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银屑病共病的现状及诊治

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  • 上海市皮肤病医院/同济大学附属皮肤病医院,同济大学医学院银屑病研究所,上海 200443

收稿日期: 2022-06-10

  网络出版日期: 2023-11-17

基金资助

国家自然科学基金(82073429);国家自然科学基金(82273510);国家自然科学基金(82103707);上海市教委科研创新计划(2019-01-07-0-007-E00046);上海市优秀学术带头人计划(20XD1403300);上海申康中心第二轮三年行动计划重大临床研究项目(SHDC2020CR1014B)

Psoriasis comorbidity: prevalence, diagnosis and treatment

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  • Shanghai Skin Disease Hospital, Shanghai 200443, China

Received date: 2022-06-10

  Online published: 2023-11-17

摘要

全球银屑病发病率为1%~3%,我国银屑病发病率约为0.47%。57.9%的银屑病患者至少合并1种银屑病共病,共病不仅影响患者的银屑病进程及严重程度,同时影响患者的治疗选择和效果。银屑病共病中,银屑病关节炎最常见,全球银屑病患者的银屑病关节炎患病率介于6%~42%,其中亚洲人群约为14%,中国人群约为4.9%。银屑病是心脏疾病的危险因素之一,是心肌梗死的独立危险因素。相较于非银屑病患者,银屑病患者的代谢性疾病患病率明显升高,银屑病患者的患糖尿病的风险增加0.69倍;轻度银屑病患者患肥胖的风险增加0.46倍,而中重度银屑病患者患肥胖的风险增加1.23倍。此外,银屑病患者的抑郁症患病率增加0.5倍,自身免疫性疾病等患病风险增加更高。在银屑病并共病治疗中,系统抗炎治疗不仅可以减轻或消退患者的皮肤炎症,同时可缓解银屑病共病的发生发展或严重程度。银屑病共病治疗原则需考虑患者银屑病的病情,同时决于共病病种、共病恶化风险等。多学科联合是诊治银屑病及银屑病共病的趋势,皮肤科医生与专科医生的跨学科合作十分重要。

本文引用格式

史玉玲, 陈文娟 . 银屑病共病的现状及诊治[J]. 诊断学理论与实践, 2023 , 22(03) : 221 -229 . DOI: 10.16150/j.1671-2870.2023.03.03

Abstract

The global incidence of psoriasis is about 1%-3%, and in China is about 0.47%. It is reported that 57.9% of psoriasis patients have at least one psoriasis comorbidity, which not only affects the progression and severity of psoriasis, but also affects the treatment choice and therapeutic effect for patients. Psoriatic arthritis is the most common comorbidity, with the prevalence of 6% to 42% in the world, of approximately 14% in Asia,and of about 4.9% in Chinese population. Psoriasis is one of the risk factors for cardiovascular disease and is an independent risk factor for myocardial infarction. Compared with non-psoriasis patients, psoriasis patients have an higher prevalence of metabolic diseases.The risk of diabetes in psoriasis patients increases by 0.69 times.The risk of obesity increases by 0.46 times in mild psoriasis patients and by 1.23 times in moderate to severe psoriasis patients. In addition, the prevalence of depression in psoriasis patients increases by 0.5 times, and the risk of autoimmune diseases is also higher. For treatment of psoriasis and psoriasis comorbidities, systemic anti-inflammatory treatment can not only relieve or eliminate skin inflammation, but also alleviate the occurrence, progression or severity of psoriasis comorbidities. The treatment principle of psoriasis comorbidities should take the condition of the patient’s psoriasis into consideration, and should also depend on the type of comorbidity, the risk of worsening of comorbidity, etc. Multidisciplinary collaboration is the trend in the diagnosis and treatment of psoriasis and its comorbidities. The cross-disciplinary cooperation between dermatologists and specialists matters a lot.

参考文献

[1] 中华医学会皮肤性病学分会银屑病专业委员会. 中国银屑病诊疗指南(2018简版)[J]. 中华皮肤科杂志, 2019, 52(4):223-230.
[1] Committee on Psoriasis, Chinese Society of Dermatology. Guideline for the diagnosis and treatment of psoriasis in China (2018 simplified edition)[J]. Chin J Dermatol, 2019, 52(4):223-230.
[2] NAST A, ALTENBURG A, AUGUSTIN M, et al. German S3-Guideline on the treatment of Psoriasis vulgaris, adapted from EuroGuiDerm - Part 2: Treatment monito-ring and specific clinical or comorbid situations[J]. J Dtsch Dermatol Ges, 2021, 19(7):1092-1115.
[3] AUGUSTIN M, REICH K, GLAESKE G, et al. Co-morbidity and age-related prevalence of psoriasis: Analysis of health insurance data in Germany[J]. Acta Derm Venereol, 2010, 90(2):147-151.
[4] ROSEN? N A L, L?RUP E H, RICHARDSON C, et al. Exploring disease comorbidities and temporal disease progression of psoriasis: an observational, retrospective, multi-database, cohort study[J]. Br J Dermatol, 2023, 188(3):372-379.
[5] BUJA A, MIATTON A, COZZOLINO C, et al. The Prevalent Comorbidome at the Onset of Psoriasis Diagnosis[J]. Dermatol Ther (Heidelb), 2023, 13(9):2093-2105.
[6] FERNáNDEZ-ARMENTEROS J M, GóMEZ-ARBONéS X, BUTI-SOLER M, et al. Psoriasis, metabolic syndrome and cardiovascular risk factors. A population-based study[J]. J Eur Acad Dermatol Venereol, 2019, 33(1):128-135.
[7] TAKESHITA J, WANG S, SHIN D B, et al. Effect of psoriasis severity on hypertension control: a population-based study in the United Kingdom[J]. JAMA Dermatol, 2015, 151(2):161-169.
[8] CHIU H Y, CHANG W L, SHIU M N, et al. Psoriasis is associated with a greater risk for cardiovascular procedure and surgery in patients with hypertension: A nationwide cohort study[J]. J Dermatol. 2018; 45(12):1381-1388.
[9] WAN M T, SHIN D B, HUBBARD R A, et al. Psoriasis and the risk of diabetes: A prospective population-based cohort study[J]. J Am Acad Dermatol, 2018, 78(2):315-322.e1.
[10] SEMENOV Y R, HERBOSA C M, ROGERS A T, et al. Psoriasis and mortality in the United States: Data from the National Health and Nutrition Examination Survey[J]. J Am Acad Dermatol, 2021, 85(2):396-403.
[11] ENOS C W, RAMOS V L, MCLEAN R R, et al. Comorbid obesity and history of diabetes are independently associated with poorer treatment response to biologics at 6 months: A prospective analysis in Corrona Psoriasis Re-gistry[J]. J Am Acad Dermatol, 2022, 86(1):68-76.
[12] PINTER A, GERDES S, PAPAVASSILIS C, er al. Characterization of responder groups to secukinumab treatment in moderate to severe plaque psoriasis[J]. J Dermatolog Treat, 2020, 31(8):769-775.
[13] LEBWOHL M G, LEONARDI C L, MEHTA N N, et al. Tildrakizumab efficacy, drug survival, and safety are comparable in patients with psoriasis with and without metabolic syndrome: Long-term results from 2 phase 3 randomized controlled studies (reSURFACE 1 and reSURFACE 2)[J]. J Am Acad Dermatol, 2021, 84(2):398-407.
[14] ALINAGHI F, CALOV M, KRISTENSEN L E, et al. Prevalence of psoriatic arthritis in patients with psoriasis: A systematic review and meta-analysis of observational and clinical studies[J]. J Am Acad Dermatol, 2019, 80(1):251-265.e19.
[15] ZHANG H, CHEN M, CUI R, et al. Prevalence of psoria-tic arthritis in Chinese population with psoriasis: A multicenter study conducted by experienced rheumatologists[J]. Chin Med J (Engl), 2023, 136(12):1439-1447.
[16] Ocampo D V, Gladman D. Psoriatic arthritis[J]. F1000Res. 2019; 8:F1000 Faculty Rev-1665.
[17] GRUNDY S M, STONE N J, BAILEY A L, et al. 2018 AHA/ACC/AACVPR/AAPA/ABC/ACPM/ADA/AGS/APhA/ASPC/NLA/PCNA Guideline on the Management of Blood Cholesterol: Executive Summary: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines published correction appears in Circulation[J]. Circulation, 2019, 139(25):e1046-e1081.
[18] GELFAND J M, NEIMANN A L, SHIN D B, et al. Risk of myocardial infarction in patients with psoriasis[J]. JAMA, 2006, 296(14):1735-1741.
[19] WU H, LUO Z, LIU J, et al. Association between psoriasis and coronary artery calcification: A systematic review and meta-analysis[J]. Front Cardiovasc Med, 2022, 9:1044117.
[20] GELFAND J M, DOMMASCH E D, SHIN D B, et al. The risk of stroke in patients with psoriasis[J]. J Invest Dermatol, 2009, 129(10):2411-2418.
[21] AHLEHOFF O, GISLASON G H, J?RGENSEN C H, et al. Psoriasis and risk of atrial fibrillation and ischaemic stroke: a Danish Nationwide Cohort Study[J]. Eur Heart J, 2012, 33(16):2054-2064.
[22] EDER L, JOSHI A A, DEY A K, et al. Association of Tumor Necrosis Factor Inhibitor Treatment With Reduced Indices of Subclinical Atherosclerosis in Patients With Psoriatic Disease[J]. Arthritis Rheumatol, 2018, 70(3):408-416.
[23] ARMSTRONG A W, HARSKAMP C T, ARMSTRONG E J. The association between psoriasis and hypertension: a systematic review and meta-analysis of observational studies[J]. J Hypertens, 2013, 31(3):433-443.
[24] SHAH K, MELLARS L, CHANGOLKAR A, et al. Real-world burden of comorbidities in US patients with psoriasis[J]. J Am Acad Dermatol, 2017, 77(2):287-292.e4.
[25] MAMIZADEH M, TARDEH Z, AZAMI M. The association between psoriasis and diabetes mellitus: A systema-tic review and meta-analysis[J]. Diabetes Metab Syndr, 2019, 13(2):1405-1412.
[26] ARMSTRONG A W, HARSKAMP C T, ARMSTRONG E J. The association between psoriasis and obesity: a systematic review and meta-analysis of observational studies[J]. Nutr Diabetes, 2012, 2(12):e54.
[27] GALLUZZO M, TALAMONTI M, PERINO F, et al. Bioelectrical impedance analysis to define an excess of body fat: evaluation in patients with psoriasis[J]. J Dermatolog Treat, 2017, 28(4):299-303.
[28] RAMEZANI M, ZAVATTARO E, SADEGHI M. Evaluation of serum lipid, lipoprotein, and apolipoprotein levels in psoriatic patients: a systematic review and meta-analysis of case-control studies[J]. Postepy Dermatol Alergol, 2019, 36(6):692-702.
[29] LUO L, GUO Y, CHEN L, et al. Crosstalk between cholesterol metabolism and psoriatic inflammation[J]. Front Immunol, 2023, 14:1124786.
[30] 中华医学会糖尿病学分会代谢综合征研究协作组. 中华医学会糖尿病学分会关于代谢综合征的建议[J]. 中华糖尿病杂志, 2004, 12(3):156-161.
[30] Collaborative Group of Metabolic Syndrome Research, diabetes Branch. Chinese Medical Association recommendations of Diabetes Branch of Chinese Medical Association on metabolic syndrome[J] Chinese Journal of diabetes, 2004, 12(3):156-161.
[31] CHOUDHARY S, PRADHAN D, PANDEY A, et al. The Association of Metabolic Syndrome and Psoriasis: A Systematic Review and Meta-Analysis of Observational Study[J]. Endocr Metab Immune Disord Drug Targets, 2020, 20(5):703-717.
[32] BELLINATO F, GISONDI P, MANTOVANI A, et al. Risk of non-alcoholic fatty liver disease in patients with chronic plaque psoriasis: an updated systematic review and meta-analysis of observational studies[J]. J Endocrinol Investm, 2022, 45(7):1277-1288.
[33] OGDIE A, GREWAL S K, NOE M H, et al. Risk of Incident Liver Disease in Patients with Psoriasis, Psoriatic Arthritis, and Rheumatoid Arthritis: A Population-Based Study[J]. J Invest Dermatol, 2018, 138(4):760-767.
[34] HEDEMANN T L, LIU X, KANG C N, et al. Associations between psoriasis and mental illness: an update for clinicians[J]. Gen Hosp Psychiatry, 2022, 75:30-37.
[35] LI C R, CHEN L, WANG L F, et al. Association between uveitis and psoriatic disease: a systematic review and Meta-analysis based on the evidence from cohort studies[J]. Int J Ophthalmol, 2020, 13(4):650-659.
[36] EPPINGA H, POORTINGA S, THIO H B, et al. Prevalence and Phenotype of Concurrent Psoriasis and Inflammatory Bowel Disease[J]. Inflamm Bowel Dis, 2017, 23(10):1783-1789.
[37] LIU C Y, TUNG T H, LEE C Y, et al. Association of Multiple Sclerosis with Psoriasis: A Systematic Review and Meta-Analysis of Observational Studies[J]. Am J Clin Dermatol, 2019, 20(2):201-208.
[38] FURUE K, ITO T, TSUJI G, et al. Autoimmunity and autoimmune co-morbidities in psoriasis[J]. Immunology, 2018, 154(1):21-27.
[39] WAN J, WANG S, HAYNES K, et al. Risk of moderate to advanced kidney disease in patients with psoriasis: population based cohort study[J]. BMJ, 2013, 347:f5961.
[40] SVEDBOM A, DALéN J, MAMOLO C, et al. Increased cause-specific mortality in patients with mild and severe psoriasis: a population-based Swedish register study[J]. Acta Derm Venereol, 2015, 95(7):809-815.
[41] ZHANG X, GU H, XIE S, et al. Periodontitis in patients with psoriasis: A systematic review and meta-analysis[J]. Oral Dis, 2022, 28(1):33-43.
[42] SHALOM G, DREIHER J, COHEN A. Psoriasis and obstructive sleep apnea[J]. Int J Dermatol 2016, 55(11):e579-e584.
[43] UNGPRASERT P, SRIVALI N, THONGPRAYOON C. Association between psoriasis and chronic obstructive pulmonary disease: A systematic review and meta-analysis[J]. J Dermatolog Treat, 2016, 27(4):316-321.
[44] ACHARYA P, MATHUR M. Association between psoriasis and celiac disease: A systematic review and meta-analysis[J]. J Am Acad Dermatol, 2020, 82(6):1376-1385.
[45] LAMBERT J L W, SEGAERT S, GHISLAIN P D, et al. Practical recommendations for systemic treatment in psoriasis in case of coexisting inflammatory, neurologic, infectious or malignant disorders (BETA-PSO: Belgian Evidence-based Treatment Advice in Psoriasis; part 2)[J]. J Eur Acad Dermatol Venereol, 2020, 34(9):1914-1923.
[46] MARTINEZ-LOPEZ A, BLASCO-MORENTE G, PEREZ-LOPEZ I, et al. Studying the effect of systemic and biological drugs on intima-media thickness in patients suffering from moderate and severe psoriasis[J]. J Eur Acad Dermatol Venereol, 2018, 32(9):1492-1498.
[47] RIDKER P M, EVERETT B M, PRADHAN A, et al. Low-Dose Methotrexate for the Prevention of Atherosclerotic Events[J]. N Engl J Med. 2019; 380(8):752-762.
[48] TSAI M H, C CHAN T, LEE M S, et al. Cardiovascular Risk Associated with Methotrexate versus Retinoids in Patients with Psoriasis: A Nationwide Taiwanese Cohort Study[J]. Clin Epidemiol, 2021, 13:693-705.
[49] AHLEHOFF O, SKOV L, GISLASON G, et al. Cardiovascular outcomes and systemic anti-inflammatory drugs in patients with severe psoriasis: 5-year follow-up of a Danish nationwide cohort[J]. J Eur Acad Dermatol Venereol, 2015, 29(6):1128-1134.
[50] GELFAND J M, SHIN D B, ARMSTRONG A W, et al. Association of Apremilast With Vascular Inflammation and Cardiometabolic Function in Patients With Psoriasis: The VIP-A Phase 4, Open-label, Nonrandomized Clinical Trial[J]. JAMA Dermatol, 2022, 158(12):1394-1403.
[51] GELFAND J M, SHIN D B, ALAVI A, et al. A Phase IV, Randomized, Double-Blind, Placebo-Controlled Crossover Study of the Effects of Ustekinumab on Vascular Inflammation in Psoriasis (the VIP-U Trial)[J]. J Invest Dermatol, 2020, 140(1):85-93.e2.
[52] LEISNER M Z, LINDORFF RIIS J, GNIADECKI R, et al. Psoriasis and risk of myocardial infarction before and during an era with biological therapy: a population-based follow-up study[J]. J Eur Acad Dermatol Venereol, 2018, 32(12):2185-2190.
[53] VON STEBUT E, REICH K, THA?I D, et al. Impact of Secukinumab on Endothelial Dysfunction and Other Cardiovascular Disease Parameters in Psoriasis Patients over 52 Weeks[J]. J Invest Dermatol, 2019, 139(5):1054-1062.
[54] ABRAMCZYK R, QUELLER J N, RACHFAL A W, et al. Diabetes and Psoriasis: Different Sides of the Same Prism[J]. Diabetes Metab Syndr Obes, 2020, 13:3571-3577.
[55] PINA T, ARMESTO S, LOPEZ-MEJIAS R, et al. Anti-TNF-α therapy improves insulin sensitivity in non-diabetic patients with psoriasis: a 6-month prospective study[J]. J Eur Acad Dermatol Venereol, 2015, 29(7):1325-1330.
[56] WANG H N, HUANG Y H. Changes in metabolic parameters in psoriatic patients treated with secukinumab[J]. Ther Adv Chronic Dis, 2020, 11:2040622320944777.
[57] CAI J, CUI L, WANG Y, et al. Cardiometabolic Comorbidities in Patients With Psoriasis: Focusing on Risk, Biological Therapy, and Pathogenesis[J]. Front Pharmacol, 2021, 12:774808.
[58] FEAGAN B G, SANDBORN W J, D'HAENS G, et al. 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[J]. Lancet, 2017, 389(10080):1699-1709.
[59] VENTURINI M, ZANCA A, VENTURUZZO A, et al. Secukinumab for patients with plaque psoriasis affected by multiple sclerosis: a mini-review with a representative case report[J]. J Eur Acad Dermatol Venereol, 2020, 34(2):e110-e112.
[60] BARBIERI J S, BEIDAS R S, GONDO G C, et al. Analysis of Specialist and Patient Perspectives on Strategies to Improve Cardiovascular Disease Prevention Among Persons With Psoriatic Disease[J]. JAMA Dermatol, 2022, 158(3):252-259.
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