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Psoriasis: The Heart and Skin Connection

Did you know that psoriasis is more than merely a skin condition? It's a chronic inflammatory disease that increases a patient’s risk for other systemic disorders, such as atherosclerosis and renal damage. In the last year alone, researchers at the Perelman School of Medicine at the University of Pennsylvania have published important studies showing that patients with mild, moderate and severe psoriasis have increasingly higher odds of having at least one other major medical disease, including heart attacks, stroke, kidney disease and diabetes.

Now, in an ongoing effort to understand the connection between psoriasis and other serious medical conditions, a multidisciplinary team of researchers from Penn Medicine, led by Joel M. Gelfand, MD, MSCE, associate professor of Dermatology and Epidemiology, recently announced the start of a new study exploring the effect of the common psoriasis drug ustekinumab on an important cardiovascular disease pathway, Th17. The new study will expand on their previous work, particularly a seminal 2006 study published in JAMA that established a link between severe psoriasis and an approximately 50 percent increased risk for cardiovascular disease.


Skin inflammation resulting from psoriasis pre- and post-treatment

“Now we're asking a very fundamental question: Does treating psoriasis improve aspects of the cardiovascular system in a way that would lower cardiovascular risk?” explained Gelfand. “We think that the fundamental link between the two diseases is chronic inflammation. It turns out that the same type of inflammation that drives psoriasis actually occurs in the blood vessels and promotes atherosclerosis."

The 42 patients involved in the study will be placed on a regimen of ustekinumab or placebo to treat moderate psoriasis. At the end of the study, participants will be evaluated for aortic vascular inflammation by PET/CT scans and changes in their lipid metabolism.

"We're also looking at how well the body metabolizes cholesterol," Gelfand says. "We've shown in our previous work that people with psoriasis have increased inflammation in their aorta equivalent to being 10 years older than their stated age. And they also have impairment as to how well their 'good' cholesterol removes cholesterol from arteries."

Along with answering those questions, Gelfand and his team hope the study will help to increase patient awareness. "Psoriasis is considered to be an elective disease to treat," he says. "Most people walk around for decades with really severe skin inflammation thinking it's fine. We don't know if that's bad for them or not. This study will start answering that fundamental question. Maybe treating psoriasis benefits  more than just their skin; it may also lower their risk of heart attack or stroke."

Gelfand says the Penn team is uniquely equipped to conduct such an investigation, which encompasses a broad range of specialties. "A big part of this effort is the collaboration between dermatology, rheumatology, nuclear medicine, and cardiology,” he says. “It's really a beautiful example of the type of collaborative research done at Penn that really impacts patients in very meaningful ways."

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