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 Table of Contents  
ORIGINAL ARTICLE
Year : 2015  |  Volume : 35  |  Issue : 1  |  Page : 20-22

Prevalence of metabolic syndrome in psoriatic arthritis compared with psoriasis: a cross-sectional study in a South Indian population


1 Department of Dermatology, Father Muller Medical College, Mangalore, India
2 Department of Dermatology, Kasturba Medical College, Mangalore, India
3 Department of Community Medicine, Kasturba Medical College, Mangalore, India

Date of Submission13-Mar-2015
Date of Acceptance05-May-2015
Date of Web Publication7-Aug-2015

Correspondence Address:
Neema Mohammed Ali
Flat no 402, Sundari Apartments, Shivabagh, Kadri, Mangalore 575001, Karnataka
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/1110-6530.162226

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  Abstract 

Objective
The objective of this study was to assess and compare the prevalence of metabolic syndrome (MetS) in patients with psoriasis (PsO) and in those with psoriatic arthritis (PsA).
Materials and methods
This was a cross-sectional study with no follow-up and was performed among outpatients attending the speciality clinics of an institutional tertiary referral centre. A consecutive sample of 100 patients with PsO was included in the study. Height, weight, BMI, blood pressure and waist circumference of patients were measured at the time of enrolment. Venous samples were taken after 8 h of overnight fasting for the estimation of serum cholesterol, triglycerides and plasma glucose levels.
Results
MetS was seen in 62.9% (17) of patients with PsO and in 32.8% of patients with PsA. This difference was statistically highly significant (P < 0.001).
Conclusion
MetS is common in Asian Indian patients with PsA than in patients with cutaneous PsO only.

Keywords: Metabolic syndrome, psoriasis, psoriatic arthritis


How to cite this article:
Ali NM, Maria K, Bhaskaran U. Prevalence of metabolic syndrome in psoriatic arthritis compared with psoriasis: a cross-sectional study in a South Indian population. Egypt J Dermatol Venerol 2015;35:20-2

How to cite this URL:
Ali NM, Maria K, Bhaskaran U. Prevalence of metabolic syndrome in psoriatic arthritis compared with psoriasis: a cross-sectional study in a South Indian population. Egypt J Dermatol Venerol [serial online] 2015 [cited 2020 May 31];35:20-2. Available from: http://www.ejdv.eg.net/text.asp?2015/35/1/20/162226


  Introduction Top


Psoriasis (PsO) is a T-cell (Th1 and Th17)-mediated chronic inflammatory skin disorder with clinically apparent joint involvement in nearly 30% of patients. The reported prevalence of psoriatic arthritis (PsA) varies from 1 to 420 cases (median 180) per 10 5 population and affects men and women equally [1]. The metabolic syndrome (MetS) [visceral obesity, dyslipidaemia, hyperglycaemia and hypertension (HTN)] has become one of the major public health challenges worldwide [2]. MetS increases the risk of developing atherosclerotic cardiovascular disease at least two-fold and type 2 diabetes mellitus (T2DM) by five-fold [3].

Several studies in India [4],[5],[6] and abroad [7],[8],[9],[10],[11] conducted over the past few years have proven the increased prevalence of MetS in psoriatic patients when compared with normal healthy controls. This is because PsO is a prototypical Th1 inflammatory disease characterized by expansion and activation of Th1 T cells, antigen-presenting cells and Th1 cytokines. Similarly, chronic Th1 inflammation is important to the pathophysiology of obesity, MetS, diabetes, atherosclerosis and myocardial infarction [12].

MetS and PsO are conditions of chronic low-grade inflammation. It can be presumed that PsA might have an increased incidence of MetS because of a greater degree of underlying systemic inflammation. Among patients with rheumatological disease (rheumatoid arthritis, ankylosing spondyl it is and PsA), PsA patients show the highest risk for MetS. The basis for the relationship between PsO, PsA and MetS is complex, with the effects of chronic systemic inflammation, psychosocial issues and potential adverse effects of therapies likely to be important [13].

Mok et al. [14] found that the prevalence of MetS was significantly higher in PsA (38%) than in rheumatoid arthritis (20%) and ankylosing spondylitis (11%; P < 0.001).

In this study, we try to ascertain the prevalence of MetS in patients with PsA in comparison with psoriatic patients without arthritis.


  Materials and methods Top


This was a hospital-based case-control study involving a series of 100 psoriatic patients (cases) presenting to the outpatient clinics of KMC Attavar and Government Wenlock Hospital, Mangalore. Inclusion criteria for cases were age more than 18 years and a clinical diagnosis of chronic plaque PsO. Patients receiving any systemic treatment for PsO, including acitretin, cyclosporine, methotrexate or phototherapy, for at least 1 month before enrolment were eligible for participation. After obtaining their signed informed consent, a detailed history was taken and the data were entered in the proforma. A detailed general physical and systemic examination was performed. Blood pressure was recorded as the average of two measurements after the patient had been sitting for 5 min. To determine waist circumference, we located the upper hipbone and placed a measuring tape at the level of the upper-most part of the hipbone around the abdomen (ensuring that the tape measure was horizontal). The tape measure was snug but did not cause compression on the skin. The severity of PsO was assessed according to the Psoriasis Area and Severity Index (PASI) [15]. Laboratory investigations including haemoglobin, total leucocyte count, differential leucocyte count, erythrocyte sedimentation rate, fasting lipid profile and fasting and postprandial blood sugar were carried out.

MetS was diagnosed according to International Diabetes Federation criteria [2]: central obesity (waist circumference >90 cm in Indian men and >80 cm in Indian women) plus any two of the following criteria - raised triglycerides greater than 150 mg/dl or specific treatment for this lipid abnormality; reduced HDL cholesterol less than 40 mg/dl in men or less than 50 mg/dl in women or specific treatment for this lipid abnormality; elevated systolic blood pressure greater than 130 mmHg, diastolic blood pressure greater than 85 mmHg or treatment for previously diagnosed HTN; or fasting plasma glucose greater than 100 mg/dl or previously diagnosed type 2 diabetes. The data were statistically analysed.


  Results Top


A total of 100 psoriatic patients were included in the study. Among the 100 patients, 27 had PsA and 73 had only cutaneous PsO without arthritis [Table 1].

Among the 100 psoriatic patients, 27 had PsA, of whom 74% were male. MetS was seen in 62.9% (17) of patients with PsA, of whom 59% (10) were male and 41% (7) were female.
Table 1: Comparison of patients with PsO and PsA

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The mean age of patients with PsA was 49.5 years and that of patients with PsO was 48.5 years. The average duration of disease in patients with PsA and PsO was 10.84 and 10.5 years, respectively. The differences were not statistically significant.

Among the 17 patients with PsA and MetS, 58.5% (10) had DM, 88% (15) had HTN, 94.1% (16) had dyslipidaemia and 100% had truncal obesity. The mean PASI of PsA with MetS was 8.2. The mean age of PsA patients with MetS was 36 years. Among these 17 patients, 76.4% (13) had severe PsO or PASI greater than 10 [Table 2].
Table 2: Components of Mets among PsA and PsO patients with MetS

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Among the 100 psoriatic patients, 73 had only cutaneous PsO without arthritis. Among patients with PsO, 24 (32.8%) had MetS, out of whom 12 (50%) had DM, 20 (83.3%) had dyslipidaemia, 20 (83.3%) had HTN and 24 (100%) had truncal obesity.

The mean age of PsO patients with MetS was 52 years. The mean PASI of PsO patients with MetS was 9.25. Severe PsO (PASI>10) was seen in 58.3% (14) of PsO patients.

An overall 62.9% of patients with PsA had MetS, whereas only 32.8% of PsO patients had MetS. This difference was statistically highly significant (P < 0.001). No significant difference was seen in the mean PASI of patients with and without PsO.

We also found that PsA was significantly more common among psoriatic patients with MetS (40.5%) than in those without MetS (19%) (P < 0.002) [Table 3].
Table 3: Psoriatic arthritis in patients with metabolic syndrome

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  Discussion Top


MetS is common in Asian Indian patients with PsA, especially in those with long-standing PsO and active joint disease [1].

This study demonstrated an increase in the frequency of MetS in patients with PsA. In this study, 62.9% of patients with PsA had MetS. This is much higher than the finding of Pehlevan et al. [16] and Bostoen et al. [13], in which only 35.5 and 25% of patients had PsA had MetS, respectively. However, our results were comparable to the results of Raychaudhuri et al. [3], which showed 58% of patients with PsA had MetS.

The higher prevalence of MetS in PsA was consistent with the findings of Pehlevan et al. [16] and Raychaudhuri et al. [3], but was in contrast to that of Bostoen et al. [13], in which there was a decreased prevalence of MetS in PsA patients (25.5%) than in PsO patients (44.9%).

Among the components of MetS, all patients with PsA and PsO had truncal obesity. Dyslipidaemia was significantly higher in patients with PsA (94.1%>83%). There were no statistically significant differences in the other components of MetS, such as diabetes and HTN, in both groups. PsA had a higher percentage of patients with severe disease (PASI>10) (76.4% >58.35%).

In our study, MetS was more prevalent in patients with PsA than in those with PsO, even though all patients in both groups were obese. This could probably be because of the significantly higher prevalence of dyslipidaemia in PsA patients.

Patients with PsA should be closely followed in terms of cardiovascular events, and aggressive treatment should be performed for both cardiovascular risk factors and the disease itself. As truncal obesity and dyslipidaemia were the most common components of MetS in PsA, lifestyle modification, diet changes and weight reduction may go a long way in reducing the incidence of MetS in patients with PsA. A drawback of this study is the small sample size.


  Acknowledgements Top


Conflicts of interest

There are no conflicts of interest.

 
  References Top

1.
Sharma A, Gopalakrishnan D, Kumar R, Vijayvergiya R, Dogra S. Metabolic syndrome in psoriatic arthritis patients: a cross-sectional study. Int J Rheum Dis 2013; 16 :667-673.  Back to cited text no. 1
    
2.
Alberti KG, Zim P, Shaw JIDF. Epidemiology Task Force Consensus Group. The metabolic syndrome: a new worldwide definition. Lancet 2005; 366 :1059-1062.  Back to cited text no. 2
    
3.
Raychaudhuri SK, Chatterjee S, Nguyen C, Kaur M, Jialal I, Raychaudhuri SP. Increased prevalence of the metabolic syndrome in patients with psoriatic arthritis. Metab Syndr Relat Disord 2010; 8 :331-334.  Back to cited text no. 3
    
4.
Nisa N, Qazi MA. Prevalence of metabolic syndrome in patients with psoriasis. Indian J Dermatol Venereol Leprol 2010; 76 :662-665.  Back to cited text no. 4
    
5.
Madanagobalane S, Anandan S. Prevalence of metabolic syndrome in South Indian patients with psoriasis vulgaris and the relation between disease severity and metabolic syndrome: a hospital-based case-control study. Indian J Dermatol 2012; 57 :353-357.  Back to cited text no. 5
    
6.
Malhotra SK, Dhaliwal GS, Puri KJPS, Gambhir ML, Mahajan M. An insight into relationship between psoriasis and metabolic syndrome. Egypt Dermatol Online J 2011; 7 :5.  Back to cited text no. 6
    
7.
Gisondi P, Tessari G, Conti A, Piaserico S, Schianchi S, Peserico A, et al. Prevalence of metabolic syndrome in patients with psoriasis: a hospital-based case-control study. Br J Dermatol 2007; 157 :68-73.  Back to cited text no. 7
    
8.
Ahmed EF, Seliem MK, El-Kamel M, Abdelgawad MM, Shady I. Prevalence of metabolic syndrome in Egyptian patients with psoriasis. Egypt J Dermatol Androl 2009; 29:91-100.  Back to cited text no. 8
    
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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.  Back to cited text no. 9
    
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Cohen AD, Gilutz H, Henkin Y, Zahger D, Shapiro J, Bonneh DY, Vardy DA. Psoriasis and the metabolic syndrome. Acta Dermatol Venereol 2007; 87:506-509.  Back to cited text no. 10
    
11.
Choi WJ, Park EJ, Kwon IH, Kim KH, Kim KJ. Association between psoriasis and cardiovascular risk factors in Korean patients. Ann Dermatol 2010; 22 :300-306  Back to cited text no. 11
    
12.
Griffiths CEM, Barker JN. Pathogenesis and clinical features of psoriasis. Lancet 2007; 370:263-271.  Back to cited text no. 12
    
13.
Bostoen J, Van Praet, L, Brochez, L, Mielants, H, Lambert, J. A cross-sectional study on the prevalence of metabolic syndrome in psoriasis compared to psoriatic arthritis. J Eur Acad Dermatol Venereol 2014; 28 :507-511.  Back to cited text no. 13
    
14.
Mok CC, Ko GT, Ho LY, Yu KL, Chan PT, To CH. Prevalence of atherosclerotic risk factors and the metabolic syndrome in patients with chronic inflammatory arthritis. Arthritis Care Res (Hoboken) 2011; 63 :195-202.  Back to cited text no. 14
    
15.
Feldman SR. The design of clinical trials in psoriasis: lessons for clinical practice. J Am Acad Dermatol 2003; 49(Suppl) : S62-S65.  Back to cited text no. 15
    
16.
Pehlevan S, Yetkin DO, Bahadýr C, Goktay F, Pehlevan Y, Kayatas K, et al . Increased prevalence of metabolic syndrome in patients with psoriatic arthritis. Metab Syndr Relat Disord 2014; 12:43-48.  Back to cited text no. 16
    



 
 
    Tables

  [Table 1], [Table 2], [Table 3]


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