Psoriasis reaches more than skin deep, and there is now a large and convincing body of evidence linking it to heart disease, diabetes, psoriatic arthritis, certain cancers, depression, and inflammatory bowel disease.
The smoking gun is likely inflammation, and Nehal N. Mehta, MD, MSCE, FAHA, Chief of Inflammation and Cardiometabolic Diseases at the National Heart, Lung, and Blood Institute in Bethesda, MD, has devoted his career to studying this common denominator. He spoke to Practical Dermatology® magazine about what we know and what questions remain.
Why did you decide to study these inflammatory entities?
Dr. Mehta: Early on in my career as a preventive cardiologist, I was curious as to why people with obesity had heart disease. This led me to research inflammation, and during that time I started seeing patients with psoriasis develop heart disease. At that point, I decided to dedicate my efforts on understanding why inflammation leads to heart disease. And I think my background in nuclear cardiology, preventive cardiology, and as a physician scientist have positioned me well for this work.
What can psoriasis teach us about other disease states?
Dr. Mehta: Psoriasis is a chronic inflammatory skin disease, and it has been demonstrated to the medical field that chronic inflammation in the skin can drive processes that lead to diabetes and heart attack. Psoriasis is linked to the development of arthritis in about a third of patients and also with other chronic inflammatory conditions including inflammatory bowel disease in about two percent. Other diseases associated with psoriasis include diabetes, hypertension, hyperlipidemia, and heart disease.
Given these associations in psoriasis, other inflammatory diseases, such as atopic dermatitis, are now increasingly being recognized as whole body diseases as well.
What role should dermatologists play in making sure individuals are appropriately monitored for comorbidities?
Dr. Mehta: Healthcare providers play a critical role in making patients aware that these associations exist. The role of the dermatologist should be to inform the patient that they have an increased risk of arthritis, diabetes, and heart disease. Working closely with the healthcare-providing team including a primary care provider and other practitioners, dermatologists and their patients should mitigate cardiovascular risk factors early on in the disease.
Does treating psoriasis aggressively lower risk of comorbidities?
Dr. Mehta: In observational studies, we have seen that treatment of psoriasis does, in fact, lower the incidence of comorbid disease. However, ongoing randomized trials will inform whether or not these are proven findings.
What can we say about inflammation and disease today? What questions still need to be answered.
Dr. Mehta: The science is clear that there is a definite association with chronic inflammation and the development of cardiovascular risk factors.
Currently there is a trial treating inflammation in patients with heart disease, and it has shown that heart disease was reduced by 15 percent. Therefore, we have a lot to learn about why treating inflammation in the body can reduce heart disease.
In the meantime, as physicians we should remind patients that inflammation in the body has far-reaching consequences. And an important part of that message is that maintaining a healthy diet and exercising regularly can reduce inflammation over time.