Psoriasis Resource Center

Solving the psoriasis comorbidity puzzle

Psoriasis is often a serious condition just by itself, but people with the disease are often affected by other conditions, ranging heart disease to depression to diabetes. In some cases, psoriasis may play a causal role; so, for example, serious cases of psoriasis may affect self-esteem and that may lead to depression. In others, psoriasis and the other disease may share a causal factor, such as a genetic mutation, an immunologic abnormality, or inflammation. The hows and whys of this web of comorbidity is a massive puzzle that researchers are working to solve, usually one small piece at a time. 

One example of this incremental progress is research presented by Elizabeth Evans of King’s College in London and her colleagues at the Society of Endocrinology meeting in Glasgow last month. They used a mouse model of psoriasis to show that the inflammation associated with the psoriasis-like condition caused subcutaneous adipose tissue to become insulin resistant while also increasing insulin secretion by islets in the pancreas.

Many studies have shown an association between psoriasis and heart attacks and stroke. Gwendalyn Randolph of Washington University and her colleagues reported results in Cell Metabolism last month shed some light on why that may be. 

It’s another mouse model, so, yes, cue up the caveats. But the long-story-made-short version of their pathogenic narrative goes something like this: Psoriasis-affected skin lesions result in the production of interleukin-17–producing T cells that go on to circulate in the bloodstream. There they play a role in trapping cholesterol and thickening the "collagenous matrix." Blood vessel walls thicken and the lumen narrows. As a result the chances of heart attack and stroke increase.

Cosentyx (secukinumab) and Taltz (ixekizumab) target interleukin-17, so some of the psoriasis drugs already on the market could, perhaps, have the beneficial side effect of lowering people’s heart disease risk.

“It’ll take a few years before we know for sure, but we predict that the anti-IL-17 antibodies that already are being used to treat autoimmune diseases will be effective at reducing risk of cardiovascular disease,” Randolph said in a Washington University press release about the Cell Metabolism paper. “This would be important because some other drugs on the market seem to improve the skin disease but not reduce cardiovascular risk.”