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Psoriasis Not Just Skin and Bone

Psoriasis Not Just Skin and Bone. Dr Verity Blackwell West Hertfordshire Dermatology Team. P soriasis. 2.3% of population 125 million people world wide Associated with Arthritis Depression Reduced quality of life Increased prevalence of cardiovascular and cerebrovascular disease.

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Psoriasis Not Just Skin and Bone

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  1. PsoriasisNot Just Skin and Bone Dr Verity Blackwell West Hertfordshire Dermatology Team

  2. Psoriasis • 2.3% of population • 125 million people world wide • Associated with • Arthritis • Depression • Reduced quality of life • Increased prevalence of cardiovascular and cerebrovascular disease

  3. Psoriasis • Patients with severe psoriasis have increased mortality • 19.6% deaths versus 9% in controls • Increased risk of myocardial infarction independent of other risk factors • Increased risk of Stroke

  4. Prevalence of cardiovascular risk factors in patients with psoriasis. [J Am AcadDermatol. 2006 Gelfand et al] • Prospective UK based study • 20-90 yr olds, mean 5.4 yr follow up • Controlled for age, sex, previous MI,diabetes,hypertension,smoking, hyperlipidaemia,BMI • Psoriasis absent(controls),mild or severe • Severe if ever received systemic therapy

  5. Prevalence of cardiovascular risk factors in patients with psoriasis. [J Am AcadDermatol. 2006 Gelfand et al] • 555,995 controls • 127,139 mild psoriasis • 3837 severe psoriasis • MI controls=2% • mild psoriasis =1.8% • severe psoriasis= 2.9% • Relative risk of MI with severe psoriasis • Aged 30=3.1 aged 60 =1.36 • Aged 40=2.69 aged 60= 1.92(Danish study 2009)

  6. Psorisiasis and risk of AF and Ischaemic Stroke • Danish study July 2011 • >36,000 pts with mild psoriasis,2793 pts with severe psoriasis versus controls • Rate ratio for AF • Mild psoriasis <50yrs=1.5 >50yrs=1.16 • Severe psoriasis <50yrs 2.98 >50yrs 1.29 • Rate ratio for Ischaemic stroke • Mild psoriasis <50yrs =1.97 >50yrs =1.13 • Severe psoriasis <50yrs=2.8 >50yrs =1.34

  7. Why? • Genetics • Lifetime burden of inflammation

  8. Association of cardiovascular risk factors and psoriasis Large UK study showed increased incidence of • Obesity • Hypertension • Dyslipidaemia • Diabetes • Hyperhomocysteinaemia • Smoking

  9. Atherosclerosis • Chronic immuno-inflammatory disorder of arterial wall • Chronic inflammation implicated in formation of fatty streaks • Activation of TH1 mediated cytokine cascade also trigger for acute coronary event

  10. Psoriasis • Most common Th1 disorder • Chronic inappropriate activation of Th1 cytokines • TNF,IFN,IL2 • Also new Th –IL-17 subset that has role in pathogenesis of psoriatic lesion and via IL12 also stimulates Th1 response in arteries

  11. What can we do as dermatologists • Obesity • Measure BMI; advice re diet and exercise • Hypertension • >140/90 advise repeat in primary care • Diabetes • ?check fasting blood sugar if obese Refer to primary care

  12. What can we do? • Cholesterol • Refer pt to primary care • Aspirin therapy • Refer patient to primary care

  13. What can we do? • Smoking • Advising pt to stop increases cessation rate by 30% • Give out NHS helpline cards • Single most important intervention in improving patient health

  14. Summary • Dermatologist and dermatology nurses may be seeing patient more frequently than primary care team • May be best placed to nudge patients to see GP about controlling risk factors • Severe psoriasis independently increases risk of cardiovascular disease • ?will treating severe psoriasis lower this risk?

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