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 Table of Contents  
ORIGINAL ARTICLE
Year : 2021  |  Volume : 34  |  Issue : 3  |  Page : 896-901

Correlation between psoriasis area severity index score and metabolic syndrome in psoriatic patients in Menoufia University


1 Department of Dermatology, Andrology and Venerolgy, Dar El Salam General Hospital, Cairo, Egypt
2 Department of Dermatology, Andrology and STDs, Faculty of Medicine, Menoufia University, Menoufia, Egypt
3 Department of Medical Biochemistry and Molecular Biology, Faculty of Medicine, Menoufia University, Menoufia, Egypt

Date of Submission16-Feb-2020
Date of Decision21-Mar-2020
Date of Acceptance28-Mar-2020
Date of Web Publication18-Oct-2021

Correspondence Address:
Aliaa I. A. Mohaseb
Fysal, Giza
Egypt
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/mmj.mmj_46_20

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  Abstract 


Objective
This study was to assess the association between psoriasis and metabolic syndrome (MBS) and to determine if there is an association between psoriasis severity and MBS.
Background
Background: Psoriasis is a chronic inflammatory disease that affects not only the skin but also other organs. Genetic factors play an important role in individual predisposition. Lately, a positive association has been confirmed between psoriasis and MBS, in Western as well as in Middle Eastern countries.
Patients and methods
This case–control study was conducted at the Dermatology, Andrology and Sexually Transmitted Disease and Medical Biochemistry and Molecular Biology Departments, Faculty of Medicine, Menoufia University. It included 120 patients: 60 psoriatic patients and 60 age-matched and gender-matched healthy controls. Patients were collected from Dermatology Outpatient Clinics, Menoufia University Hospitals. Clinical, biometric, and necessary laboratory evaluations were performed. Statistical analysis was performed by using the Statistical Package for the Social Sciences (SPSS version 16.0).
Results
The patients with psoriasis were two times more likely to have MBS as compared with controls (38.3 vs 18.0%, P < 0.001) with an odds ratio of 2.4. All components of MBS were more prevalent in psoriasis patients than in controls. The psoriasis area severity index score was greater in patients with MBS than those without MBS (10.5 11.5 vs 7.0 8.1, P = 0.05). MBS prevalence tended to be higher in the inverse type than in others (52.2 vs 32.3%; P = 0.06) and in patients with nail pitting versus those without (45.3 vs 28.2%; P = 0.03).
Conclusion
This study concluded that there is an association between psoriasis and MBS.

Keywords: hypertension, lipid profile, metabolic syndrome, psoriasis, waist circumference


How to cite this article:
Mohaseb AI, El-Farargy SM, Yasien HA, Ghanayem NM. Correlation between psoriasis area severity index score and metabolic syndrome in psoriatic patients in Menoufia University. Menoufia Med J 2021;34:896-901

How to cite this URL:
Mohaseb AI, El-Farargy SM, Yasien HA, Ghanayem NM. Correlation between psoriasis area severity index score and metabolic syndrome in psoriatic patients in Menoufia University. Menoufia Med J [serial online] 2021 [cited 2024 Mar 29];34:896-901. Available from: http://www.mmj.eg.net/text.asp?2021/34/3/896/328337




  Introduction Top


Psoriasis is a chronic T helper 1 cell-mediated disease affecting 1–3% of the population worldwide. The chronic inflammatory nature of psoriasis predisposes patients to other diseases with an inflammatory component; the most notable being cardiovascular and metabolic disorders [1].

Recently, several comorbidities have been described in psoriasis patients, including cardiovascular comorbidities, metabolic syndrome (MBS), and malignancies. Hypertension, heart failure, and diabetes mellitus are more common among psoriasis patients [2].

MBS is a group of risk factors for cardiovascular disease and diabetes consisting of raised blood glucose level, increased blood pressure, high triglyceride levels, low high-density lipoprotein (HDL) cholesterol (HDL-c) levels, and central obesity [3].

This concept is supported by studies showing that psoriasis is associated with cardiovascular risk factors such as diabetes, obesity, hypertension, and dyslipidemia [4]. Genetic factors play a crucial role in individual predisposition, labeling this disease as hereditary. It is characterized by proliferation and abnormal differentiation of keratinocytes associated with infiltration of T cells in the epidermis and dermis [5].

The extrapolating data and results across countries are not always reasonable. Although the relationship between MBS and psoriasis was widely investigated, data on the relationship with different types or with the severity of psoriasis are very scarce [6].

Numerous studies have shown a correlation between psoriasis and MBS in many developed and developing countries [7]. The association of these two disorders presents early opportunities for diagnosing and treating MBS in psoriasis patients, which could lead to a substantial reduction in morbidity and mortality [8]. This study aimed to study the association between psoriasis and MBS and also to determine if there is an association between psoriasis severity and MBS.


  Patients and methods Top


This case–control study was conducted at the Dermatology, Andrology, and Sexually Transmitted Disease and Medical Biochemistry and Molecular Biology Departments, Faculty of Medicine, Menoufia University. It included 120 subjects, 60 psoriatic patients (group B) and 60 age- matched and gender-matched healthy controls (group A). Group B was classified into two subgroups: group B1 included psoriatic patients with MBS and group B2 included psoriatic patients without MBS. Patients were collected from the Dermatology Outpatient Clinics, Menoufia University Hospitals, from January to October 2018.

Before the collection of samples, written informed consent form was obtained from all studied individuals and the study was approved by the Ethics Committee of Medical Research of Menoufia Faculty of Medicine.

Inclusion criteria included new patients who had not received any treatment yet and patients with plaque psoriasis who were treated before by topical or systemic medications.

Exclusion criteria included potential study participants who will be excluded if they reported the presence of secondary hyperlipidemia, chronic renal insufficiency, and obstructive liver diseases. Patients who were less than 18 years, those who had a history of connective tissue diseases, viral hepatitis, and patients experiencing other types of psoriasis were also excluded.

The studied individuals were submitted to the following: history taking included personal history, present history, history, and family history

Thorough clinical examination is done for the exclusion of any systemic diseases. A general physical examination was done. Weight and height were measured barefooted, body mass index is calculated by the formula: weight (in kg)/(height in m)2. Waist circumference was measured by placing a measuring tape at the level of the iliac crest and the blood pressure was recorded. Dermatological examination included assessment of age of onset of psoriasis and type of psoriasis. Psoriasis severity was assessed by the psoriasis area severity index (PASI). Psoriasis was considered mild to moderate if the PASI score was less than or equal to 10 and severe if the PASI score was greater than 10. Dermatological diseases other than psoriasis were excluded. Laboratory investigation included measurement of fasting blood sugar and lipid profile in serum.

A measure of 5 ml blood was collected after an overnight fasting under complete aseptic condition using sterile vacationers, left to stand at room temperature, and then centrifuged at a speed of 2000–3000 rpm for 20 min. The serum obtained was stored at −20°C until analysis of serum glucose and lipid profile.

Measurement of serum glucose was estimated by enzymatic reference method using hexokinase: fasting blood glucose greater than or equal to 100 mg/dl.

Serum triglycerides were determined using Spectrum Diagnostics liquizyme triglycerides reagent provided by Spectrum', ''Hannover , Germany: hypertriglyceridemia greater than 150 mg/dl.

Total serum cholesterol is determined using Spectrum Diagnostics liquizyme reagent provided by Spectrum.

Measurement of HDL-c: The HDL-c fraction is determined using the total cholesterol enzymatic reagent provided by Spinreact Girona, Spain. Low HDL-c (<40 mg/dl for men and <50 mg/dl for women) [9].

Low-density lipoprotein (LDL) was calculated by the following equation [10]:

LDL-c = total cholesterol−(TG/5 + HDL-c).

The diagnosis of MBS was based on the criteria of the National Cholesterol Education Program–Adult Treatment Plan III, with Asian modification for abdominal circumference [11]. The criteria are as follows:

  1. Increased waist circumference – in Asian populations, greater than or equal to 90 cm in men and greater than or equal to 80 cm in women
  2. Raised triglycerides greater than or equal to 150 mg/dl (or on treatment for raised triglycerides)
  3. Decreased HDL less than 40 mg/dl in men and less than 50 mg/dl in women (or on treatment for reduced HDL-c)
  4. Increased blood pressure systolic greater than or equal to 130 and/or diastolic greater than or equal to 85 mmHg (or on treatment for hypertension)
  5. Increased fasting glucose greater than or equal to 100 mg/dl (or on treatment for increased blood glucose). The presence of any 3 or more of these five risk factors constitutes a diagnosis of MS [11].


The data were collected, tabulated, and analyzed by SPSS (the Statistical Package for the Social Sciences) version 17.0 on IBM compatible computer (SPSS Inc., Chicago, Illinois, USA). Two types of statistics were done: descriptive statistics: mean and SD for quantitative data and percentage.

Analytic statistics: χ2-test was used to study the association between two qualitative variables; t test is a test of significance used for comparison between two groups normally distributed having quantitative variables; Mann–Whitney U-test is a nonparametric test of significance used for comparison between two groups not normally distributed having quantitative variables; Spearman's correlation (r) is a test used to measure the association between two not normally distributed quantitative variables or one quantitative and one qualitative ordinal variable and Kruskal–Wallis test (nonparametric test) was used for testing equality of population medians among groups, it is an extension of the Mann–Whitney test: statistically significant (S) when P less than 0.05, highly significant (HS) when P less than 0.01, and not significant (NS) when P greater than 0.05.


  Results Top


There is no significant statistical difference between patients and controls regarding age and gender [Table 1].
Table 1: Statistical comparison between the two studied groups regarding demographic data

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There is a significant statistical difference between psoriatic patients and control regarding BMI, waist circumference, LDL-c, total cholesterol, triglycerides, and systolic blood pressure. A nonsignificant statistical difference existed regarding other MBS parameters [Table 2].
Table 2: Statistical comparison between patients and controls regarding metabolic syndrome parameters

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There is a significant statistical difference between psoriatic patients with MBS and those without MBS regarding BMI, waist circumference, LDL-c, and total cholesterol, whereas there is a nonsignificant statistical difference that existed between the two groups regarding other parameters of MBS [Table 3].
Table 3: Statistical comparison between patient subgroups regarding metabolic syndrome parameters

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There is a nonsignificant statistical difference between the studied patient groups regarding disease duration, age of onset of disease, severity, and family history, whereas there is a significant difference regarding the PASI score [Table 4].
Table 4: Statistical comparison of clinical data of studied patient groups

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There is a significant statistical difference between mild and severe psoriasis patients regarding FBS and blood pressure, whereas there is a nonsignificant statistical difference existed regarding other MBS parameters [Table 5].
Table 5: Statistical comparison between mild and severe psoriasis as regards metabolic syndrome parameters

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There is a significant positive correlation between PASI score and each of waist circumference, fasting blood glucose, and blood pressure in psoriatic patients with MBS [Table 6]. There is a nonsignificant negative correlation with each of disease duration, HDL, total cholesterol, and triglycerides. A nonsignificant positive correlation existed with BMI and LDL-c [Table 5].
Table 6: Correlation coefficient between psoriasis area severity index score and different parameters in the patient group (n=60)

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  Discussion Top


Psoriasis is not an isolated pathology of the skin but considered a multi-organ disorder that requires multidisciplinary approach signs [12].

Both psoriasis and MBS constitute a proinflammatory state and psoriasis shares many pathogenic features with the development of atherosclerotic plaques [13].

Several observational studies have suggested an epidemiological link between psoriasis and MBS, but there is a paucity of data on this association [14].

There was a nonsignificant difference between patients and controls regarding age and gender. This agreed with a study carried out by Kim et al. [15]. All components of MBS were more prevalent in patients with psoriasis than in controls (P < 0.05), but the difference did not reach statistical significance for fasting blood sugar. These results come in line with the results of Salunke [16].

The prevalence of MBS observed in this study was similar to what was reported in North African and Western populations. Conversely, reports from Asian populations such as Japan and Korea showed a lower prevalence of MBS, suggesting a possible role of ethnicity and environmental factors [17].

The current study showed a significant statistical difference between psoriasis patients with MBS and those without MBS regarding the PASI score. This agrees with the results of Neimann et al. [18]. However, in another study done by Madanagobalane documented the presence of MBS irrespective of the severity of psoriasis [19].

Arias-Santigo et al. [20] concluded that patients with psoriasis with MBS had significantly higher PASI scores than those without MBS (PASI >10).

The current study found a nonsignificant statistical increase in fasting blood glucose in psoriatic patients compared with controls in agreement with Khungar et al. [21], who found that the level of hyperglycemia was not significantly associated with psoriasis. Some studies have shown a higher prevalence of diabetes mellitus in psoriatic patients compared with controls [22].

In the current study, fasting blood glucose, LDL-c, total cholesterol, and blood pressure are increased and HDL-c is decreased in severe psoriatic patients (PASI >10) compared with mild cases. This agrees with those of Salunke [16].

This study showed that there is a significant positive correlation between PASI score and each of waist circumferences, fasting blood glucose, and blood pressure psoriatic patients with MBS. These results agree with Kimball et al. [23], who reported that MBS is an aggravating factor in the prognosis of psoriasis.

The present study found a nonsignificant positive correlation between PASI score and BMI in psoriatic patients with MBS. This result comes in line with Rosa et al. [24], who found that all variables of MBS were significantly linked with disease severity except for abdominal obesity.

It was reported that the proposed mechanisms for shared pathogenesis between psoriatic diseases and cardiovascular diseases are inflammation, insulin resistance, dyslipidemia, angiogenesis, oxidative stress, and endothelial dysfunction [25].


  Conclusion Top


The result of this study confirmed that there is a higher prevalence of MBS in psoriatic patients. All psoriatic patients should be screened for early diagnosis and treatment of associated MBS to reduce the high burden of morbidity and mortality.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
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    Tables

  [Table 1], [Table 2], [Table 3], [Table 4], [Table 5], [Table 6]



 

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