphoma. The list continues to expand as we learn more. It’s beginning to look like there might be associations between psoriasis and chronic obstructive pulmonary disease, for example, and with peptic ulcer disease.
We speak of disease associations as ‘comorbidity’. The word sounds dreadful, but it just refers to the simultaneous presence of chronic conditions together. Having psoriasis does not mean you’ll necessarily have all or any of these other comorbid conditions, or that having any of those means you’ll develop psoriasis.
But they are related statistically, and gradually we’re beginning to understand why some of that is, biochemically.
The lesson is that widely ranging comorbidities imply that psoriasis is actually quite a complex syndrome, much more than we used to think. This is what we like to explain to patients who come for help with their psoriasis, and who sometimes find themselves frustrated by how long it takes before there’s an improvement.
Treating psoriasis isn’t always as simple as putting on some cream. This isn’t like treating your eczema.
In fact, there actually isn’t a cure for psoriasis at all, in the usual sense of the word. It’s an auto-immune disorder. It can be managed, however, and fairly well … but management can be tricky. Topical vitamin-D and corticosteroid creams do often help. Light-therapy can also be beneficial. There are also oral and injected medications for severe cases. You can ask your doctor about ‘PDE4 inhibitors’, ‘TNF-alpha inhibitors’, and of course, biologic agents. There is much that can be done.
But psoriasis is a complex disease. It isn’t a superficial skin condition. And that’s why treating it can often take some time.
1JAMA Cardiol. 2019 Jul 31. doi: 10.1001/jamacardio.2019.2589. [Epub ahead of print]
3J Am Acad Dermatol. 2017 Mar;76(3):377-390.
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