A study of association of metabolic syndrome and psoriasis at tertiary health care centre

 

T V Ramana Rao^1*, Prathyusha Y², Ajay Kumar Reddy Bobba³

 

 

Abstract              Background: Psoriasis is now considered as a systemic inflammatory disease. The chronic inflammatory nature of psoriasis has been suggested to be a contributing and potentially independent risk factor for development of MS. Aims and Objectives: To Study association of metabolic syndrome and psoriasis at tertiary health care centre. Methodology: After approval from institutional ethical committee this cross-sectional study was carried out at the department of Skin and VD of a tertiary health care centre during one year period i.e. June 2017 to June 2018 in the patients with Psoriasis were studied. All details of the patients like age, sex etc. were noted. The statistical analysis was done by chi-square test and unpaired t-test, was analyzed by SPSS 18 version. Result: The age distribution both the group was comparable i.e. average age both the group was 7 ±3.16 and 7 ±4.95 respectively. (p>0.05). The male to female ratio in group A was 1.91:1 and in Group B was 1.18: 1 was comparable to each other (p>0.05). The disease duration in patients with Metabolic syndrome was 9±5.12 Yrs. and 4±2.34 Yrs. was significantly higher (t = 5.2546, df = 68, p<0.0001). As per the PASI score the severity of psoriasis was significantly more in the patients with Metabolic syndrome (χ² = 6.898, df=1, p< 0.0086), as per the area of body affected by BSA score; the significantly more area was affected in the patients with metabolic syndrome (χ² =8.289, df=1, p< 0.004). Conclusion: It can be concluded from our study that severity of the psoriasis and area of affected was significantly associated with the Metabolic syndrome.

Key Words: Metabolic Syndrome (MS), Psoriasis Area and Severity Index (PASI), Body surface area (BSA).

 

INTRODUCTION

Psoriasis is now considered as a systemic inflammatory disease. The chronic inflammatory nature of psoriasis has been suggested to be a contributing and potentially independent risk factor for development of MS.¹Several studies has shown an association between psoriasis and MS. Most of these were of cross sectional design. There have been only a few case control studies addressing the issue.^1,2,3,4,5,6 Only a few studies from India have used the revised population specific criteria for diagnosis of MS.^2,3,6 A recent study concluded that inclusion of modified waist circumference and specific body mass index (BMI) cut offs for Asians may help predict MS at an early stage.⁷ So we have studied the association of metabolic syndrome and psoriasis at tertiary health care centre.

 

MATERIAL AND METHODS

After approval from institutional ethical committee this cross-sectional study was carried out at the department of Skin and VD of a tertiary health care centre during one year period i.e. June 2017 to June 2018 in the patients with Psoriasis were studied. Metabolic syndrome was diagnosed by the presence of three or more of the five criteria of the National Cholesterol Education Program Adult Panel III (ATP III): Waist circumference >102 cm in men or >88 cm in women; hypertriglyceridemia, >1.7 mmol/L (150 mg/dL); HDL cholesterol 130/85 mmHg; fasting plasma glucose of >6.1 mmol/L (100 mg/dL). Those patients who shown above features were included into Group A (with Metabolic Syndrome) were 35, Group B without metabolic syndrome were 35 allotted randomly. Severity of psoriasis was assessed according to Psoriasis Area and Severity Index (PASI) and body surface area (BSA)¹⁰. All details of the patients like age, sex etc. were noted. The statistical analysis was done by chi-square test and unpaired t-test, was analyzed by SPSS 18 version.

 

RESULT

 

Table 1: Distribution of the patients as per the age

The age distribution both the group was comparable i.e. average age both the group was 7 ±3.16 and 7 ±4.95 respectively. (p>0.05)

 

Table 2: Sex wise distribution of the patients

The male to female ratio in group A was 1.91:1 and in Group B was 1.18: 1 was comparable to each other (p>0.05)

 

Table 3: Distribution of the patients as per the Severity of Psoriasis

The disease duration in patients with Metabolic syndrome was 9±5.12 Yrs. and 4±2.34 Yrs. was significantly higher (t = 5.2546, df = 68, p<0.0001). As per the PASI score the severity of psoriasis was significantly more in the patients with Metabolic syndrome (χ² = 6.898, df=1,p< 0.0086), as per the area of body affected by BSA score ; the significantly more area was affected in the patients with metabolic syndrome (χ² =8.289,df=1,p< 0.004).

 

DISCUSSION

Psoriasis is a chronic immune‑mediated inflammatory disorder affecting 1%–3% of the general population. Metabolic syndrome (MS) which encompasses the following, namely, central obesity, atherogenic dyslipidemia, hypertension, and glucose intolerance, is considered to arise from insulin resistance and abnormal adipose tissue function.⁸ Chronic inflammation with persistent elevation of proinflammatory cytokines forms the crux of MS. Various immune mediators such as leptin, adiponectin, tumor necrosis factor-alpha (TNF-α), and interleukin (IL)‑6 have been regarded to play an important role in insulin resistance and therefore in psoriasis pathogenesis associated with MS.⁹ The age distribution both the group was comparable i.e. average age both the group was 7 ±3.16 and 7 ±4.95 respectively. (p>0.05). The male to female ratio in group A was 1.91 :1 and in Group B was 1.18 : 1 was comparable to each other (p>0.05). The disease duration in patients with Metabolic syndrome was 9±5.12 Yrs. and 4±2.34 Yrs. was significantly higher (t = 5.2546, df = 68, p<0.0001). As per the PASI score the severity of psoriasis was significantly more in the patients with Metabolic syndrome (χ² = 6.898, df=1,p< 0.0086), as per the area of body affected by BSA score ; the significantly more area was affected in the patients with metabolic syndrome (χ² =8.289,df=1,p< 0.004). These findings are similar to Chintaginjala Aruna ¹⁰ Metabolic syndrome was signifi cantly more common among patients with psoriasis than among controls [42% vs 22%, odds ratio (OR) = 2.5674, P < 0.0028] also Some other studies have reported an increased prevalence of MS in patients with moderate-to-severe psoriasis.^11,12 Other studies^13,14 detected no correlation between severity of psoriasis and MS. This difference in the findings could be due to difference in study population and difference in the genetic and geographic variation.

 

CONCLUSION

It can be concluded from our study that severity of the psoriasis and area of affected was significantly associated with the Metabolic syndrome

 

REFERENCES

1. Davidovici BB, Sattar N, Prinz JC, Jörg PC, Puig L, Emery P, et al. Psoriasis and systemic inflammatory diseases: potential mechanistic links between skin disease and co-morbid conditions. J Invest Dermatol. 2010; 130: 1785–96.
2. Madanagobalane S, Anandan S. Prevalence of metabolic syndrome in South Indian patients with psoriasis vulgaris and the relation between disease severity and metabolic syndrome: A hospital based case control study. Indian Journal of Dermatology 2012; 57(5):353-357.
3. Nisa N, Qazi M. Prevalence of metabolic syndrome in patients with psoriasis. Ind J Dermatol Venereol Leprol 2010; 76: 662-665.
4. Love TJ, Qureshi AA, Karlson EW, Gelfand JM, Choi HK. Prevalence of the metabolic syndrome in psoriasis: results from the National Health and Nutrition Examination Survey, 2003-2006. Arch Dermatol. 2011; 147(4):419-24.
5. Gisondi P, Tessari G,Conti A, Piaserico S,Schianchi S, Peserico A, et al. Prevalence of metabolic syndrome in patients with psoriasis: A hospital- based case-control study. Br J Dermatol 2007; 157:68-73.
6. Khunger N, Gupta D, Ramesh V. Is psoriasis a new marker for Metabolic syndrome? A study in Indian patients.Indian J Dermatol 2013; 58(4):313-4.
7. Hydrie MZ, Shera AS, Fawwad A, Basit A, Hussain A. Prevalence of metabolic syndrome in urban Pakistan (Karachi): comparison of newly proposed International Diabetes Federation and modified Adult Treatment Panel III criteria.Metab Syndr Relat Disord 2009; 7(2):119-24.
8. Schön MP, Boehncke WH. Psoriasis. N Engl J Med 2005; 352:1899-912.
9. Shenoy C, Shenoy MM, Rao GK. Dyslipidemia in dermatological disorders. N Am J Med Sci 2015; 7:421‑8.
10. Aruna C, Rao GV, Ramanamurthy P, Rambabu P. Prevalence of metabolic syndrome in patients with psoriasis: A hospital-based case control study from a tertiary care center in Andhra Pradesh. J NTR Univ Health Sci 2016; 5:13-6.
11. Langan SM, Seminara NM, Shin DB, Troxel AB, Kimmel SB, Mehta NN, Margolis DJ, Gelfand JM. Prevalence of Metabolic Syndrome in Patients with Psoriasis: A Population-Based Study in the United Kingdom. Journal of Investigative Dermatology 2012; 132: 556–562
12. Sommer DM, Jenisch S, Suchan M, Christophers E, Weichenthal M. Increased prevalence of the MetS in patients with moderate to severe psoriasis. Arch Dermatol Res 2006; 298:321-8.
13. Armstrong AW, Harskamp CT, Armstrong EJ. Psoriasis and metabolic syndrome: A systematic review and meta-analysis of observational studies. J Am Acad Dermatol 2013; 68:654-662.
14. Takahashi H, Tsuji H, Takahashi I, Hashimoto Y, Ishida-Yamamoto A, Lizuka H. Prevalence of obesity/adiposity in Japanese psoriasis patients: Adiposity is correlated with the severity of psoriasis. J Dermatol Sci 2009; 55:74-6.