BOSTON, Massachusetts—Mounting scientific evidence suggests that psoriasis is a systemic illness linked to diabetes, heart disease, stroke, and metabolic syndrome, but TNF-blockade may reduce these risks, said Mark G. Lebwohl, MD, at the American Academy of Dermatology’s 2009 Summer Academy Meeting in Boston.1 Dr. Lebwohl is professor and chair of dermatology at the Mount Sinai School of Medicine in New York City, NY.

“We know that patients with psoriasis are more likely to smoke, less likely to exercise and eat well than people without psoriasis [and] we also know that some markers showing inflammation in psoriasis such as C-reactive protein (CRP) contribute to the development of heart disease.”—Mark G. Lebwohl, MD
Dr. Lebwohl is also the chairman of the Medical Board of the National Psoriasis Foundation, the founding editor of Psoriasis Forum and the medical editor of the bulletin of the National Psoriasis Foundation, Psoriasis Advance.

“We know that patients with psoriasis are more likely to smoke, less likely to exercise and eat well than people without psoriasis,” Dr. Lebwohl said during the meeting’s plenary session. “We also know that some markers showing inflammation in psoriasis, such as C-reactive protein (CRP), contribute to the development of heart disease.”

Other inflammatory mediators elevated in psoriasis patients include glycoprotein, leptin, and homocysteine, Dr. Lebwohl said. Moreover, adiponectin levels are lower, and there is evidence of platelet hyperactivity in psoriasis patients.

These factors more than triple the risk of myocardial infarction in psoriasis patients than individuals without psoriasis. “There is also an increase in risk for the metabolic syndrome, peripheral artery disease, stroke, high blood pressure and hyperlipidemia in psoriasis patients,” Dr. Lebwohl said.

Does anti-TNF treatment improve outlook and survival?

At least one TNF-blocker, etanercept (Enbrel), reduces CRP levels, so some researchers are looking at whether TNF-blockade can protect against cardiovascular disease, according to Dr. Lebwohl, and some studies in rheumatoid arthritis (RA) patients have shown positive results.

“In one study of RA patients on TNF-blockers, there was a 50% reduced risk of death due to the dramatic reduction in heart attacks in RA patients treated with TNF-blockers,” said Dr. Lebwohl.

And expensive biologic agents are not the only hope for reducing the risk of heart attack and death. “Methotrexate also reduce risk of cardiovascular death in RA,” Dr. Lebwohl added.

Reference
1. Lebwohl MG. Psoriasis: A Newly Defined Systemic Illness. Do Treatments Affect Comorbidities? Presented at: American Academy of Dermatology’s Summer Academy Meeting 2009. July 29-August 2, 2009; Boston, Mass.