Psoriasis was previously thought to just affect the skin and joints. However, our understanding of the associated comorbidities (having two chronic conditions at the same time) has grown considerably in recent years.
Recent evidence has revealed an increased overall mortality risk in patients with severe psoriasis. Thus, understanding these clinical comorbidities will help in effectively treating psoriatic patients.
Heart Disease and Metabolic Syndrome
Patients with psoriasis have an increased risk of cardiovascular disease due to frequent obesity, hypertension and high cholesterol at the onset of psoriasis.
Cardiovascular diseases are observed more often in psoriasis patients. Similarly, the prevalence of metabolic syndromes have also been found to be elevated in hospitalized patients with psoriasis when compared to hospitalized patients without psoriasis.
Psoriasis patients also have a higher rate of heart attack after correcting for heart disease risk factors like diabetes, smoking, obesity, hyperlipidemia and hypertension.
Patients with systemic lupus also have an increased incidence of coronary artery disease, which suggests that chronic inflammation is the promoter for both processes.
Preliminary data suggest that controlling such inflammation with methotrexate and/or TNF inhibitors can significantly decrease cardiovascular mortality. This is likely due to a control in systemic inflammation, often measured by a CRP or ESR, which are laboratory markers for systemic inflammation.
A number of studies have found that people with psoriasis and psoriatic arthritis have an increased risk of certain types of cancer. A connection also exists between patients with psoriasis and the development of lymphoma as well as non-melanoma/melanoma skin cancers.
One study of more than 2,700 psoriasis patients followed for four years indicated a near threefold increased relative risk of developing any type of lymphoma compared with controls adjusted for age and gender.
A recent study showed that no single treatment of psoriasis raises the risk of cancer, suggesting that it is the disease itself that is to blame. People with psoriasis should get regular cancer screenings.
Other Autoimmune Diseases
Autoimmune diseases, such as Crohn’s disease and ulcerative colitis, have been shown to be more prevalent in patients with psoriasis. Multiple sclerosis and psoriasis have also been genetically linked in families. And there is an association with other autoimmune diseases, such as rheumatoid arthritis, Sjogren syndrome and lupus.
Psoriasis has been associated with an increased prevalence of depression (up to 60 percent) and anxiety. When assessing quality-of-life indices, especially in young patients, having psoriasis rates as bad as having cancer, congestive heart failure and chronic lung disease.
In one study, nearly 10 percent of psoriasis patients wished to be dead and 5 percent reported active suicidal ideation. Another study looking at patients with psoriasis treated with etanercept (Enbrel) showed a decrease in overall depression scores.
A small study of people with psoriatic disease found that 60 percent had osteopenia (an early form of osteoporosis) and 18 percent had full-fledged osteoporosis.
According to the study, the risk of developing the bone disease increases the longer a person has psoriatic disease. While osteoporosis usually affects women more than men, in this case, men were affected more than women. A bone-density scan is necessary to screen patients with psoriasis.
Type 2 Diabetes
People with psoriasis and psoriatic arthritis have an increased risk for Type 2 diabetes, according to a 2012 study. In particular, people with severe psoriasis are 30 percent more likely to have Type 2 diabetes.
Psoriasis and psoriatic arthritis raise your risk of developing uveitis, an inflammatory disease of the eye. According to recent studies, about 7 percent of people with psoriatic arthritis will develop uveitis. Systemic treatment for psoriatic disease can help with some of the symptoms, but uveitis usually requires specific treatment.
People with psoriasis and psoriatic arthritis may be at greater risk for a liver condition called nonalcoholic fatty liver disease. It is possible that there is a link between the increased prevalence of obesity in psoriatic patients and fatty liver disease. In severe and chronic forms of this disease, death from liver failure may result.