Can Psoriasis Cause a Globulin Level of 3.9 g/dL?
Yes, psoriasis can cause elevated globulin levels, and a value of 3.9 g/dL is consistent with the inflammatory state associated with this disease.
Evidence for Elevated Globulin in Psoriasis
The most direct evidence comes from a hospital-based case-control study that specifically measured serum globulin levels in psoriasis patients compared to healthy controls 1. This study demonstrated that:
- Serum globulin levels were significantly elevated in psoriasis patients (mean 3.296 g/dL) compared to controls (mean 2.596 g/dL, P = 0.0014) 1
- The elevation occurred alongside decreased albumin levels (3.762 g/dL vs. 4.103 g/dL in controls) 1
- Your patient's globulin level of 3.9 g/dL falls above the mean for psoriasis patients in this study, suggesting active inflammatory disease 1
Mechanism: Psoriasis as Systemic Inflammation
The elevated globulin reflects the systemic inflammatory nature of psoriasis rather than just a skin condition:
- Psoriasis triggers an acute phase response mediated by proinflammatory cytokines (IL-1, IL-6, TNF-α), which stimulates hepatic production of acute phase proteins including globulins 2
- This inflammatory cascade is not completely extinguished even during clinical remission, as evidenced by persistently elevated acute phase reactants 2
- The systemic inflammation in psoriasis shares immunopathogenic similarities with atherosclerosis and contributes to cardiovascular comorbidities 3
Clinical Implications and Monitoring
Given the association between psoriasis severity and metabolic/cardiovascular comorbidities, the elevated globulin should prompt comprehensive screening:
- Screen for metabolic syndrome components: blood pressure, fasting glucose or HbA1c, lipid panel, BMI calculation, and abdominal circumference 4
- Cardiovascular risk assessment is recommended for all psoriasis patients, with screening for hypertension, diabetes, and hyperlipidemia according to national guidelines 4
- For patients with moderate-to-severe psoriasis (>10% BSA or requiring systemic therapy), apply a 1.5 multiplication factor when calculating cardiovascular risk scores 4
Disease Severity Correlation
The degree of globulin elevation may correlate with psoriasis severity:
- Metabolic syndrome prevalence increases with psoriasis severity: 34% in psoriasis patients overall versus 26% in controls (OR 1.50) 4
- Severe psoriasis (>10% BSA) shows stronger associations with systemic abnormalities compared to mild disease 4
Common Pitfall to Avoid
Do not dismiss elevated globulin as an isolated laboratory finding. The elevation reflects systemic inflammation that contributes to the 3-4 year reduction in life expectancy seen in severe psoriasis patients, primarily through increased cardiovascular events 3. This warrants proactive screening and management of cardiovascular risk factors, not just treatment of skin manifestations 4.