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Brief Report
May 31, 2017

Association Between Skin and Aortic Vascular Inflammation in Patients With PsoriasisA Case-Cohort Study Using Positron Emission Tomography/Computed Tomography

Author Affiliations
  • 1National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland
  • 2University of Arizona College of Medicine at South Campus, Tucson
  • 3Chevy Chase Dermatology Associates, Chevy Chase, Maryland
  • 4Department of Dermatology, George Washington Hospital, Washington, DC
  • 5DermAssociates, Silver Spring, Maryland
  • 6Department of Radiology and Imaging Sciences, National Institutes of Health Clinical Research Center, Bethesda, Maryland
  • 7Department of Dermatology, University of Pennsylvania, Philadelphia
  • 8The Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania, Philadelphia
JAMA Cardiol. Published online May 31, 2017. doi:10.1001/jamacardio.2017.1213
Key Points

Question  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?

Findings  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.

Meaning  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.


Importance  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.

Objective  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.

Exposure  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.

Results  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.