Continuing medical educationPsoriasis: Which therapy for which patient: Psoriasis comorbidities and preferred systemic agents
Section snippets
Psoriatic arthritis
Psoriatic arthritis develops in ≤30% of patients, but severe deforming arthritis is much less common, seen in about 5% patients. Psoriasis usually precedes joint manifestations in ≤85% patients by 10 years on average; however, in approximately 15% of cases, arthritis either precedes or occurs simultaneously with skin disease.3, 4, 5, 6 There is a paucity of validated tools for the assessment of drug efficacy in patients with psoriatic arthritis; therefore, American College of Rheumatology (ACR)
Crohn's disease
Psoriasis and Crohn's disease (CD) are chronic inflammatory disorders with similarities in genetic susceptibilities and immune-mediated inflammation.38, 39, 40 Several studies have reported a high rate of co-occurrence of psoriasis and IBD.41, 42, 43, 44, 45, 46
Traditional agents
The association of methotrexate with malignancies is not clear in patients with psoriasis. In a long-term study of 248 psoriasis patients treated with methotrexate, 10 patients developed malignant neoplasms including lymphomas, but this study concluded that methotrexate therapy for psoriasis did not contribute to the development of neoplasms.71 However, there are several reports of newly diagnosed Epstein–Barr virus–associated lymphomas in patients with psoriasis who were taking methotrexate.72
Obesity
Moderate to severe psoriasis is associated with the metabolic syndrome, which includes obesity, hyperlipidemia, and diabetes mellitus.99 Patients with psoriasis tend to be more obese than age- and sex-matched individuals without psoriasis.100, 101
Cardiac diseases
Gelfand et al120 published the landmark study that identified psoriasis as an independent risk factor for cardiovascular diseases. Chronic inflammation is a hallmark for psoriasis and is also known to play an important role in atherosclerosis, which explains the increased risk of MACEs in patients with psoriasis.121, 122, 123, 124
Congestive heart failure
The association between psoriasis and congestive heart failure (CHF) is unclear, but it is suggested that moderate to severe psoriasis increases the risk of heart failure.139, 140
Multiple sclerosis
Recent Danish- and US-based studies reported a significant association between multiple sclerosis (MS) and psoriasis, although the precise mechanism of this association is still not clear.151, 152, 153 In contrast, a few other studies did not identify any association between psoriasis and MS.154, 155
Lupus
Psoriasis and lupus erythematosus (LE) are both immune-mediated diseases but their coexistence is rare. Zalla et al171 reported that 0.69% of patients with psoriasis have SLE and 1.1% of patients with SLE have psoriasis.
References (191)
- et al.
Psoriasis and comorbid diseases: epidemiology
J Am Acad Dermatol
(2017) - et al.
Prevalence of undiagnosed psoriatic arthritis among psoriasis patients: systematic review and meta-analysis
J Am Acad Dermatol
(2015) - et al.
Outcomes of the Memorial Sloan Kettering Cancer Center International General Surgical Oncology Fellowship
J Am Coll Surg
(2016) - et al.
Etanercept in the treatment of psoriatic arthritis and psoriasis: a randomised trial
Lancet
(2000) - et al.
Secukinumab, a human anti-interleukin-17A monoclonal antibody, in patients with psoriatic arthritis (FUTURE 2): a randomised, double-blind, placebo-controlled, phase 3 trial
Lancet
(2015) - et al.
Ixekizumab for the treatment of patients with active psoriatic arthritis and an inadequate response to tumour necrosis factor inhibitors: results from the 24-week randomised, double-blind, placebo-controlled period of the SPIRIT-P2 phase 3 trial
Lancet
(2017) - et al.
The IL-23/Th17 axis in the immunopathogenesis of psoriasis
J Invest Dermatol
(2009) - et al.
Epidemiology and comorbidities of psoriasis patients in a national database in Taiwan
J Dermatol Sci
(2011) - et al.
The association of psoriasis with autoimmune diseases
J Am Acad Dermatol
(2012) - et al.
European trial of cyclosporine in chronic active Crohn's disease: a 12-month study. The European Study Group
Gastroenterology
(1995)
Maintenance infliximab for Crohn's disease: the ACCENT I randomised trial
Lancet
Human anti-tumor necrosis factor monoclonal antibody (adalimumab) in Crohn's disease: the CLASSIC-I trial
Gastroenterology
Reinduction with certolizumab pegol in patients with relapsed Crohn's disease: results from the PRECiSE 4 Study
Clin Gastroenterol Hepatol
Comparative effectiveness of infliximab and adalimumab for Crohn's disease
Clin Gastroenterol Hepatol
Adalimumab and infliximab are equally effective for Crohn's disease in patients not previously treated with anti-tumor necrosis factor-alpha agents
Clin Gastroenterol Hepatol
Subcutaneous golimumab induces clinical response and remission in patients with moderate-to-severe ulcerative colitis
Gastroenterology
Secukinumab long-term safety experience: a pooled analysis of 10 phase II and III clinical studies in patients with moderate to severe plaque psoriasis
J Am Acad Dermatol
Inflammatory bowel disease among patients with psoriasis treated with ixekizumab: a presentation of adjudicated data from an integrated database of 7 randomized controlled and uncontrolled trials
J Am Acad Dermatol
Induction therapy with the selective interleukin-23 inhibitor risankizumab in patients with moderate-to-severe Crohn's disease: a randomised, double-blind, placebo-controlled phase 2 study
Lancet
Methotrexate-induced pulmonary lymphoma
Chest
Treatments for psoriasis and the risk of malignancy
J Am Acad Dermatol
Risk of malignancies in psoriasis patients treated with cyclosporine: a 5 y cohort study
J Invest Dermatol
Acitretin treatment of premalignant and malignant skin disorders in renal transplant recipients: clinical effects of a randomized trial comparing two doses of acitretin
J Am Acad Dermatol
Malignancy rates in a large cohort of patients with systemically treated psoriasis in a managed care population
J Am Acad Dermatol
Rapid onset of cutaneous squamous cell carcinoma of the penis in a patient with psoriasis on etanercept therapy
J Am Acad Dermatol
Rapid onset of cutaneous squamous cell carcinoma in patients with rheumatoid arthritis after starting tumor necrosis factor alpha receptor IgG1-Fc fusion complex therapy
J Am Acad Dermatol
Long-term safety experience of ustekinumab in patients with moderate to severe psoriasis (part II of II): results from analyses of infections and malignancy from pooled phase II and III clinical trials
J Am Acad Dermatol
Risk of malignancy with systemic psoriasis treatment in the Psoriasis Longitudinal Assessment Registry
J Am Acad Dermatol
Patient perspectives in the management of psoriasis: results from the population-based Multinational Assessment of Psoriasis and Psoriatic Arthritis Survey
J Am Acad Dermatol
Longitudinal study of clinical and radiological progression in psoriatic arthritis
J Rheumatol
Progression of peripheral joint disease in psoriatic arthritis: a 5-yr prospective study
Rheumatology (Oxford)
A systematic literature review of drug therapies for the treatment of psoriatic arthritis: current evidence and meta-analysis informing the EULAR recommendations for the management of psoriatic arthritis
Ann Rheum Dis
A randomized placebo-controlled trial of methotrexate in psoriatic arthritis
Rheumatology (Oxford)
Limitations of clinical trials in chronic diseases: is the efficacy of methotrexate (MTX) underestimated in polyarticular psoriatic arthritis on the basis of limitations of clinical trials more than on limitations of MTX, as was seen in rheumatoid arthritis?
Clin Exp Rheumatol
Cyclosporine in the treatment of psoriatic arthritis
Arch Dermatol
Cyclosporin A in psoriatic arthritis: an open study
Ann Rheum Dis
Low dose cyclosporine A in psoriatic arthritis: relation between soluble interleukin 2 receptors and response to therapy
J Rheumatol
Anti-inflammatory efficacy of low-dose cyclosporin A in psoriatic arthritis. A prospective multicentre study
Br J Dermatol
A randomised, double blind, placebo controlled, multicentre trial of combination therapy with methotrexate plus ciclosporin in patients with active psoriatic arthritis
Ann Rheum Dis
Combination therapy with ciclosporin and etanercept in patients with psoriatic arthritis
Ann Rheum Dis
Do patients with psoriatic arthritis who present early fare better than those presenting later in the disease?
Ann Rheum Dis
Early treatment of psoriatic arthritis is associated with improved patient-reported outcomes: findings from the etanercept PRESTA trial
Clin Exp Rheumatol
Adalimumab for the treatment of patients with moderately to severely active psoriatic arthritis: results of a double-blind, randomized, placebo-controlled trial
Arthritis Rheum
Golimumab, a new human tumor necrosis factor alpha antibody, administered every four weeks as a subcutaneous injection in psoriatic arthritis: twenty-four-week efficacy and safety results of a randomized, placebo-controlled study
Arthritis Rheum
Effect of certolizumab pegol on signs and symptoms in patients with psoriatic arthritis: 24-week results of a phase 3 double-blind randomised placebo-controlled study (RAPID-PsA)
Ann Rheum Dis
Efficacy and safety of the anti-IL-12/23 p40 monoclonal antibody, ustekinumab, in patients with active psoriatic arthritis despite conventional non-biological and biological anti-tumour necrosis factor therapy: 6-month and 1-year results of the phase 3, multicentre, double-blind, placebo-controlled, randomised PSUMMIT 2 trial
Ann Rheum Dis
Onset of psoriatic arthritis during ustekinumab treatment for psoriasis: a case series of seven patients
Br J Dermatol
Infliximab maintains a high degree of clinical response in patients with active psoriatic arthritis through 1 year of treatment: results from the IMPACT 2 trial
Ann Rheum Dis
Adalimumab for long-term treatment of psoriatic arthritis: 2-year data from the Adalimumab Effectiveness in Psoriatic Arthritis Trial (ADEPT)
Ann Rheum Dis
How effective is ustekinumab in controlling psoriatic arthritis?
Dermatol Ther
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Funding sources: None.
Dr Lebwohl is an employee of Mount Sinai and receives research funds from Abbvie, Boehringer Ingelheim, Eli Lilly, Incyte, Janssen/Johnson & Johnson, Leo Pharmaceuticals, MedImmune/AstraZeneca, Novartis, Pfizer, Sciderm, Valeant, and ViDac. Dr Lebwohl is also a consultant for Allergan, Aqua, Boehringer-Ingelheim, LEO Pharma, Menlo, Mitsubishi, Promius, and Theravance. Dr Kaushik has no conflicts of interest to disclose.
Reprints not available from the authors.
Date of release: January 2019
Expiration date: January 2022