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EADV 2020 | Psoriasis: A Systemic Disease

Comorbidities, Genetics, Immunology 2020

Presented by Paolo Gisondi, MD

A report from the 29th Congress of the European Academy of Dermatology and Venereology  

Psoriasis patients have an increased risk of systemic inflammatory disorders. Though the exact pathophysiology remains unclear, there are many overlapping risk genes between psoriasis and these metabolic conditions.


Psoriatic inflammatory mediators from both the Th1 and Th17 pathways could exert systemic effects on liver, adipose tissue, and skeletal muscle. This in turn may upregulate tissue-specific inflammation, contributing to endothelial dysfunction and ultimately atherosclerotic plaque instability. A striking visual representation was demonstrated in studies in which PET-CT performed on psoriasis patients exhibited foci of inflammation in the aorta and various other tissues.1,2


Studying this link between psoriasis, obesity, and cardiovascular disease, Dr. Gisondi found that adipocytokines mediate crosstalk between skin and adipose tissue, and that both adipocytes and CRP are significantly increased in psoriasis.3  Further, he found that non-alcoholic fatty liver disease (NAFLD) is frequent in psoriasis (48% vs 25% controls) and correlates with worsening PASI score. He suggests that increased release of IL-6, TNF-α, and adipocytokines may drive this NAFLD.4,5


Like metabolic comorbidities, the development of psoriatic arthritis (PsA) is mediated by genetics, immunology, and the environment. Though PsA can develop insidiously, imaging can detect PsA prior to symptom development.6 Using ultrasound, Dr. Gisondi found that even asymptomatic patients display entheseal abnormalities, and that quadriceps tendon thickness is an independent predictor of PsA development.7-8


Given this self-perpetuating inflammatory loop in psoriasis, the metabolic syndrome, cardiovascular disease, and PsA, Dr. Gisondi hypothesizes that early intervention could mitigate or even abate the development of such comorbidities, and therefore further studies are essential.9,10




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