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The importance of disease associations and concomitant therapy for the long-term management of psoriasis patients

Mrowietz U, Elder JT, Barker J - Arch. Dermatol. Res. (2006)

Bottom Line: QoL, direct health care expenditures and pharmacokinetics of concomitant therapies are impacted by the presence of comorbid conditions.For example, methotrexate is contraindicated in hepatic impairment, while patients on cyclosporin should be monitored for kidney function.Consequently, collaboration between physicians in different specialties is essential to ensuring that psoriasis treatment benefits the patient without exacerbating associated conditions.

Affiliation: Department of Dermatology, University of Kiel, Schittenhelmstrasse 7, 24105 Kiel, Germany. umrowietz@dermatology.uni-kiel.de

ABSTRACT

It is well established that several inflammatory-type conditions, such as arthritis, diabetes, cardiovascular disease, and irritable bowel disease exist comorbidly and at an increased incidence in patients with psoriasis. Psoriasis and other associated diseases are thought to share common inflammatory pathways. Conditions such as these, with similar pathogenic mechanisms involving cytokine dysregulation, are referred to as immune-mediated inflammatory diseases (IMIDs). Considerable evidence for the genetic basis of comorbidities in psoriasis exists. The WHO has reported that the occurrence of chronic diseases, including IMIDs, are a rising global burden. In addition, conditions linked with psoriasis have been associated with increasing rates of considerable morbidity and mortality. The presence of comorbid conditions in psoriasis patients has important implications for clinical management. QoL, direct health care expenditures and pharmacokinetics of concomitant therapies are impacted by the presence of comorbid conditions. For example, methotrexate is contraindicated in hepatic impairment, while patients on cyclosporin should be monitored for kidney function. In addition, some agents, such as beta blockers, lithium, synthetic antimalarial drugs, NSAIDs and tetracycline antibiotics, have been implicated in the initiation or exacerbation of psoriasis. Consequently, collaboration between physicians in different specialties is essential to ensuring that psoriasis treatment benefits the patient without exacerbating associated conditions.

Inflammatory pathway in psoriasis [50]. Working model for immunopathogenesis of psoriasis. Multiple stages are proposed for trafficking patterns of immunocytes, involving signals in which symptomless skin is converted into a psoriatic plaque. Key inflammatory events include intraepidermal trafficking by CD8+ T cells and neutrophils. Reproduced with permission from J Clin Invest (2004, 113:1664–1675). Copyright 2004, The American Society for Clinical Investigation
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Fig1: Inflammatory pathway in psoriasis [50]. Working model for immunopathogenesis of psoriasis. Multiple stages are proposed for trafficking patterns of immunocytes, involving signals in which symptomless skin is converted into a psoriatic plaque. Key inflammatory events include intraepidermal trafficking by CD8+ T cells and neutrophils. Reproduced with permission from J Clin Invest (2004, 113:1664–1675). Copyright 2004, The American Society for Clinical Investigation

Mentions: The immune system has been strongly implicated in the pathogenesis of psoriasis that resembles a T cell-mediated, autoimmune, inflammatory disease [7]. T cells are found in the dermis and epidermis and are accompanied by increased numbers of dermal dendritic cells, macrophages and mast cells [51]. It is thought that a stimulus (such as trauma or infection) triggers a plexus of cellular events by inciting a cascade of cytokines, creating an inflammatory response. Dendritic cells and T cells become activated with the formation of an immunological synapse—a multimolecular complex at the T cell-antigen-presenting cell interface that facilitates immune cell interactions. Once activated, dendritic antigen-presenting cells and T cells release cytokines, chemokines and growth factors, which trigger keratinocyte proliferation, altered differentiation and an angiogenic tissue response, giving rise to psoriatic lesions (Fig. 1).Fig. 1

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The importance of disease associations and concomitant therapy for the long-term management of psoriasis patients

Mrowietz U, Elder JT, Barker J - Arch. Dermatol. Res. (2006)

Inflammatory pathway in psoriasis [50]. Working model for immunopathogenesis of psoriasis. Multiple stages are proposed for trafficking patterns of immunocytes, involving signals in which symptomless skin is converted into a psoriatic plaque. Key inflammatory events include intraepidermal trafficking by CD8+ T cells and neutrophils. Reproduced with permission from J Clin Invest (2004, 113:1664–1675). Copyright 2004, The American Society for Clinical Investigation
© Copyright Policy
Fig1: Inflammatory pathway in psoriasis [50]. Working model for immunopathogenesis of psoriasis. Multiple stages are proposed for trafficking patterns of immunocytes, involving signals in which symptomless skin is converted into a psoriatic plaque. Key inflammatory events include intraepidermal trafficking by CD8+ T cells and neutrophils. Reproduced with permission from J Clin Invest (2004, 113:1664–1675). Copyright 2004, The American Society for Clinical Investigation
Mentions: The immune system has been strongly implicated in the pathogenesis of psoriasis that resembles a T cell-mediated, autoimmune, inflammatory disease [7]. T cells are found in the dermis and epidermis and are accompanied by increased numbers of dermal dendritic cells, macrophages and mast cells [51]. It is thought that a stimulus (such as trauma or infection) triggers a plexus of cellular events by inciting a cascade of cytokines, creating an inflammatory response. Dendritic cells and T cells become activated with the formation of an immunological synapse—a multimolecular complex at the T cell-antigen-presenting cell interface that facilitates immune cell interactions. Once activated, dendritic antigen-presenting cells and T cells release cytokines, chemokines and growth factors, which trigger keratinocyte proliferation, altered differentiation and an angiogenic tissue response, giving rise to psoriatic lesions (Fig. 1).Fig. 1

Bottom Line: QoL, direct health care expenditures and pharmacokinetics of concomitant therapies are impacted by the presence of comorbid conditions.For example, methotrexate is contraindicated in hepatic impairment, while patients on cyclosporin should be monitored for kidney function.Consequently, collaboration between physicians in different specialties is essential to ensuring that psoriasis treatment benefits the patient without exacerbating associated conditions.

Affiliation: Department of Dermatology, University of Kiel, Schittenhelmstrasse 7, 24105 Kiel, Germany. umrowietz@dermatology.uni-kiel.de

ABSTRACT

It is well established that several inflammatory-type conditions, such as arthritis, diabetes, cardiovascular disease, and irritable bowel disease exist comorbidly and at an increased incidence in patients with psoriasis. Psoriasis and other associated diseases are thought to share common inflammatory pathways. Conditions such as these, with similar pathogenic mechanisms involving cytokine dysregulation, are referred to as immune-mediated inflammatory diseases (IMIDs). Considerable evidence for the genetic basis of comorbidities in psoriasis exists. The WHO has reported that the occurrence of chronic diseases, including IMIDs, are a rising global burden. In addition, conditions linked with psoriasis have been associated with increasing rates of considerable morbidity and mortality. The presence of comorbid conditions in psoriasis patients has important implications for clinical management. QoL, direct health care expenditures and pharmacokinetics of concomitant therapies are impacted by the presence of comorbid conditions. For example, methotrexate is contraindicated in hepatic impairment, while patients on cyclosporin should be monitored for kidney function. In addition, some agents, such as beta blockers, lithium, synthetic antimalarial drugs, NSAIDs and tetracycline antibiotics, have been implicated in the initiation or exacerbation of psoriasis. Consequently, collaboration between physicians in different specialties is essential to ensuring that psoriasis treatment benefits the patient without exacerbating associated conditions.

View Similar Images In: Results  - Collection
View Article: PubMed Central -  PubMed
Show All Figures - Show MeSH
getmorefigures.php?pmc=1705513&rFormat=json&query=null&req=5