Rheumatology (Oxford) 2012;51:552C6

Rheumatology (Oxford) 2012;51:552C6. the spondyloarthritides and as such has both spinal and peripheral joint involvement as well as enthesitis and dactylitis. In addition to the joint and skin manifestations, PsA is associated with numerous extra-articular immune-mediated manifestations such as inflammatory bowel disease and autoimmune ophthalmic disease. Studies have shown that patients with psoriatic disease suffer also from associated comorbidities, including cardiovascular disease, obesity and metabolic syndrome, diabetes, osteoporosis, malignancy, fatty liver disease, depression, and anxiety.1 To ensure an optimal outcome, identifying these comorbidities is of utmost importance. The objectives of this review are to present and discuss the available evidence on comorbidities in PsA patients. CARDIOVASCULAR DISEASE Cardiovascular disease (CVD) is one of the most significant comorbidities in rheumatic diseases in general, and in psoriatic disease in particular, where the systemic inflammation leads to increased insulin resistance, endothelial cell dysfunction, and the development of atherosclerosis.2 A meta-analysis of 75 observational studies found that psoriasis is associated with a relative risk of 1.4 (95% CI 1.2C1.7) for CVD.3 Although there are fewer studies on cardiovascular risk in PsA compared with that in psoriasis, several studies have shown a similar trend.4,5 A recent population-based cohort study has shown that the risk of major adverse cardiovascular events was higher in PsA patients not prescribed a disease-modifying antirheumatic drug (DMARD) (HR 1.24, 95% CI 1.03C1.49) compared to the general population after adjusting for traditional cardiovascular risk factors but without increase in mortality.6 The association was found to be independent of traditional CVD risk factors such as hypertension, dyslipidemia, and smoking and correlated with markers of disease severity and activity,7 suggesting that optimal treatment of the disease would improve CVD outcomes. To date, however, as far as we could find in a far-ranging review of the literature, no study has specifically examined the effect of aggressive PsA treatment regimens on the risk of cardiovascular events. On the other hand, studies on patients with rheumatoid arthritis and psoriasis have shown a reduced rate of cardiovascular events among patients treated with anti-tumor necrosis factor alpha (TNF) medications.8,9 In patients with comorbid CVD, the use of non-steroidal anti-inflammatory drugs should be at the lowest effective dose for the shortest period of time possible.10 DIABETES MELLITUS, METABOLIC SYNDROME, AND OBESITY Diabetes mellitus, metabolic syndrome, and obesity were reported to be at increased prevalence in many studies on patients with psoriatic arthritis, with a crude OR of 2.18 (95% CI 1.36C3.50) of type 2 diabetes mellitus in PsA, and patients with severe psoriasis having a higher risk.11C13 Among diabetic patients, psoriasis is generally associated with higher rates of microvascular and macrovascular complications.14 Patients with PsA have a higher BMI compared to rheumatoid arthritis patients and the general population.15 In patients with PsA, metabolic syndrome and insulin resistance are highly prevalent and were found to be independently associated with the severity of underlying PsA.16 Several mechanisms could explain the association between PsA and diabetes, such as patients unhealthy lifestyle,17 the inflammatory cytokine milieu that drives insulin resistance,18C20 as well as shared genetic loci for susceptibility to psoriasis and diabetes.21C23 A large study on patients with PsA conducted in Israel also found an association with diabetes even after controlling for potential confounders, including age, obesity, and steroid treatment.24 This finding might also have therapeutic implications, as ongoing studies are investigating the effect of antidiabetic drugs on psoriasis.25,26 OSTEOPOROSIS Osteoporosis was reported in studies on individuals with various inflammatory rheumatic diseases,27C30 as well as increased risk for low bone density and fragility fractures.31 Skeletal manifestations of PsA are complex and comprise both fresh bone formation manifesting with bone ankylosis, periostitis, and syndesmophytes, and bone resorption in the form of erosions. The prevalence of osteoporosis in PsA has not been studied to the same degree. The literature review with regard to bone mineral denseness in PsA shows inconsistent and conflicting results.32C34 Individuals with PsA in Israel, however, were also found to be at increased risk of osteoporosis.24 INFLAMMATORY BOWEL DISEASE Inflammatory bowel disease (IBD) as well as subclinical bowel inflammation have been observed with increased incidence in individuals with psoriasis, and a pronounced risk was found in individuals with concomitant PsA (RR 6.43, 95% CI 2.04C20.32) for Crohns disease but not for ulcerative colitis.35,36 Occasionally, individuals may develop a paradoxical IBD when being treated.Hepatoprotective effect of tumour necrosis factor alpha blockade in psoriatic arthritis: a cross-sectional study. greatest importance. The objectives of this evaluate are to present and discuss the available evidence on comorbidities in PsA individuals. CARDIOVASCULAR DISEASE Cardiovascular disease (CVD) is one of the most significant comorbidities in rheumatic diseases in general, and in psoriatic disease in particular, where the systemic swelling leads to improved insulin resistance, endothelial cell dysfunction, and the development of atherosclerosis.2 A meta-analysis of 75 observational studies found that psoriasis is associated with a family member risk of 1.4 (95% CI 1.2C1.7) for CVD.3 Although there are fewer studies on cardiovascular risk in PsA compared with that in psoriasis, several studies have shown a similar tendency.4,5 A recent population-based cohort study has shown that the risk of major adverse cardiovascular events was higher in PsA individuals not prescribed a disease-modifying antirheumatic drug (DMARD) (HR 1.24, 95% CI 1.03C1.49) compared to the general human population after modifying for traditional cardiovascular risk factors but without increase Rabbit Polyclonal to USP42 in mortality.6 The association was found to be independent of traditional CVD risk factors such as hypertension, dyslipidemia, and smoking and correlated with markers of disease severity and activity,7 suggesting that optimal treatment of the disease would improve CVD outcomes. To day, however, as far as we could find inside a far-ranging review of the literature, no study offers specifically examined the effect of aggressive PsA treatment regimens on the risk of cardiovascular events. On the other hand, studies on individuals with rheumatoid arthritis and psoriasis have shown a reduced rate of cardiovascular events among individuals treated with anti-tumor necrosis element alpha (TNF) medications.8,9 In patients with comorbid CVD, the use of non-steroidal anti-inflammatory drugs should be at the lowest effective dose for the shortest period of time possible.10 DIABETES MELLITUS, METABOLIC SYNDROME, AND OBESITY Diabetes (-)-Borneol mellitus, metabolic syndrome, and obesity were reported to be at increased prevalence in many studies on individuals with psoriatic arthritis, having a crude OR of 2.18 (95% CI 1.36C3.50) of type 2 diabetes mellitus in PsA, and individuals with severe psoriasis having a higher risk.11C13 Among diabetic patients, psoriasis is generally associated with higher rates of microvascular and macrovascular complications.14 Individuals with PsA have a higher BMI compared to rheumatoid arthritis individuals and the general human population.15 In patients with PsA, metabolic syndrome and insulin resistance are highly prevalent and were found to be independently associated with the severity of underlying PsA.16 Several mechanisms could clarify the association between PsA and diabetes, such as individuals unhealthy lifestyle,17 the inflammatory cytokine milieu that drives insulin resistance,18C20 as well as shared genetic loci for susceptibility to psoriasis and diabetes.21C23 A large study on individuals with PsA conducted in Israel also found an association with diabetes even after controlling for potential confounders, including age, obesity, and steroid treatment.24 This finding might also have therapeutic implications, as ongoing studies are investigating the effect of antidiabetic medicines on psoriasis.25,26 OSTEOPOROSIS Osteoporosis was reported in studies on individuals with various inflammatory rheumatic diseases,27C30 as well as increased risk for (-)-Borneol low bone density and fragility fractures.31 Skeletal manifestations of PsA are complex and comprise both fresh bone formation manifesting with bone ankylosis, periostitis, and syndesmophytes, and bone resorption in the form of erosions. The prevalence of osteoporosis in PsA has not been studied to the same degree. The literature review with regard to bone mineral denseness in PsA shows inconsistent.https://doi.org/10.1001/jama.2011.1211. joint and skin manifestations, PsA is definitely associated with several extra-articular immune-mediated manifestations such as inflammatory bowel disease and autoimmune ophthalmic disease. Studies have shown that individuals with psoriatic disease suffer also from connected comorbidities, including cardiovascular disease, obesity and metabolic syndrome, diabetes, osteoporosis, malignancy, fatty liver disease, major depression, and panic.1 To ensure an optimal outcome, identifying these comorbidities is of utmost importance. The objectives of this review are to present and discuss the available evidence on comorbidities in PsA individuals. CARDIOVASCULAR DISEASE Cardiovascular disease (CVD) is one of the most significant comorbidities in rheumatic diseases in general, and in psoriatic disease in particular, where the systemic swelling leads to improved insulin resistance, endothelial cell dysfunction, and the development of atherosclerosis.2 A meta-analysis of 75 observational studies found that psoriasis is associated with a family member risk of 1.4 (95% CI 1.2C1.7) for CVD.3 Although there are fewer studies on cardiovascular risk in PsA compared with that in psoriasis, several studies have shown a similar tendency.4,5 A recent population-based cohort study has shown that the risk of major adverse cardiovascular events was higher in PsA individuals not prescribed a disease-modifying antirheumatic drug (DMARD) (HR 1.24, 95% CI 1.03C1.49) compared to the general human population after adjusting for traditional cardiovascular risk factors but without increase in mortality.6 The association was found to be independent of traditional CVD risk factors such as hypertension, dyslipidemia, and smoking and correlated with markers of disease severity and activity,7 suggesting that optimal treatment of the disease would improve CVD outcomes. To date, however, as far as we could find in a far-ranging review of the literature, no study has specifically examined the effect of aggressive PsA treatment regimens on the risk of cardiovascular events. On the other hand, studies on patients with rheumatoid arthritis and psoriasis have shown a reduced rate of cardiovascular events among patients treated with anti-tumor necrosis factor alpha (TNF) medications.8,9 In patients with comorbid CVD, the use of non-steroidal anti-inflammatory drugs should be at the lowest effective dose for the shortest period of time possible.10 DIABETES MELLITUS, METABOLIC SYNDROME, AND OBESITY Diabetes mellitus, metabolic syndrome, and obesity were reported to be at increased prevalence in many studies on patients with psoriatic arthritis, with a crude OR of 2.18 (95% CI 1.36C3.50) of type 2 diabetes mellitus in PsA, and patients with severe psoriasis having a higher risk.11C13 Among diabetic patients, psoriasis is generally associated with higher rates of microvascular and macrovascular complications.14 Patients with PsA have a higher BMI compared to rheumatoid arthritis patients and the general populace.15 In patients with PsA, metabolic syndrome and insulin resistance are highly prevalent and were found to be independently associated with the severity of underlying PsA.16 Several mechanisms could explain the association between PsA and diabetes, such as patients unhealthy lifestyle,17 the inflammatory cytokine milieu that drives insulin resistance,18C20 as well as shared genetic loci for susceptibility to psoriasis and diabetes.21C23 A large study on patients with PsA conducted in Israel also found an association with diabetes even after controlling for potential confounders, including age, obesity, and steroid treatment.24 This finding might also have therapeutic implications, as ongoing studies are investigating the effect of antidiabetic drugs on psoriasis.25,26 OSTEOPOROSIS Osteoporosis was reported in studies on patients with various inflammatory rheumatic diseases,27C30 as well as increased risk for low bone density and fragility fractures.31 Skeletal manifestations of PsA are complex and comprise both new bone formation manifesting with bone ankylosis, periostitis, and syndesmophytes, and bone resorption in the form of erosions. The prevalence of osteoporosis in PsA has not been studied to the same degree. The literature review with regard to bone mineral density in PsA shows inconsistent and conflicting results.32C34 Patients with PsA in Israel, however, were also found to be at increased risk of osteoporosis.24 INFLAMMATORY BOWEL DISEASE Inflammatory bowel disease (IBD) as well as.Maruotti N, (-)-Borneol Corrado A, Cantatore FP. autoimmune ophthalmic disease. Studies have shown that patients with psoriatic disease suffer also from associated comorbidities, including cardiovascular disease, obesity and metabolic syndrome, diabetes, osteoporosis, malignancy, fatty liver disease, depressive disorder, and stress.1 To ensure an optimal outcome, identifying these comorbidities is of utmost importance. The objectives of this review are to present and discuss the available evidence on comorbidities in PsA patients. CARDIOVASCULAR DISEASE Cardiovascular disease (CVD) is one of the most significant comorbidities in rheumatic diseases in general, and in psoriatic disease in particular, where the systemic inflammation leads to increased insulin resistance, endothelial cell dysfunction, and the development of atherosclerosis.2 A meta-analysis of 75 observational studies found that psoriasis is associated with a relative risk of 1.4 (95% CI 1.2C1.7) for CVD.3 Although there are fewer studies on cardiovascular risk in PsA compared with that in psoriasis, several studies have shown a similar pattern.4,5 A recent population-based cohort study has shown that the risk of major adverse cardiovascular events was higher in PsA patients not prescribed a disease-modifying antirheumatic drug (DMARD) (HR 1.24, 95% CI 1.03C1.49) compared to the general populace after adjusting for traditional cardiovascular risk factors but without increase in mortality.6 The association was found to be independent of traditional CVD risk factors such as hypertension, dyslipidemia, and smoking and correlated with markers of disease severity and activity,7 suggesting that optimal treatment of the disease would improve CVD outcomes. To date, however, as far as we could find in a far-ranging review of the literature, no study has specifically examined the effect of aggressive PsA treatment regimens on the risk of cardiovascular events. On the other hand, studies on patients with rheumatoid arthritis and psoriasis have shown a reduced rate of cardiovascular events among patients treated with anti-tumor necrosis factor alpha (TNF) medications.8,9 In patients with comorbid CVD, the use of non-steroidal anti-inflammatory drugs should be at the lowest effective dose for the shortest period of time possible.10 DIABETES MELLITUS, METABOLIC SYNDROME, AND OBESITY Diabetes mellitus, metabolic syndrome, and obesity were reported to be at increased prevalence in many studies on patients with psoriatic arthritis, with a crude OR of 2.18 (95% CI 1.36C3.50) of type 2 diabetes mellitus in PsA, and patients with severe psoriasis having a higher risk.11C13 Among diabetic patients, psoriasis is generally associated with higher rates of microvascular and macrovascular complications.14 Patients with PsA possess an increased BMI in comparison to rheumatoid arthritis individuals and the overall inhabitants.15 In patients with PsA, metabolic syndrome and insulin resistance are highly prevalent and had been found to become independently from the severity of underlying PsA.16 Several systems could clarify the association between PsA and diabetes, such as for example individuals unhealthy lifestyle,17 the inflammatory cytokine milieu that drives insulin resistance,18C20 aswell as shared genetic loci for susceptibility to psoriasis and diabetes.21C23 A big study on individuals with PsA conducted in Israel also found a link with diabetes even after controlling for potential confounders, including age, weight problems, and steroid treatment.24 This finding may also have therapeutic implications, as ongoing studies are looking into the result of antidiabetic medicines on psoriasis.25,26 OSTEOPOROSIS Osteoporosis was reported in research on individuals with various inflammatory rheumatic illnesses,27C30 aswell as increased risk for low bone relative density and fragility fractures.31 Skeletal manifestations of PsA are complex and comprise both fresh bone tissue formation manifesting with bone tissue ankylosis, periostitis, and syndesmophytes, and bone tissue resorption by means of erosions. The prevalence of osteoporosis in PsA is not studied towards the same level. The books review in regards to to bone nutrient denseness in PsA displays inconsistent and conflicting outcomes.32C34 Individuals with PsA in Israel, however, were also found to become at increased threat of osteoporosis.24 INFLAMMATORY BOWEL DISEASE Inflammatory bowel disease (IBD) aswell as subclinical bowel inflammation have already been observed with an increase of incidence in individuals with psoriasis, and a pronounced risk was within individuals with concomitant PsA (RR 6.43, 95% CI 2.04C20.32).