From the Guidelines
Psoriasis is commonly associated with several comorbidities that significantly impact patients' overall health, including psoriatic arthritis, cardiovascular diseases, metabolic disorders, mental health conditions, and inflammatory bowel disease, as supported by recent guidelines 1. The most frequent comorbidities include:
- Psoriatic arthritis, which affects approximately 30% of psoriasis patients and causes joint inflammation, pain, and potential joint destruction
- Cardiovascular diseases, with psoriasis patients having an increased risk of hypertension, atherosclerosis, myocardial infarction, and stroke due to chronic inflammation promoting endothelial dysfunction and atherosclerosis
- Metabolic disorders, including obesity, diabetes mellitus, dyslipidemia, and metabolic syndrome, with inflammation serving as a common pathophysiological link
- Mental health conditions, such as depression and anxiety, stemming from both psychological stress related to visible skin symptoms and shared inflammatory pathways
- Other associated conditions, including inflammatory bowel disease (particularly Crohn's disease), non-alcoholic fatty liver disease, uveitis, and an increased risk of certain malignancies like lymphoma These comorbidities share underlying inflammatory mechanisms with psoriasis, with TNF-alpha, IL-17, and IL-23 playing key roles in both skin manifestations and systemic effects, as noted in a national psoriasis foundation clinical consensus on psoriasis comorbidities 1. Regular screening for these conditions is essential in psoriasis management, as treating the underlying inflammation may benefit both the skin disease and its associated comorbidities, and guidelines recommend CV risk assessment and management according to national guidelines 1. Key recommendations for screening and management include:
- CV risk assessment (screening for hypertension, diabetes, and hyperlipidemia) for all patients with psoriasis
- Early and more frequent screening for hypertension, diabetes, and hyperlipidemia in patients who are candidates for systemic or phototherapy or who have psoriasis involving ≥10% body surface area
- Adaptation of risk score models for patients with psoriasis by introducing a 1.5 multiplication factor for those with ≥10% body surface area involvement or who are candidates for systemic or phototherapy
- CV risk management according to national guidelines, with target blood pressure and lipid levels based on risk as previously calculated, and use of antihypertensives and statins as in the general population.
From the Research
Comorbidities Associated with Psoriasis
The comorbidities associated with psoriasis include:
- Cardiovascular disease 2, 3, 4, 5, 6
- Metabolic syndrome 2, 4, 6
- Obesity 2, 4, 6
- Diabetes 2, 3, 4, 5, 6
- Fatty liver disease 2
- Inflammatory bowel disease 2, 6
- Ophthalmic disease 2
- Kidney disease 2, 6
- Osteoporosis 2
- Depression 2, 4, 5, 6
- Anxiety 2, 6
- Psoriatic arthritis 2, 4, 6
- Hypertension 3, 5
- Ischemic heart disease (IHD) 3
- Sleep disorder/insomnia 5
- Chronic obstructive pulmonary disease 5
- Gastroesophageal reflux disease 5
- Certain types of malignancy 6
- Hepatic disease 6
- Renal disease 6
Prevalence of Comorbidities
The prevalence of comorbidities in patients with psoriasis varies, with:
- Diabetes mellitus affecting 4.67% of patients 3
- Hypertension affecting 4% of patients 3
- Ischemic heart disease (IHD) affecting 3.33% of patients 3
- Single comorbidity affecting 7.33% of patients 3
- Multiple comorbidities affecting 3.33% of patients 3
Management and Screening
Patients with psoriasis should be routinely screened for comorbidities, including: