11 The burden of psoriasis: le comorbidità. s. Chimenti

The burden of psoriasis:
le comorbidità
Alessandro Giunta e Sergio Chimenti
Clinica Dermatologica - Università di Roma Tor Vergata
Conflitti di interesse
Consulente, relatore, board member o investigator per Abbott, Abbvie, Novartis, Pfizer
Definizione di comorbidità
Per comorbidità si intende una o più condizioni morbose che
insorgono in associazione con una data malattia di base, spesso
in relazione a meccanismi patogenetici comuni
Al contrario delle sindromi, in cui i sintomi sono in genere sincroni
o comunque in stretta correlazione temporale, le comorbidità
sono indipendenti dal punto di vista temporale dalla patologia di
base
Comorbidità e psoriasi
La prima descrizione di una
comorbidità nella psoriasi è
opera di Alibert che, nel 1818,
osservò che i pazienti affetti da
psoriasi frequentemente
soffrivano di una artropatia
infiammatoria
Questo avvenne solo 10 anni dopo la
classificazione della psoriasi come
una entità distinta da parte di Willan
Willan R. On Cutaneous Diseases. London, 1808
Alibert JL. Précis Théorique et Pratique sur les Maladies de la Peau, Vol. 1. Caille et Ravier, Paris, 1818
Le comorbidità nella psoriasi
Malattia
Trattamento
Paziente
Le comorbidità nella psoriasi
Malattia
Trattamento
Paziente
Comorbidità e psoriasi
Malattie endocrino-metaboliche
A. Diabete mellito e insulino-resistenza
B. Dislipidemia
C. Obesità
D. Sindrome metabolica
Apparato cardiocircolatorio
E. Scompenso cardiaco
F. Infarto del miocardio
G. Ipertensione arteriosa
Apparato gastrointestinale
A. Morbo di Chron
B. Celiachia
Malattie psichiatriche
Maltattie dell’apparato visivo
Malattie dell’apparato renale
Comorbidità e psoriasi
Malattie endocrino-metaboliche
A. Diabete mellito e insulino-resistenza
B. Dislipidemia
C. Obesità
D. Sindrome metabolica
Apparato cardiocircolatorio
E. Scompenso cardiaco
F. Infarto del miocardio
G. Ipertensione arteriosa
Apparato gastrointestinale
A. Morbo di Chron
B. Celiachia
Malattie psichiatriche
Maltattie dell’apparato visivo
Malattie dell’apparato renale
Psoriasi e morbo di Chron
Downloaded from gut.bmj.com on February 8, 2014 - Published by group.bmj.com
Gut, 1968, 9, 17-21
Diseases associated with ulcerative colitis and
Crohn's disease
BARBARA HAMMER, PAMELA ASHURST, AND J. NAISH
From the Department of Gastroenterology, Frenchay Hospital, Bristol
The causes of both ulcerative colitis and Crohn's
disease remain unknown, but a number of clues
point towards a relationship between these two
diseases and a possible genetic background for
both. The studies of Evans and Acheson (1965) and
of Wigley and Maclaurin (1962), preceded by those
of Houghton and Naish (1958), indicate that the
prevalence of ulcerative colitis in people of predominantly British stock is approximately 1 per 1,000
population, whereas the prevalence of Crohn's
disease is approximately 1 per 8,000. The evidence
from the North Island of New Zealand (Wigley and
Maclaurin, 1962) is that those of Maori stock who
are living the same urban or rural life as those of
European stock have a very much decreased risk of
contracting ulcerative colitis. In fact, the disease in
Maoris is excessively rare. It is almost certain that
the disease is equally rare amongst the Chinese and
Japanese, but in countries where the chronic
dysenteries are the commonest inflammatory bowel
disorder it will probably be some years before
reliable epidemiological studies can be made of the
prevalence of such diseases as colitis and Crohn's
disease.
In the meantime the epidemiological evidence from
Britain (Evans and Acheson, 1965) and from the
U.S.A. points to a definite genetic susceptibility to
both ulcerative colitis and Crohn's disease (Kirsner
and Spencer, 1963; Sherlock, Bell, Steinberg, and
Almy, 1963). In various studies of populations
culled through hospital records, the most informative of which is that of Evans and Acheson (1965)
in which the hospital statistics were related to the
population at risk (Oxfordshire, England), it has
been shown that some 5% of colitics and 8% of
sufferers from Crohn's disease have a first-degree
relative suffering from the same disease. Furthermore, a significant number of colitics have near
relatives suffering from Crohn's disease and vice
versa. The increased liability of the Jewish population to contract colitis and Crohn's disease has
been noted in many publications (Acheson, 1960;
Birnbaum, Groen, and Kallner, 1960).
There are other interesting links between ulcerative colitis and Crohn's disease on the one hand
and ankylosing spondylitis (Acheson, 1960; McBride, King, Baikie, Crean, and Sircus, 1963) and
autoimmune hepatitis (Holdsworth, Hall, Dawson,
and Sherlock, 1965) on the other. Since either disease may precede the development of the other, and
since the prevalence of the linked disease is often
higher than can be accounted for by chance in the
first degree relatives of propositi, it is reasonable to
assume that there may be a weak genetic predisposition to the development of one or more of
these diseases with environmental stress determining the onset and expression.
In an attempt to find out more about the question
of familial susceptibility we have ascertained the
prevalence of certain diseases, some of which are
thought to be of an allergic or autoclastic nature, in
a group of patients suffering from ulcerative colitis, a group of patients suffering from Crohn's
disease, and in their first degree relatives.
METHODS AND MATERIAL
17
The case records of 242 patients suffering from ulcerative
colitis and 45 patients suffering from Crohn's disease
were first scrutinized. All these patients had been under
the care of one of us (J.M.N.) at Frenchay Hospital or
Southmead Hospital, Bristol, during the years 1952 to
1965 inclusive. All of the patients with Crohn's disease
were interviewed and the criteria of diagnosis critically
reviewed. Diagnosis was based on histological data in all
but a few of these cases and in these few the radiological
and clinical findings were unequivocally those of Crohn's
disease. Cases of Crohn's disease of the colon were
included. Of the 242 patients with ulcerative colitis, 48
were rejected either because they were dead, because the
criteria for diagnosis (radiological, sigmoidoscopic,
histological, and haematological) were incomplete, or
because they could not be traced. This left 198 patients
available for analysis. Of these 97 were interviewed and
101 replied to a postal questionnaire. The questions put
to these patients were as follows: any personal history of
constitutional eczema (not dermatitis), psoriasis, hay
fever, asthma, polyarthritis, any thyroid disease? Any
Psoriasi e morbo di Chron
A. Nel 1973, Verbov in uno studio prospettico sulle patologie
dermatologiche di 142 pazienti affetti da IBD, osservò una
prevalenza della psoriasi del 5% nel Morbo di Crohn e del
7,5% nella rettocolite ulcerosa
B. Per quanto interessanti, I suoi risultati erano difficili da
interpretare, essendo la psoriasi una patologia di comune
osservazione nella popolazione generale
C. Più recentemente, una possibile patogenesi comune delle
due patologie è stata suggerita dalla vicinanza sul
cromosoma 6q21 del gene CARD-15 e del locus di
suscettibilità PSORS8
Verbov J. Transactions of the St.John's Hospital Dermatological Society. 1973
CARD-15, MC e PsO
A. Borgiani P, Vallo L, D'Apice MR, Giardina E, Pucci S, Capon F, Nistico S,
Chimenti S, Pallone F, Novelli G. Exclusion of CARD15/NOD2 as a
candidate susceptibility gene to psoriasis in the Italian population.
Eur J Dermatol. 2002 Nov-Dec;12(6):540-2
B. Giardina E, Novelli G, Costanzo A, Nistico S, Bulli C, Sinibaldi C, Sorgi
ML, Chimenti S, Pallone F, Taccari E, Borgiani P. Psoriatic arthritis and
CARD15 gene polymorphisms: no evidence for association in the
Italian population. J Invest Dermatol. 2004 May;122(5):1106-7
C. Jenisch S, Hampe J, Elder JT, Nair R, Stuart P, Voorhees JJ, Schreiber S,
Kabelitz D, Christophers E, Weichenthal M. CARD15 mutations in
patients with plaque-type psoriasis and psoriatic arthritis: lack of
association. Arch Dermatol Res. 2006 Mar;297(9):409-11
D. Lascorz J, Burkhardt H, Huffmeier U, Bohm B, Schurmeyer-Horst F,
Lohmann J, Stander M, Wendler J, Kelsch R, Baumann C, Kuster W,
Traupe H, Reis A. Lack of genetic association of the three more
common polymorphisms of CARD15 with psoriatic arthritis and
psoriasis in a German cohort. Ann Rheum Dis. 2005 Jun;64(6):951-4.
Psoriasi e IBDs
20%
15%
10%
5%
0%
9,39%
9,19%
Morbo di Chron
Rettocolite ulcerosa
Prevalenza della psoriasi (%)
Comorbidità e psoriasi
Malattie endocrino-metaboliche
A. Diabete mellito e insulino-resistenza
B. Dislipidemia
C. Obesità
D. Sindrome metabolica
Apparato cardiocircolatorio
E. Scompenso cardiaco
F. Infarto del miocardio
G. Ipertensione arteriosa
Apparato gastrointestinale
A. Morbo di Chron
B. Celiachia
Malattie psichiatriche
Maltattie dell’apparato visivo
Malattie dell’apparato renale
La Sindrome Metabolica
Per sindrome metabolica si intende uno stato fisiopatologico che
identifica un sottogruppo di pazienti con un aumentato rischio di
patologia cardiovascolare e diabete mellito di tipo 2
In pazienti senza altri fattori di rischio cardiovascolare o diabete,
la sindrome metabolica comportava un rischio:
A. da 1,5 a 2 volte maggiore per lo sviluppo di coronaropatia
B. di circa 2 volte maggiore per l’ictus ischemico
C. di circa 3 volte per lo sviluppo di diabete mellito di tipo 2
Huang PL. A comprehensive definition for metabolic syndrome. Dis Model Mech 2009 May-Jun; 2 (5-6):
231-237.
McNeill AM, Rosamond WD, Girman CJ, Hill Golden S, Schmidt MI, East HE, Ballantyne CM, Heiss G. The
metabolic syndrome and 11-year of risk incident cardiovascular disease in the atherosclerosis risk in
communities study. Diabetes Care 2005; 28: 385-390.
Ford ES. Risks for all-cause mortality, cardiovascular disease, and diabetes associated with the metabolic
syndrome: a summary of the evidence. Diabetes Care 2005; 28: 1769-1778
NCEP-AT P III (2005)
National Cholesterol Education Program Adult Treatment Panel III
Si può correttamente porre diagnosi di sindrome metabolica, se
si riscontrano tre o più dei seguenti criteri:
A. Circonferenza vita > 102 cm (uomini) o > 88 cm (donne);
B. PA sistolica > 130 mmHg o PA diastolica > 85
mmHg o in trattamento farmacologico
C. Trigliceridemia ≥ 150 mg/dl o in trattamento farmacologico
D. HDL < 40 mg/dl (uomini) o < 50 mg/dl (donne) o in
trattamento farmacologico
E. Glicemia a digiuno ≥ 100 mg/dl o in trattamento
farmacologico
Psoriasi e Obesità
Tra le varie componenti della sindrome metabolica,
l’associazione tra psoriasi e obesità è quella maggiormente
documentata
Psoriasi e Obesità
Tra le varie componenti della sindrome metabolica,
l’associazione tra psoriasi e obesità è quella maggiormente
documentata
Nurses’ Health Study II
A. Studio prospettico longitudinale su 78.626 donne statunitensi
per un periodo di 14 anni
B. Relazione tra vari indici di adiposità (BMI, circonferenza della
vita, circonferenza dei fianchi e Waist-to-Hip Ratio) e l’incidenza
di psoriasi
C. Limiti dello studio: autodeterminazione delle misure
antropometriche e diagnosi dermatologica non necessariamente
confermata da visita specialistica
Prima evidenza prospettica che l’obesità possa favorire lo
sviluppo della psoriasi
Hamminga EA, van der Lely AJ, Neumann HA, Thio HB. Chronic inflammation in psoriasis and obesity:
implications for therapy. Med Hypoth 2006; 67: 768-773
Obesità e risposta terapeutica
61 pazienti obesi con psoriasi in un trial clinico randomizzato
doppio cieco
A. Introduzione di una dieta ipocalorica con perdita di peso
B. Trattamento con ciclosporina a basse dosi
Maggiore efficacia del farmaco
Gisondi P, Del Giglio M, Di Francesco V, Zamboni M, Girolomoni G. Weight loss improves the response of
obese patients with moderate-to-severe chronic plaque psoriasis to low-dose cyclosporine therapy: a
randomized, controlled, investigator-blinded clinical trial. Arch Dermatol 2010; 146 (5): 544-546
Obesità e terapie biologiche
Significativo aumento di peso e di BMI nei pazienti trattati con antiTNF-α rispetto al gruppo di controllo, con un incremento ponderale
medio a 48 settimane pari a 2,18 kg per ETA, 1,53 kg per IFX e 2,57
kg per ADA
A. l’aumento di peso e del BMI non influisca negativamente sulla
efficacia della terapia biologica
B. Nessuna alterazione significativa del profilo dei lipidi plasmatici
(trigliceridi, colesterolo totale, HDL e LDL)
Saraceno R, Schipani C, Mazzotta A, Esposito M, Di Renzo L, De Lorenzo A, Chimenti S. Effect of anti-tumor
necrosis factor-alpha therapies on body mass index in patients with psoriasis. Pharmacol Res 2008; 57:
290-295
Psoriasi e insulino-resistenza
Diversi studi osservazionali, con differenti modalità, hanno
dimostrato una maggiore prevalenza dell’insulino-resistenza
(o diabete) nei pazienti con psoriasi rispetto alla
popolazione sana
Cohen AD, Gilutz H, Henkin Y, Zahger D, Shapiro J, Bonneh DY, Vardy DA. Psoriasis and the Metabolic
Syndrome. Acta Derm Venereol 2007; 87: 506-509
Neimann AL, Shin DB, Wang X, Margolis DJ, Troxel AB, Gelfand JM. Prevalence of cardiovascular risk factors
in patients with psoriasis. J Am Acad Dermatol 2006;55: 829-835
Sommer DM, Jenish S, Suchan M, Cristophers E, Weichenthal M. Increased prevalence of the metabolic
syndrome in patients with moderate to severe psoriasis. Arch Dermatol Res 2006; 298: 321-328
Shapiro J, Cohen AD, David M, Hodak E, Chodik G, Viner A, Kremer E, Heymann A. The association between
psoriasis, diabetes mellitus, and atherosclerosis in Israel: a case-control study. J Am Acad Dermatol 2007;
56 (4): 629-634
Cohen AD, Dreiher J, Shapiro Y, Vidavsky L, Vardy DA, Davidovici B, Meyerovitch J. Psoriasis and diabetes: a
population-based cross-sectional study. J Eur Acad Dermatol Venereol 2008; 22: 585-589
Psoriasi e insulino-resistenza
A. Correlazione significativa tra gravità della psoriasi,
secrezione insulinica e livelli sierici di resistina,
un’adipochina implicata nella patogenesi dell’insulinoresistenza .(1) L’obesità (e l’iperproduzione di resistina)
contribuisce notevolmente a questa condizione
B. Tuttavia, anche i pazienti psoriasici non obesi mostrano una
tendenza verso lo sviluppo di insulino-resistenza (2)
C. Inoltre, i parametri indicativi di insulino-resistenza
(Homeostasis Model Assesment for Insulin Resistance,
HOMA-IR, e il Fasting Insulin Resistance Index, FIRI) così
come la glicemia e l’insulinemia a digiuno erano
significativamente più elevati nei pazienti psoriatici rispetto
ai controlli, e ancor più nei pazienti con psoriasi di tipo II
rispetto al tipo I
(1)
Boehncke S, Thaci D, Beschmann H, Ludwig RJ, Ackermann H, Badenhoop K, Boehncke WH. Psoriasis patients
show signs of insulin resistance. Br J Dermatol 2007; 157 (6): 1249-1251
(2)
Ucak S, Ekmekci TR, Basat O, Koslu A, Altuntas Y. Comparison of various insulin sensitivity indices in psoriasis
patients and their relationship with type of psoriasis. J Eur Acad Dermatol Venereol 2006; 20: 517-522
Non Alcholic Fatty Liver Disease (NAFLD)
Epatomegalia lieve-moderata dovuta ad accumulo diffuso di grassi
neutri (trigliceridi) negli epatociti
A. Attualmente considerata come una manifestazione epatica della
sindrome metabolica
B. Causa più comune di elevazione dei livelli di transaminasi
C. Forma più diffusa di patologia epatica nei paesi più
industrializzati, colpendo circa un terzo della popolazione
generale
Rivera R, Vanaclocha F. Nonalcoholic fatty liver disease and psoriasis. Actas Dermosifiliogr. 2010; 101 (8):
657-658
Gisondi P, Targher G, Zoppini G, Girolomoni G. Non-alcoholic fatty liver disease in patients with chronic plaque
psoriasis. Journal of Hepatology 2009; 51: 758-764
Prevalenza della SM nei pazienti psoriasici
USA
40
India
38
Tunisia
35,5
Giappone
24,4
Cina
38,1
0
10
20
30
40
Nisa N, Qazi MA. Prevalence of metabolic syndrome in patients with psoriasis. Indian J Dermatol Venereol
Leprol 2010; 76 (6): 662-665
Mebazaa A, El Asmi M, Zidi W, Zayani Y, Cheikh Rouhou R, El Ounifi S, Kanoun F, Mokni M, Osman AB, Feki M,
Slimane H, Mebazaa A, Kaabachi N. Metabolic syndrome in Tunisian psoriatic patients: prevalence and
determinants. J Eur Acad Dermatol Venereol 2010
Takahashi H, Takahashi I, Honma M, Ishida-Yamamoto A, Iizuka H. Prevalence of metabolic sindrome in
Japanese psoriasis patients. J Dermatol Sci 2010 ;57 (2):143-4
Li F, Jin HZ, Wang BX. Prevalence of metabolic syndrome in psoriasis inpatients in Peking Union Medical
College Hospital. Acta Acad Med Sin 2010. 32 (5): 583- 585
Identikit del paziente con SM
A. sesso maschile
B. età > 50 anni
C. BMI > 25
D. psoriasi moderato-severa (PASI > 10)
E. malattia di lungo corso
F. esordio della malattia in età giovanile.
Ahdout J, Kim J, Chiu M. Modifiable metabolic syndrome-associated lifestyle factors in psoriasis patients. J
Am Acad Dermatol 2009; 60: AB169
Miele L, De Simone C, Cefalo C, Vallone S, Bussoletti C, Forgione A, Gabrieli ML, Vero V, Di Stasi C, D’Agostino
M, Amerio P, Gasbarrini G, Grieco A. Prevalence of nonalcoholic fatty liver disease (NADFL) and metabolic
syndrome in patients with psoriasis. Digestive and Liver Disease 2008; 40: S179
- Comorbidità Cardiovascolari Types of costs
Odds Ratio and 95% CI
OR
95% CI
P
Diabetes
1.42
1.10-1.84
<0.01
Hypertension
1.49
1.23-1.80
<0.01
High Cholesterol
1.35
1.11-1.63
<0.01
Congestive Heart
Failure
1.19
0.69-2.06
NS
0
1
2
3
Wu Y, et al. J Drugs Dermatol. 2008;7(4):373-7.
- Psoriasi e Infarto del Miocardio -
Relative risk
(95% confidence intervals)
10
1.0
0.5
20!
30!
40!
50!
60!
70!
80!
Age (years)
Severe psoriasis
Adjusted relative risk is shown on a log scale
Gelfand JM, et al. JAMA. 2006;296:1735-41.
Mild psoriasis
BJD
British Journal of Dermatology
T H E R A P E U T I CS
Survival rate of antitumour necrosis factor-a treatments for
psoriasis in routine dermatological practice: a multicentre
observational study
M. Esposito,1 P. Gisondi,2 N. Cassano,3 G. Ferrucci,4 M. Del Giglio,2 F. Loconsole,3 A. Giunta,1 G.A. Vena,3
S. Chimenti1 and G. Girolomoni2
1
Department of Dermatology, University of Rome Tor Vergata, Viale Oxford 81 – 00133, Rome, Italy
Section of Dermatology and Venereology, Department of Medicine, University of Verona, Verona, Italy
3
Unit of Dermatology and Venereology, Department of Biomedical Sciences and Human Oncology, University of Bari, Bari, Italy
4
Informa s.r.l., Rome, Italy
2
Summary
Correspondence
Maria Esposito.
E-mail: espositomaria@virgilio.it
Accepted for publication
30 April 2013
Background Adherence is an overall marker of treatment success, and it depends on
multiple factors including efficacy and safety. Despite the wide use of tumour
necrosis factor (TNF)-a blockers in the treatment of plaque-type psoriasis, few
data regarding treatment adherence in routine clinical practice are available.
Objectives To estimate the long-term survival rate of anti-TNF-a therapy in a
cohort of patients with psoriasis in routine clinical practice; to evaluate the rea-
- Comorbidità e Biologici: esperienza personale 36,2%
Chron Disease
21,7%
Cardiac disorders
Diabetes
Liver disorders
Observed patients
(n): 650
11,8%
8,8%
5,7%
Dislipidemia
Hypertension
0,2%
Proportion of patients (%)
Coexistence of symptomatic PsA (diagnosed by CASPAR criteria) was observed in 381 subjects (58.6%), without differences
among the 3 drugs
Original Paper
Dermatology 2012;225:312–319
DOI: 10.1159/000345623
Received: May 24, 2012
Accepted after revision: October 29, 2012
Published online: December 28, 2012
Efficacy and Safety of Subcutaneous Anti-Tumor
Necrosis Factor-Alpha Agents, Etanercept and
Adalimumab, in Elderly Patients Affected by
Psoriasis and Psoriatic Arthritis: An Observational
Long-Term Study
Maria Esposito a Alessandro Giunta a Annamaria Mazzotta a Arianna Zangrilli a
Graziella Babino a Mauro Bavetta a Roberto Perricone b Sergio Chimenti a
Maria Sole Chimenti b
Departments of a Dermatology and b Rheumatology, University of Rome ‘Tor Vergata’, Rome, Italy
- Elderly patients: esperienza personale -
a"
Adalimumab
Etanercept
Total
Cardiovascular
67.86
49.18
55.05
Metabolic
37.71
34.42
34.83
-
11.47
7.86
7.14
6.56
6.74
-
4.92
3.37
10.71
4.92
6.74
Comorbidity
Chronic renal insufficiency
Infective
Respiratory chronic insufficiency
Other
Comorbidities observed in adalimumab and etanercept treated patients. They have been classified in 6 groups: (i) cardiovascular,
including mainly hypertension (40 patients) or history of acute myocardial infarction (9 patients); (ii) metabolic, patients with type II
diabetes and hypercholesterolemia; (iii) chronic renal insufficiency; (iv) infective: latent tuberculosis (2 patients; etanercept group)
and chronic hepatitis C virus infection patients (4 patients; 2 etanercept and 2 adalimumab group); (v) respiratory chronic
insufficiency: all patients have been heavy smokers (>15 cigarettes daily); (vi) other, including hyperthyroidism (2 patients,
etanercept group) and hypothyroidism (4 patients; 1 etanercept and 3 adalimumab group).
Comorbidità e psoriasi
Malattie endocrino-metaboliche
A. Diabete mellito e insulino-resistenza
B. Dislipidemia
C. Obesità
D. Sindrome metabolica
Apparato cardiocircolatorio
E. Scompenso cardiaco
F. Infarto del miocardio
G. Ipertensione arteriosa
Apparato gastrointestinale
A. Morbo di Chron
B. Celiachia
Malattie psichiatriche
Maltattie dell’apparato visivo
Malattie dell’apparato renale
Le comorbidità nella psoriasi
Malattia
Trattamento
Paziente
- Psoriasi e QoL Physical Component Summary
(PCS) Score of SF-36
60
55
50
47
45
45
44
43
43
42
42
41
40
35
30
Dermatitis
Healthy
adults
Depression
Cancer
Arthritis
Hypertension
Chronic lung
Psoriasis
disease
Myocardial
Type 2
Congestive
infarction
diabetes
heart failure
Rapp SR et al. J Am Acad Dermatol. 1999; 41:401.
- Psoriasi e QoL -
Mental Component Summary
(PCS) Score of SF-36
60
53
52
52
50
52
50
49
49
46
46
45
40
35
30
Hypertension
Healthy
adults
Myocardial
Cancer
Dermatitis
Chronic lung
infarction
disease
Type 2
Congestive
Arthritis
Psoriasis
Depression
diabetes
heart failure
Rapp SR et al. J Am Acad Dermatol. 1999; 41:401.
Clinical and Laboratory Investigations
Dermatology 2006;212:123–127
DOI: 10.1159/000090652
Received: October 1, 2004
Accepted: June 16, 2005
An Italian Study on Psoriasis and
Depression
Maria Espositoa Rosita Saracenoa Alessandro Giuntaa Mara Maccaroneb
Sergio Chimentia
a
Department of Dermatology, Tor Vergata University of Rome, Rome, and b ADIPSO Italia – Associazione per la
Difesa degli Psoriasici, Italy
Key Words
Psoriasis ! Psychological disorders ! Depression !
Italian population
Abstract
Background: Psoriasis is often associated with the risk
of physical disability, social discomfort and psychological disorders. Objectives: The aim of this study was to
investigate the prevalence of depressive symptomatology among Italian patients with psoriasis vulgaris, in order to better evaluate the disease severity in this patient
population. Methods: Five thousand Italian patients with
psoriasis were mailed the Center for Epidemiological
Studies-Depression Scale (CES-D) questionnaire, a 20item instrument developed to perform epidemiological
studies of depressive symptomatology in the general
population. Questionnaires with responses to 16 or more
items were considered evaluable. Results: We received
evaluable questionnaires from 2,391 patients, including
1,528 men (63.9%) and 863 women (36.1%). Depressive
symptomatology was observed in 1,482/2,391 patients
(62% overall; females, 63%; males, 61%). Men !40 years
of age were significantly more likely to report depressive
symptoms than were men 640 years of age (67 vs. 58%,
respectively; p = 0.002). Depressive symptomatology
was more prevalent in psoriatic patients with only primary or secondary education than in psoriatic patients
with higher education (51 vs. 32%, respectively; p ! 0.02).
© 2006 S. Karger AG, Basel
1018–8665/06/2122–0123$23.50/0
Fax +41 61 306 12 34
E-Mail karger@karger.ch
www.karger.com
Accessible online at:
www.karger.com/drm
Conclusion: Our results are consistent with previous
studies showing that psoriasis is associated with profound psychological morbidity, in particular with depression in a large number of patients. It is important to consider this association in the overall management of
psoriasis.
Copyright © 2006 S. Karger AG, Basel
Psoriasis is a chronic skin disease affecting 1–2% of
the population [1]. Psoriasis is characterized by hyperproliferation of epidermis resulting in thick, red, scaly
lesions [2]. Itchiness, skin flaking, swelling, redness, pain
and other manifestations frequently accompany the lesions, and the arthritic complications of the disease can
cause pain and lead to loss of mobility and even disability [3]. Psoriatic outbreaks are often unpredictable, and
psoriasis can have an enormous physical, functional and
psychological impact on a patient’s quality of life. It is not
surprising that psoriasis is associated with significant social and economic problems [3–11].
To assess the severity of disease it is necessary to use an
index that takes into account both the physical and psychological status of the patient [12–15]. The validated indexes most frequently used in clinical practice to measure
the severity of psoriasis in terms of physical involvement
are the Body Surface Area index [16], the Psoriasis Area
and Severity Index (PASI) [17] and the Self-Administered
PASI [18]. Some of the tools for evaluation of the psycho-
Sergio Chimenti
Department of Dermatology, Tor Vergata University of Rome
Policlinico Tor Vergata, viale Oxford 81
IT–00133 Rome (Italy)
Tel. +39 06 2090 2743, Fax +39 06 2090 2742, E-Mail chimenti@dermatologica.it
- Psoriasi, fumo e alcol A. Cigarette smoking and the use of tranquilizers, sleeping
medications, and antidepressants are statistically correlated
with impaired psoriasis-related quality of life 1
B. Alcohol intake is increased in psoriasis patients (2–3-fold) and
alcohol misuse is related to a higher incidence and greater
severity of psoriasis 2
C. The prevalence of smoking is increased in psoriasis compared
to a non-psoriasis population (37% vs 13%) 3
D. Increased intensity of smoking is associated with a 2-fold
increased risk of severe psoriasis 4
1. Davidsson S, et al. In J Dermatol. 2005;44:378-83. 2. Farber EM, Nall L. Cutis. 1994;53:21-7. 3. Herron MD, et al. Arch Dermatol. 2005;141:1527-34.
4. Fortes C, et al. Arch Dermatol. 2005;141:1580-4.
Psoriasi e comorbidità
A. Obesità (~2-fold) 1,2
B. Fumo di sigaretta (~2-fold) 1
C. Diabete (~1.5-fold) 2
D. Ipertensione (~2-fold)2
E. Scompenso cardiaco (~2-fold) 2
F. Infarto del miocardio (pso lieve: ~1.5-fold; pso severa: ~7-fold) 3
G. Aumentata mortalità cardiovascolare (~1.5-fold) 4
H. Depressione (5.5% ideazioni suicide) 5
I. Mortalità (pso severa: ~1.5 fold) 6
1. Herron MD, et al. Arch Dermatol. 2005; 141:1527-34. 2. Henseler T, et al. J Am Acad Dermatol.
1995;32:982-6. 3. Gelfand JM, et al. JAMA. 2006; 296:1735-41. 4. Mallbris L, et al. Eur J Epidemiol.
2004;19:225-30. 5. Gupta MA, Gupta AK. Br J Dermatol. 1998;139:846-50. 6. Gelfand JM, et al. Arch
Dermatol. 2007; 143:1493-9.
PSORIASI
PSORIASI
Malattie
cardiovascolari
Diabete e sindrome
metabolica
Depressione e disturbi
del comportamento
Malattie infiammatorie
croniche intestinali
The burden of psoriasis:
le comorbidità
Alessandro Giunta e Sergio Chimenti
Clinica Dermatologica - Università di Roma Tor Vergata

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