From the Guidelines
Psoriasis is a systemic inflammatory disease that can cause a wide range of systemic symptoms beyond skin manifestations, including increased risk of psoriatic arthritis, cardiovascular disease, hypertension, obesity, diabetes, and other immune-related ailments. The disease is associated with significant morbidity and comorbid conditions, with patients having an increased incidence of lymphoma, heart disease, and metabolic syndrome 1. The chronic systemic inflammation in psoriasis can lead to adverse health outcomes, including coronary artery disease and myocardial infarction, and patients with severe psoriasis have an increased risk for mortality, largely attributable to cardiovascular death 1.
Some of the common systemic symptoms of psoriasis include:
- Fatigue and malaise
- Joint pain and psoriatic arthritis, which can occur in up to 42% of individuals with psoriasis 1
- Inflammatory bowel symptoms, such as Crohn's disease, which is 3.8 to 7.5 times more common in patients with psoriasis than in the general population 1
- Eye inflammation, such as uveitis
- Cardiovascular complications, including heart disease and metabolic syndrome
The severity of systemic symptoms often correlates with the extent of skin disease, though not always 1. Patients with moderate to severe psoriasis should be monitored for these comorbidities, and treatment approaches that address both skin manifestations and systemic inflammation, such as biologics targeting specific inflammatory pathways, may provide better overall disease control and reduce long-term health risks. The use of biologics, such as tumor necrosis factor (TNF)-alpha inhibitors and interleukin (IL)-12 and IL-23 inhibitors, has been shown to be effective in reducing systemic inflammation and improving disease outcomes in patients with psoriasis 1.
Overall, psoriasis is a complex disease that requires a comprehensive treatment approach that addresses both skin manifestations and systemic inflammation to reduce the risk of comorbidities and improve overall health outcomes.
From the Research
Systemic Symptoms of Psoriasis
- Psoriasis is a systemic inflammatory disease associated with increased risk of comorbidities, such as psoriatic arthritis, Crohn's disease, malignancy, obesity, and cardiovascular diseases 2.
- The disease is characterized by development of erythematous, indurated, scaly, pruritic and often painful skin plaques, and its pathogenesis is driven by proinflammatory cytokines 3.
- Psoriasis is associated with increased risk for comorbidities, including psoriatic arthritis, cardiovascular disease, diabetes mellitus, obesity, inflammatory bowel disease, and nonalcoholic fatty liver disease compared with the general population 3, 4.
Impact of Systemic Symptoms
- The presence of comorbidities has a significant impact on the decision to use one therapy over another, and treatment regimens for psoriasis patients should be tailored to meet the specific needs based on disease severity, the impact on quality of life, the response to previous therapies, and the presence of comorbidities 2.
- Patients with psoriasis experience substantial morbidity and increased rates of inflammatory arthritis, cardiometabolic diseases, and mental health disorders 4.
- The most rapid advancements addressing plaque psoriasis have been in its pathogenesis, genetics, comorbidities, and biologic treatments 4.
Treatment of Systemic Symptoms
- Biological therapies, such as anti-tumor necrosis factor (TNF) therapies and a monoclonal antibody against interleukin (IL)-12 and IL-23, are suitable options for patients with extensive disease 5.
- Biologics that inhibit TNF-α, p40IL-12/23, and IL-17 are also approved for the treatment of psoriatic arthritis 4.
- Apremilast can be safely combined with all biologic agents in patients with plaque psoriasis or psoriatic arthritis not responding adequately to biologics alone 6.