Альманах клинической медицины. 2018; 46: 76-81
Разнообразие коморбидной патологии у больных псориазом тяжелого течения
https://doi.org/10.18786/2072-0505-2018-46-1-76-81Аннотация
Актуальность. Отмечается рост тяжелых форм псориаза, торпидных к лечению, а также коморбидной патологии.
Цель – изучить распространенность сопутствующей патологии в госпитальной когорте пациентов с тяжелым псориазом.
Материал и методы. Проведен ретроспективный анализ данных историй болезни 890 больных псориазом тяжелого и среднетяжелого течения (PASI > 10), находившихся на стационарном лечении в период с 2010 по 2015 г. Мужчин было 516 (58%), женщин – 374 (42%), средний возраст пациентов составил 51,9 ± 11,6 года, среднее значение PASI – 44,3 ± 7,8.
Результаты. Сопутствующая патология была диагностирована у 61% (543 из 890) больных тяжелыми формами псориаза. В структуре коморбидности лидирующее место занимали заболевания сердечно-сосудистой системы – 58% (516 из 890) случаев, далее следовали заболевания желудочно-кишечного тракта и гепатобилиарной системы – 46,4% (413 из 890). Псориатический артрит выявлялся в 34% (у 303 из 890) случаев, другие заболевания костно-мышечной системы, не связанные с псориазом, – в 19,8% (176 из 890). Доля сахарного диабета составила 15,4% (137 из 890).
Заключение. Выявлена высокая частота сочетания псориаза с сопутствующей патологией, особенно с поражением сердечно-сосудистой системы. Это значительно отягощает течение псориаза, ухудшает ответ на терапию, в ряде случаев (в связи с имеющимися противопоказаниями) снижает возможность назначения полноценного антипсориатического лечения.
Список литературы
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14. Davidovici BB, Sattar N, Prinz J, Puig L, Emery P, Barker JN, van de Kerkhof P, Ståhle M, Nestle FO, Girolomoni G, Krueger JG. Psoriasis and systemic inflammatory diseases: potential mechanistic links between skin disease and co-morbid conditions. J Invest Dermatol. 2010;130(7): 1785–96. doi: 10.1038/jid.2010.103.
15. Augustin M, Vietri J, Tian H, Gilloteau I. Incremental burden of cardiovascular comorbidity and psoriatic arthritis among adults with moderate-to-severe psoriasis in five European countries. J Eur Acad Dermatol Venereol. 2017;31(8): 1316–23. doi: 10.1111/jdv.14286.
16. Sommer DM, Jenisch S, Suchan M, Christophers E, Weichenthal M. Increased prevalence of the metabolic syndrome in patients with moderate to severe psoriasis. Arch Dermatol Res. 2006;298(7): 321–8. doi: 10.1007/s00403-006-0703-z.
Almanac of Clinical Medicine. 2018; 46: 76-81
Multiplicity of comorbidities in patients with severe psoriasis
https://doi.org/10.18786/2072-0505-2018-46-1-76-81Abstract
Rationale: Severe treatment-resistant psoriasis and comorbidities are on the rise.
Aim: To evaluate the prevalence of comorbidities in a hospital-based cohort of patients with severe psoriases.
Materials and methods: We performed a retrospective analysis of medical files of 890 patients with moderate-to-severe plaque psoriasis (PASI > 10) treated in a hospital from 2010 to 2015 (men, 516 [58%], women, 374 [42%]; mean age 51.9 ± 11.6 years; mean PASI, 44.3 ± 7.8 scores).
Results: Comorbidities were found in 61% (543 / 890) of the patients with severe psoriasis, with cardiovascular disorders ranking first (59%, or 516 / 890) and gastrointestinal and hepatobiliary disorders ranking second (46,4%, or 413 / 890). Psoriatic arthritis was diagnosed in 34% (303 / 890) of the patients and other disorders of the musculoskeletal system unrelated to psoriasis in 19.8% (176 / 890). The proportion of diabetes was 15.4% (137 / 890).
Conclusion: Psoriasis has a high rate of comorbidities, in particular of cardiovascular disorders. It significantly deteriorates the course of psoriasis and its response to therapy, and in some cases may reduce the possibility of adequate anti-psoriatic treatment due to contraindications.References
1. Yeung H, Takeshita J, Mehta NN, Kimmel SE, Ogdie A, Margolis DJ, Shin DB, Attor R, Troxel AB, Gelfand JM. Psoriasis severity and the prevalence of major medical comorbidity: a population-based study. JAMA Dermatol. 2013;149(10): 1173–9. doi: 10.1001/jamadermatol.2013.5015.
2. Armstrong AW, Harskamp CT, Armstrong EJ. Psoriasis and the risk of diabetes mellitus: a systematic review and meta-analysis. JAMA Dermatol. 2013;149(1): 84–91. doi: 10.1001/2013.jamadermatol.406.
3. Horreau C, Pouplard C, Brenaut E, Barnetche T, Misery L, Cribier B, Jullien D, Aractingi S, Aubin F, Joly P, Le Maître M, Ortonne JP, Paul C, Richard MA. Cardiovascular morbidity and mortality in psoriasis and psoriatic arthritis: a systematic literature review. J Eur Acad Dermatol Venereol. 2013;27 Suppl 3:12–29. doi: 10.1111/jdv.12163.
4. Mufaddel A, Abdelghani AE. Psychiatric comorbidity in patients with psoriasis, vitiligo, acne, eczema and group of patients with miscellaneous dermatological diagnoses. Open Journal of Psychiatry. 2014;4:168–75. doi: 10.4236/ojpsych.2014.43022.
5. Dogan S, Atakan N. Psoriasis: a disease of systemic inflammation with comorbidities. In: Lima H, editor. Psoriasis – types, causes and medication. InTech; 2013. doi: 10.5772/54347.
6. Batkaeva NV, Korotaeva TV, Batkaev EA. Rasprostranennost' psoriaticheskogo artrita i komorbidnykh zabolevanii u bol'nykh tyazhelym psoriazom: dannye retrospektivnogo analiza gospital'noi kogorty. Sovremennaya revmatologiya. 2017;11(1): 19–22. doi: 10.14412/1996-7012-2017-1-19-22.
7. Mehta NN, Yu Y, Saboury B, Foroughi N, Krishnamoorthy P, Raper A, Baer A, Antigua J, Van Voorhees AS, Torigian DA, Alavi A, Gelfand JM. Systemic and vascular inflammation in patients with moderate to severe psoriasis as measured by [18F]-fluorodeoxyglucose positron emission tomography-computed tomography (FDG-PET/ CT): a pilot study. Arch Dermatol. 2011;147(9): 1031–9. doi: 10.1001/archdermatol.2011.119.
8. Frers K, Bisoendial RJ, Montoya SF, Kerzkerg E, Castilla R, Tak PP, Milei J, Capani F. Psoriasis and cardiovascular risk: Immune-mediated crosstalk between metabolic, vascular and autoimmune inflammation. IJC Metabolic & Endocrine. 2015;6:43–54. doi: 10.1016/j.ijcme.2015.01.005.
9. Cohen AD, Weitzman D, Dreiher J. Psoriasis and hypertension: a case-control study. Acta Derm Venereol. 2010;90(1): 23–6. doi: 10.2340/00015555-0741.
10. Al-Mutairi N, Al-Farag S, Al-Mutairi A, Al-Shiltawy M. Comorbidities associated with psoriasis: an experience from the Middle East. J Dermatol. 2010;37(2): 146–55. doi: 10.1111/j.1346-8138.2009.00777.x.
11. Wang Y, Gao H, Loyd CM, Fu W, Diaconu D, Liu S, Cooper KD, McCormick TS, Simon DI, Ward NL. Chronic skin-specific inflammation promotes vascular inflammation and thrombosis. J Invest Dermatol. 2012;132(8): 2067–75. doi: 10.1038/jid.2012.112.
12. Prey S, Paul C, Bronsard V, Puzenat E, Gourraud PA, Aractingi S, Aubin F, Bagot M, Cribier B, Joly P, Jullien D, Maitre ML, Richard-Lallemand MA, Ortonne JP. Assessment of risk of psoriatic arthritis in patients with plaque psoriasis: a systematic review of the literature. J Eur Acad Dermatol Venereol. 2010;24 Suppl 2:31– 5. doi: 10.1111/j.1468-3083.2009.03565.x.
13. Willerson JT, Ridker PM. Inflammation as a cardiovascular risk factor. Circulation. 2004;109(21 Suppl 1):II2–10. doi: 10.1161/01.CIR.0000129535.04194.38.
14. Davidovici BB, Sattar N, Prinz J, Puig L, Emery P, Barker JN, van de Kerkhof P, Ståhle M, Nestle FO, Girolomoni G, Krueger JG. Psoriasis and systemic inflammatory diseases: potential mechanistic links between skin disease and co-morbid conditions. J Invest Dermatol. 2010;130(7): 1785–96. doi: 10.1038/jid.2010.103.
15. Augustin M, Vietri J, Tian H, Gilloteau I. Incremental burden of cardiovascular comorbidity and psoriatic arthritis among adults with moderate-to-severe psoriasis in five European countries. J Eur Acad Dermatol Venereol. 2017;31(8): 1316–23. doi: 10.1111/jdv.14286.
16. Sommer DM, Jenisch S, Suchan M, Christophers E, Weichenthal M. Increased prevalence of the metabolic syndrome in patients with moderate to severe psoriasis. Arch Dermatol Res. 2006;298(7): 321–8. doi: 10.1007/s00403-006-0703-z.
