Among a large cohort of patients with psoriasis, researchers found around 20% had an immune-mediated inflammatory disease develop before psoriasis onset and 14% had one develop after psoriasis onset, according to a study using data from the Danish National Patient Registry.
“Indeed, one may speculate whether psoriasis can, at least in a subset of patients, be considered a cutaneous manifestation of a complex composition of several coexisting IMIDs,” Yuki M.F. Andersen, MD, PhD, of the department of dermatology and allergy at Herlev and Gentofte Hospital, University of Copenhagen, and colleagues wrote. “This observation provides new insight in possible pathophysiologic mechanisms of these associations.”
Researchers identified all adults with a first-time diagnosis of psoriasis from 2007 through 2016 who had at least one diagnostic code for psoriasis. The following immune-mediated inflammatory diseases (IMIDs) were studied: multiple sclerosis, psoriatic arthritis, pyoderma gangrenosum, rheumatoid arthritis, ankylosing spondylitis, systemic lupus erythematosus, celiac disease, primary sclerosing cholangitis, primary biliary cholangitis, type 1 diabetes, asthma, sarcoidosis, Graves’ disease, iridocyclitis, ulcerative colitis and Crohn’s disease.
A total of 10,923 patients with a first-time diagnosis of psoriasis were matched with 109,230 controls from the general population. Human leukocyte antigen B27 positivity was significantly higher in the psoriasis group (P = .03), but no significant differences were identified in the immunologic laboratory profile between the psoriasis group and the control population.
Before psoriasis diagnosis, 2,181 patients (20%) received a diagnosis of an IMID compared with 8,153 control participants (7.4%) (OR = 3.10; 95% CI, 2.94-3.26). After psoriasis diagnosis, 1,607 patients (14.7%) developed one or more IMID compared with 2,928 participants (2.7%) in the control group (OR = 6.26; 95% CI, 5.87-6.68). Moreover, after psoriasis diagnosis, 1.2% of psoriasis patients and 0.1% of the control population received two or more IMID diagnoses (OR = 15.2; 95% CI, 11.6-20.0).
Before psoriasis diagnosis, the most common IMIDs were PsA (7.2%), asthma (3.7%), rheumatoid arthritis (3.4%) and type 1 diabetes (2.5%). After psoriasis diagnosis, PsA was the common comorbidity (10.5%).
Those with psoriasis had a significantly increased risk for one or more IMID after psoriasis diagnosis (IRR = 5.49; 95% CI, 5.16-5.83) and two or more IMIDs (IRR = 15.06; 95% CI, 11.45-19.82) compared with controls.
Psoriasis was associated with a higher risk for 11 of the 16 IMIDs studied and a 5-times higher risk for inflammatory diseases overall, according to the study. No significant risk was found in systemic lupus erythematosus or neurologic and biliary IMIDs.
“Although the exact pathophysiologic mechanisms of the shown association are not yet known, collectively, the current evidence shows that psoriasis is associated with presence of other IMIDs,” Andersen and colleagues wrote.
Some immune-modulating drugs may influence the risk for comorbidities through triggering or preventing other IMIDs in those with psoriasis. – by Abigail Sutton
Disclosures: Andersen reports receiving research funding from the Lundbeck Foundation, the Aage Bang Foundation and the A.P. Møller Foundation. Please see the study for all other authors’ relevant financial disclosures.