• It’s not just your skin: psoriasis linked to other serious conditions

    If psoriasis were “just” a skin disease, it would be bad enough. But we are now learning that psoriasis is associated with other serious conditions. These linkages underscore the seriousness of psoriasis, and are important reminders that psoriasis patients and their doctors must keep an eye on the entire patient profile in addition to skin symptoms.

    Psoriatic arthritis

    Up to one-third of patients with psoriasis also have psoriatic arthritis, a form of arthritis that usually combines the skin symptoms of psoriasis plus pain, swelling and stiffness in one or more joints. Most people with psoriatic arthritis also have psoriasis of the nails. As with psoriasis, psoriatic arthritis can range from mild to severe and debilitating. It can also grow progressively worse, and lead to permanent bone damage. Treatments are now available that have been shown to stop the progression of the disease. Most common in the fingers, toes and back/spine, psoriatic arthritis can also manifest itself in the neck, legs and/or elsewhere.

    Heart disease and heart attack

    People with psoriasis are at increased risk for heart attack. The increase is most pronounced for those with severe psoriasis, though studies indicate that even those with mild psoriasis have a noticeably higher risk. But sorting out exactly why this is and what it means will take further study. Is it the inflammation that comes with psoriasis that increases heart attack risk? Is it psoriasis treatments that increase the risk, or might effectively treating psoriasis reduce the heart attack risk? Or is it other factors sometimes seen with psoriasis — smoking, obesity, diabetes, depression — that might be to blame?

    Psoriasis and diabetes

    The risk of getting diabetes is about 40 percent higher in patients with psoriatic arthritis than in people without the disease, according to recent research. People with psoriasis (and rheumatoid arthritis [RA]) are also at higher risk than the general population of having diabetes. What is not yet clear is why this is. Because people with psoriasis and psoriatic arthritis have higher rates of tobacco use and obesity than the general population, this might explain the higher diabetes rate. In addition, among the risk factors for diabetes is leading a sedentary/not-very-active lifestyle, and many people with psoriasis or psoriatic arthritis are restricted by pain and other issues from some physical activities. Further research is needed to sort it all out.

    Psoriasis, stroke, and death

    A study found that severe psoriasis shortens life expectancy by an average of four years. And at least two studies that reviewed data on two groups of people over a number of years, one group of psoriasis patients and a comparable group of people without psoriasis, found about an 80% higher death rate for the psoriasis patients over that time. Other sobering news comes from studies looking at stroke risk among psoriasis patients. As one study summarized it: “Patients with psoriasis, particularly if severe, have an increased risk of stroke that is not explained by major stroke risk factors identified in routine medical care.” That study found that even after adjusting for major risk factors for stroke, over 10 years, having severe psoriasis accounted for 1 additional stroke for each 53 psoriasis patients. Overall, it put the increased risk of stroke at about 40%, while another study put it at 70%.

    Other issues

    Other health concerns associated with psoriasis include depression, obesity, and Crohn’s disease; and psoriasis appears to be linked in various ways to metabolic syndrome, a group of risk factors that signal adverse health conditions including heart disease. The science is increasingly clear that psoriasis is more than a disease of the skin.

    “What should we do?!”

    Reading these studies can be distressing, depressing, even demoralizing. But we should keep several thoughts in mind as we process this bad news.

    First, these averages are just that — averages. It does not predict a specific person’s future, and we are more than happy to tell you about vibrant people who have had psoriasis more than 50 years.

    But the studies do indicate that psoriasis is a risk factor like smoking or high cholesterol, and that is pretty stunning news given how psoriasis has traditionally been minimized as “not serious” or a “rash.” In fact, it is a serious immune system disease, as this research confirms.

    The most important take-away message for psoriasis patients from this growing body of research is to get to work on other risk factors that increase risk of heart disease, stroke, diabetes and premature death. And while we recognize the difficult challenge presented by the following items, each of them may be even more important to psoriasis patients than to the general public:

    • Quitting smoking
    • Reducing obesity
    • Stopping alcohol abuse
    • Addressing untreated depression
    Reducing high blood pressure
    • Exercising
    • Controlling cholesterol

    One vital question we need answered by future research is what role do psoriasis treatments play in these higher risks for other diseases? Does effective psoriasis treatment reduce the risks, or are the known or as-yet-unknown side-effects of various treatments part of the cause of this heightened risk?

    We are vocal proponents of treating psoriasis and psoriatic arthritis aggressively in adults (it’s a harder call with children), because improving skin and joint symptoms can dramatically improve one’s quality of life. In underscoring that psoriasis may have adverse impacts beyond what we feel in our skin or joints, this research offers us a kick in the pants, a wake-up call — pick your metaphor — to take action on those other elements of our health that can help us lead healthier and longer and happier lives.