Pediatric psoriasis: C-reactive protein levels associated with disease severity, BMI

May 1, 2009

Recent study results indicate that there is a relationship between the severity of psoriasis and CRP levels, as well as BMI in pediatric patients. These patients are also at a higher cardiovascular risk, begging the need for treatment strategies in terms of lipid-lowering therapies.

Key Points

Chicago - A recent study has found distinct associations between elevated C-reactive protein (CRP) levels and psoriasis in pediatric patients.

"It has become increasingly clear that levels of CRP are a strong indicator of cardiovascular risk. The correlation of increased CRP levels with obesity and more severe psoriasis tells us that we need to pay more attention to the pediatric population," says Amy S. Paller, M.D., professor and chairman, department of dermatology, and professor, department of pediatrics, Northwestern University Medical School, Chicago.

Study

Dr. Paller and colleagues conducted a study investigating the association of chronic inflammation with obesity and disease severity in 211 children and adolescents, ages 4 to 17, with moderate to severe plaque psoriasis.

The study ran parallel to a 36-week, randomized, double-blind, placebo-controlled, North American phase 3 study with etanercept (Enbrel, Immunex) and was divided into three phases - a double-blind phase (day one to week 12), an open-label phase (weeks 13 to 36) and a withdrawal/re-treatment phase (weeks 37 to 48).

Patients received once weekly etanercept 0.8 mg/kg up to a maximum dose of 50 mg, or matching placebo. Patients were assessed at day one, weeks two, four, eight and 12, and every four weeks thereafter. Median baseline CRP values were measured using an enzyme-linked immunosorbent assay, and results were stratified by treatment group and within subgroups by baseline BMI (body mass index) percentiles and PASI scores.

Of the 211 pediatric patients in the study, 179 had baseline CRP measurements available.

Results

Study results showed that not only were median CRP levels elevated in pediatric patients with psoriasis, but CRP levels were markedly increased in the group of children (37 percent overall) with BMI greater than 95th percentile.

In addition, a trend toward increased CRP levels was observed in patients with higher PASI scores.

"These data make evident that there is an important correlation between being overweight with moderate-to-severe psoriasis and having elevated levels of CRP," Dr. Paller says.

Surrogate marker

Known as a sensitive and reliable marker of inflammation, CRP is used as a surrogate marker of psoriasis severity in adult patients.

Past observations have shown that higher CRP levels are associated with obesity (measured by BMI), a condition often seen in patients with psoriasis.

According to Dr. Paller, there is insufficient data in children to draw conclusions, but future epidemiologic studies and clinical trials of new systemic therapies for childhood psoriasis should consider monitoring CRP as an indicator for cardiovascular risk.

Now that these associations are receiving their due attention, current and future strategies may be geared to monitor not only cholesterol and HDL levels, but also CRP levels. Administering lipid-lowering agents in patients with moderate-to-severe psoriasis, a higher BMI and high levels of CRP may positively impact their higher cardiovascular risk.

"These data are an indication that we need to be paying attention beyond the skin to our pediatric patients with moderate-to-severe psoriasis, including the taking of blood pressure measurements, analyses of BMI, and, according to the latest data, perhaps lipids and CRP levels as well," Dr. Paller says.

Disclosure: Dr. Paller reports no relevant financial interests.