How does treatment of skin disease in psoriasis associate with change in aortic vascular inflammation by 18fluorodeoxyglucose positron emission tomography/computed tomography at 1 year?
This cohort study found that improvement in skin disease severity is associated with an improvement in aortic vascular inflammation beyond cardiovascular risk factors, which was greater in patients with more improvement in skin disease severity. Furthermore, this association was stronger in those initiated with anti–tumor necrosis factor therapy.
These findings suggest that alleviating inflammation at remote sites in the body (eg, skin) has beneficial effect on vascular inflammation at 1 year, a finding that may have important implications in other inflammatory disease states.
Inflammation is critical in the development of atherosclerosis. Psoriasis is a chronic inflammatory skin disease that is associated with increased vascular inflammation by 18fluorodeoxyglucose positron emission tomography/computed tomography in vivo and future cardiovascular events. It provides a human model to understand the effect of treating inflammation in a target organ (eg, the skin) on vascular diseases.
To investigate the association between change in skin disease severity and change in vascular inflammation at 1 year and to characterize the impact of 1 year of anti–tumor necrosis factor therapy on vascular inflammation.
Design, Setting, and Participants
In this prospective cohort study, 220 participants from outpatient practices were recruited at the US National Institutes of Health. A total of 115 consecutively recruited patients with psoriasis were followed up at 1 year. The study was conducted from January 1, 2013, through October 31, 2016, with data analyzed in November 2016.
Skin inflammation measured as Psoriasis Area and Severity Index (PASI) score.
Main Outcomes and Measures
Vascular inflammation assessed as target-to-background ratio by 18fluorodeoxyglucose positron emission tomography/computed tomography.
Among the 115 patients, the mean (SD) age at 1-year follow-up was 50.8 (12.8) years and 68 were men (59%). The cohort had a low cardiovascular risk by Framingham risk score and mild-to-moderate psoriasis, with a median PASI score of 5.2 (interquartile range, 3.0-8.9). At follow-up, the total cohort had a median improvement in PASI score of 33%, with use of topical therapy (60%), biological therapy (66%, mostly anti–tumor necrosis factor) and phototherapy (15%) (P < .001). Moreover, improvement in PASI score was associated with improvement in target-to-background ratio of 6%, mainly driven by those with higher responses in PASI score (P < .001). This association persisted beyond traditional risk factors (β = 0.19; 95% CI, 0.012-0.375; P = .03) and was the strongest in those initiated with anti–tumor necrosis factor therapy (β = 0.79; 95% CI, 0.269-1.311; P = .03).
Conclusions and Relevance
Improvement in psoriasis skin disease severity was associated with improvement in aortic vascular inflammation by 18fluorodeoxyglucose positron emission tomography/computed tomography, with greater improvement in aortic vascular inflammation observed in those who had higher than 75% reduction in skin disease severity. These findings suggest that controlling remote target organ inflammation (eg, in the skin) may improve vascular diseases; however, randomized clinical trials are needed to confirm these findings.
Dey AK, Joshi AA, Chaturvedi A, Lerman JB, Aberra TM, Rodante JA, Teague HL, Harrington CL, Rivers JP, Chung JH, Kabbany MT, Natarajan B, Silverman JI, Ng Q, Sanda GE, Sorokin AV, Baumer Y, Gerson E, Prussick RB, Ehrlich A, Green LJ, Lockshin BN, Ahlman MA, Playford MP, Gelfand JM, Mehta NN. Association Between Skin and Aortic Vascular Inflammation in Patients With PsoriasisA Case-Cohort Study Using Positron Emission Tomography/Computed Tomography. JAMA Cardiol. Published online May 31, 2017. doi:10.1001/jamacardio.2017.1213