Patients with psoriasis associated with increased systemic arterial and subcutaneous adipose inflammation

1. In a retrospective cohort study of 12 patients with psoriasis, 8F-fluorodeoxyglucose (FDG) positron emission tomography (PET)/computed tomography (CT) demonstrated significantly increased arterial inflammation and subcutaneous adipose tissue inflammation compared to healthy controls.

Evidence Rating Level: 3 (Average)

Study Rundown: Psoriasis is a chronic, inflammatory skin disorder associated with an increased risk for coronary artery disease, likely resulting from a systemic pro-inflammatory state. In addition, previous studies demonstrate that subcutaneous adipose tissue inflammation, which may contribute to the pathogenesis of psoriasis, is also associated with an increased risk of cardiovascular disease. Given the multiple associations demonstrated between psoriasis, inflammation, and atherosclerotic disease, the objective of this study was to assess the relationship between global vascular inflammation and subcutaneous adipose tissue inflammation in patients with moderate-to-severe psoriasis.

The study retrospectively compared vascular and subcutaneous adipose tissue inflammation, as assessed by FDG-PET/CT in 12 patients with moderate-to-severe psoriasis and 24 matched controls without psoriasis. At the conclusion of the study, psoriasis was demonstrated to be associated with significantly increased aortic and subcutaneous adipose inflammation. The results of this study further corroborate that there may be a link between psoriasis skin inflammation, vascular inflammation, cardiovascular disease, and obesity. This study is strengthened by the use of controls matched for age and sex, as well as requiring adequate medication washout periods. However, this study is limited by the small sample size that was selected from a single dermatology clinic. Furthermore, the matched control group consisted of patients with stage 1 penile cancer or localized melanoma that had required FDG-PET/CT imaging, so was not ideal as controls for comparison purposes. There is limited generalizability to the results as mostly men were included in the study and the age of patients ranged from 50 to 70 years old. Larger, multi-center prospective trials may improve the validity of the study.

Click to read the study in BJD

Relevant Reading: Increased Prevalence of Coronary Artery Disease in Severe Psoriasis and Severe Atopic Dermatitis

In-Depth [retrospective cohort]: This study retrospectively evaluated the association between psoriasis and inflammation of the aorta and subcutaneous adipose tissue via an open-label, observational, controlled study of consecutive patients in a university hospital dermatology clinic in Finland. Overall, this study identified 12 patients with psoriasis and 24 controls without psoriasis matched for age and sex. All patients underwent whole-body FDG-PET/CT, and inflammation was measured using maximal standardized uptake values (SUVmax) and the target-to-background ratio (TBRmax). At the conclusion of the trial, in the psoriasis group, arterial inflammation was increased compared with controls (mean whole vessel TBRmax 2.46 vs. 2.09; p = 0.005). Subcutaneous adipose tissue FDG uptake was also increased compared with controls (mean TBRmax 0.49 vs. 0.31; p = 0.002). An analysis of covariance regression model adjusted for body mass index and age confirmed that patients with psoriasis remained significantly associated with elevated whole-vessel TBRmax values.

Image: CC/Wiki/James Heilman, MD

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