Psoriasis and Related Health Conditions

Psoriasis is a disease that is still a mystery not only for patients, but also for doctors. Chronic skin disease, which manifests itself in the form of inflamed painful flaking and itchy red spots, is a lot of concern. But observations show that psoriasis is often associated with other diseases and pathologies. This means that the patient should be concerned not only about the condition of his skin, but also about the health of other organs of the body. October 29, on World Psoriasis Day, what additional problems this disease threatens for the body.

Psoriasis, heart and blood vessels

Psoriasis increases the likelihood of developing hypertension and various other heart and vascular disorders by 60%. The cause is increased production of endothelin-1, which is considered the strongest vasoconstrictor, a vasoconstrictor substance. Endothelin-1 is 100 times more potent than norepinephrine. It increases the pressure in the pulmonary artery and resistance of the vascular walls, which leads to their hypertrophy (overgrowth), increased stiffness, etc. In addition, endothelin-1 increases vascular permeability, activates neutrophils and mast cells, processes of cytokine production - in general, causes inflammation.

In addition to all of the above, oxidative stress is also destructive on the tissues of vessels. As a result, the development of atherosclerosis is accelerated in the presence of psoriasis. Systemic inflammation increases the likelihood that the atherosclerotic plaque will rupture and cause a blood clot.

Unsurprisingly, these patients are dying from cardiovascular diseases more often and earlier. Doctors have shown that they need larger doses of antihypertensive drugs ("more aggressive therapy") than people with hypertension but who do not have psoriasis. Patients with psoriasis and heart and vascular disease are also more likely to be on the operating table.

Abdominal aortic aneurysm
In a separate study, a link between abdominal aortic aneurysm and psoriasis was proved. While the average incidence of the disease is 3.72 cases per 10,000 person-years in the population, the rate is already 7.30 in people with low psoriasis and 9.87 in patients with severe psoriasis. Incidence in the latter case is increased by 67% compared to those who do not suffer from skin rashes.

Type 2 diabetes with psoriasis

Psoriatic plaques most commonly appear on the scalp, knees, elbows, and extremities but can also affect the back, face, genitals, and other areas of the skin. The type of inflammation that develops in psoriasis is also known to increase insulin resistance (resistance), a factor that is an increased risk of type 2 diabetes. Moreover, people with psoriasis and type 2 diabetes share genetic mutations—scientists even suggest a biological link between the two.

Last autumn, the results of a study in which scientists calculated how much diabetes is associated with psoriasis were published. The BSA (skin lesion area) was used to estimate the total amount of psoriatic lesions.

Even with a BSA of 2% (mild disease), the risk of type 2 diabetes increased by 21% compared to people without skin conditions. People with a BSA of 10% (severe) were 64% more likely to have diabetes. Every 10% of body area affected by psoriasis increased the risk of diabetes by 20%. That is, with a BSA of 20% - the risk was higher by 84%, with a BSA of 30% - higher by 104%.

Scientists emphasized that these data are independent of other risk factors for diabetes. This means that BSA can be used to assess a patient’s condition. The higher the BSA, the more careful the doctor and the patient must be in terms of timely detection of diabetes.

Liver disease: More common than arthritis

With regard to the risk of developing some pathologies, scientists have even compared psoriasis with other autoimmune diseases, such as rheumatoid arthritis. It is with methotrexate because both are treated with similar drugs (those that contain methotrexate) that can damage the liver.

Alas, in this respect psoriasis overtook rheumatoid arthritis. With the same methotrexate treatment, patients with psoriasis were significantly more likely to develop nonalcoholic fatty liver disease (NAFLD) and cirrhosis, while people diagnosed with rheumatoid arthritis had a low risk of these pathologies.

Moreover, the presence of both psoriasis and NAFLD is a direct route to the development of metabolic syndrome. The condition includes a complex of symptoms, which include increased insulin resistance (and hyperinsulinemia—increased blood insulin levels), overweight (or obesity), hypertension, and lipid metabolism disorders that contribute to atherosclerosis. And from metabolic syndrome, it's one step to type 2 diabetes, which we talked about earlier.

The causes of liver disease due to psoriasis are the same: oxidative stress, this time inside liver cells, inflammatory reactions caused by cytokines and proteins produced by mast cells, insulin resistance.

Scientists have also shown that NAFLD is associated with an increased likelihood of developing cardiovascular diseases, even without taking into account other risk factors.

Chronic kidney disease

The kidneys also suffer from psoriasis, including chronic kidney failure. And, as with diabetes, the risks are directly related to the scale of the skin damage. Thus, if the BSA is no more than 2% of the total body surface, then the threat to the kidneys is small. However, if lesions are 3 to 10% (moderate) or more than 10%, 20% of such patients will develop kidney disease.

It should also be noted that the relative risk of kidney disease is higher in young patients, and the absolute risk increases with age. Whereas every 134th patient (per year) receives chronic kidney disease between the ages of 40 and 50, every 62nd patient between the ages of 50 and 60.

Conclusions

Psoriasis cannot be thought of as an isolated skin lesion. This autoimmune disorder affects most of the body's most important organs. Evidence shows that the vast majority of patients have at least one serious disorder other than psoriasis.

This means that people who have psoriasis should control their health by paying close attention—by their doctor—to the condition of other organs. After all, if you can catch the disease in its early stages, it will be easier to cope with it.