Psoriasis and metabolic syndrome seem to be increasingly related disease entities.
Inflammation appears to be one of the features seen in all of these diseases, and therapeutic strategies aimed at decreasing the inflammatory state of the patient may be an effective approach in treating not only psoriasis, but some of its comorbidities, as well.
Data shows that patients with severe psoriasis at age 30 have a three-fold increase in myocardial infarction, and it is presumed that inflammation is one of the contributing factors here.
"Numerous database studies have proven that psoriasis patients have increased myocardial infarctions, increased atherosclerosis, increased peripheral vascular disease, as well as a higher risk of stroke and angina. Psoriasis therapy can reduce some of these risk factors, presumably by reducing inflammation, which impacts heart disease in a beneficial way," Dr. Lebwohl says.
Whether psoriasis therapy can impact the potential for psoriasis patients to develop diabetes or other metabolic syndrome components in their future - or whether diabetes therapy can impact the development of psoriasis - remains a gray area, but some clues are emerging that appear to indicate that anti-inflammatory therapies such as anti-tumor necrosis factor (TNF)-alpha may be able to address both camps.
Psoriasis is associated with an increased expression in TNF-alpha in the skin and joints, as well as in components of the metabolic syndrome. This cytokine has numerous effects on the immune response, driving activation and recruitment of other inflammatory cells, amplifying production of IL-1, IL-6 and IL-8.
The important role of TNF-alpha in psoriasis has been largely demonstrated by the efficacy of anti-TNF-alpha biologic therapy.
According to Rosita Saraceno M.D., department of dermatology, University of Rome Tor Vergata, Rome, anti-TNF-alpha agents not only represent an effective treatment for psoriasis, but they also can address metabolic syndrome components mediated by this cytokine.
"The pathogenesis of metabolic syndrome and psoriasis is associated with an increased release and production of pro-inflammatory cytokines.
"Therefore, psoriasis therapies aimed at decreasing inflammation can potentially reduce the risk of comorbidities with similar inflammatory pathways," Dr. Saraceno said.