Prevalence of Metabolic Syndrome and Insulin Resistance in Patients with Psoriasis

Öz

Aim: Recently, it has been proposed that chronic inflammation in psoriasis lead to metabolic syndrome (MetS) development. There is limited data about the relationship between psoriasis and IR. Aim of the present study was to investigate the prevalence of IR and MetS in psoriasis patients and the association between the severities of illnesses.

Material and Method: The study consisted of 48 psoriasis patients and 45 healthy individuals. IR was estimated using homeostasis model assessment (HOMA) of IR formula. The psoriasis activity was evaluated by the psoriasis area and severity index (PASI). Patients were divided into 3 groups according to PASI scores.

Results: MetS was observed in 21 patients (43.75%) and 8 controls (17.77%) (p=0.007). IR was observed in 16 patients (33.33%) and 5 controls (11.11%) (p=0.01). The frequencies of MetS and IR increased in psoriasis patients compared to healthy controls. According to linear regression analysis, PASI was independent risk factor for IR development (p=0.003).

Conclusion: The incidences of MetS and IR were found to be higher in patients with psoriasis compared to control group. Especially there was a strong association between severe psoriasis and IR risk. Therefore, psoriasis needs to be considered as not only a skin disorder, but also a metabolic and cardiovascular disease

Anahtar Kelimeler

• metabolic syndrome, psoriasis, insulin resistance, inflammation

Prevalence of Metabolic Syndrome and Insulin Resistance in Patients with Psoriasis

Öz

Aim: Recently, it has been proposed that chronic inflammation in psoriasis lead to metabolic syndrome (MetS) development. There is limited data about the relationship between psoriasis and IR. Aim of the present study was to investigate the prevalence of IR and MetS in psoriasis patients and the association between the severities of illnesses.

Material and Method: The study consisted of 48 psoriasis patients and 45 healthy individuals. IR was estimated using homeostasis model assessment (HOMA) of IR formula. The psoriasis activity was evaluated by the psoriasis area and severity index (PASI). Patients were divided into 3 groups according to PASI scores.

Results: MetS was observed in 21 patients (43.75%) and 8 controls (17.77%) (p=0.007). IR was observed in 16 patients (33.33%) and 5 controls (11.11%) (p=0.01). The frequencies of MetS and IR increased in psoriasis patients compared to healthy controls. According to linear regression analysis, PASI was independent risk factor for IR development (p=0.003).

Conclusion: The incidences of MetS and IR were found to be higher in patients with psoriasis compared to control group. Especially there was a strong association between severe psoriasis and IR risk. Therefore, psoriasis needs to be considered as not only a skin disorder, but also a metabolic and cardiovascular disease.

Anahtar Kelimeler

• metabolik sendrom, psoriasis, insülin direnci, inflamasyon

Kaynakça

1. Zindancı I, Albayrak O, Kavala M, et al. Prevalence of metabolic syndrome in patients with psoriasis. ScientificWorldJournal. 2012;2012:312463.
2. Christophers E, Mrowietz U. Psoriasis. In: Fredberg IM, Eisen AZ, Wolff K, Austen
3. KF, Goldsmith LA, Katz SI, Fitzpatrick TB (eds). Dermatology in General Medicine. 6th edition. New York: Mc Graw Hill, 2003;407-36.
4. Reaven GM. Banting lecture 1988. Role of insulin resistance in human disease. Diabetes. 1988;37:1595-607.
5. Armstrong AW, Harskamp CT, Armstrong EJ. Psoriasis and metabolic syndrome: A systematic review and meta-analysis of observational studies. J Am Acad Dermatol. 2013;68:654-62.
6. Langley RG, Ellis CN. Evaluating psoriasis with psoriasis area and severity index. J Am Acad Dermatol 2004;51:563-9.
7. Matthews DR, Hosker JP, Rudenski AS, Naylor BA, Treacher DF, Turner RC. Homeostasis model assessment: Insulin resistance and beta-cell function from fasting plasma glucose and insulin concentrations in man. Diabetologia 1985; 28: 412 – 19.
8. Expert Panel on Detection Ea, and Treatment of High Blood Cholesterol in Adults. Executive Summary of The Third Report of The National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation, And Treatment of High Blood Cholesterol In Adults (Adult Treatment Panel III) JAMA. 2001;285:2486–97.

9. Sugiyama H, Gyulai R, Toichi E et al. Dysfunctional blood and target tissue D4+CD25 high regulatory T cells in psoriasis: mechanism underlying unrestrained pathogenic effector T cell proliferation. J Immunol 2005;174:164–73.
10. Kaur S, Zilmer K, Kairane C et al. Clear differences in adiponectin level and inflammatory cytokine revealed in obese and normal-weight patients with psoriasis. Br J Dermatol 2008;159:1364–67.
11. Recansens M, Kunz D, Graf J, et al. Hyperglycemia at admission to the intensive care unit is associated with elevated serum concentrations of interleukin-6 and reduced ex vivo secretion of tumor necrosis factor-alpha. Crit Care Med 2004;32:1109-14.
12. Lobner K, Fuchtenbusch M. Inflammation and diabetes. Fortschr Med 2004;146:32-36.
13. Bastard JP, Jardel C, Bruckert E, et al.Elavated levels of IL-6 are reduced subcutaneous adipose of obese after weight loss. J Clin Endocrinol Metab 2000;85:3338-42.
14. Ucak S, Ekmekci T, Basat O. Comparison Of Various Insulin Sensitivity Indices In Psoriatic Patients And Their Relationship. J Eur Acad Dermatol Venereol 2006;20:517–22.
15. Sommer DM, Jenisch S, Suchan M et al. Increased prevalance of the metabolic syndrome with moderate to severe psoriasis. Arch Dermatol Res 2006;298:321-8.
16. Langan SM, Seminara NM, Shin DB et al. Prevalence of metabolic syndrome in patients with psoriasis: a population-based study in the United Kingdom. J Invest Dermatol 2011;132:556–62.
17. Boehncke S, Thaci D, Beschmann H, et al. Psoriasis Patients Show Signs Of Insulin Resistance. Br J Dermatol 2007;157:1249–51.
18. Akhyani M, Ehsani AH, Robati RM, et al. The lipid profile in psoriasis: a controlled study. J Eur Acad Dermatol Venereol 2007;21:1330-32.
19. Farshchian M, Zamanian A. Serum lipid level in Iranian patients with psoriasis. J Eur Acad Dermatol Venereol 2007;21:802-5.
20. Reich K. The concept of psoriasis as a systemic inflammation: implications for disease management. J Eur Acad Dermatol Venereol. 2012;26:3-11.
21. Ormseth MJ, Swift LL, Fazio S, et al. Free fatty acids are associated with insulin resistance but not coronary artery atherosclerosis in rheumatoid arthritis. Atherosclerosis 2011;219:869-74.
22. Cunha VR, Brenol CV, Brenol JC, et al. Metabolic syndrome prevalence is increased in rheumatoid arthritis patients and is associated with disease activity. Scand J Rheumatol 2012;41:186-91.