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      Interleukin Levels and Non-Alcoholic Fatty Liver Disease in Chronic Plaque Psoriasis: An Analytical Case Control Study

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          Abstract

          Background:

          Psoriasis is a chronic, immune mediated inflammatory condition of the skin and imbalance in inflammatory mediators could result in insulin resistance, metabolic syndrome and facilitate the occurrence and progression of Non-alcoholic fatty liver disease (NAFLD).

          Objectives:

          Primary objectives:

          1. To study the frequency of NAFLD in cases of chronic plaque psoriasis and controls

          2. To study the interleukin levels in cases of chronic plaque psoriasis and controls.

          Secondary objectives:

          1. To study the BMI, lipid profile, waist circumference, FBS (fasting blood sugar), PPBS (post prandial blood sugar) and serum insulin in cases and controls

          2. To study the association of age, duration of psoriasis, PASI (psoriasis area severity index), BSA (body surface area) involved, BMI (body mass index), lipid profile, obesity, waist circumference, FBS (fasting blood sugar), PPBS (post prandial blood sugar) and serum insulin levels with NAFLD in patients of chronic plaque psoriasis

          3. To correlate serum levels of IL1-β, IL6 and TNF-α with NAFLD in patients of chronic plaque psoriasis.

          Methods:

          50 clinically diagnosed cases of chronic plaque psoriasis with age ≥ 18years, diseases duration ≥ 6 months and 30 age and sex matched controls were recruited. PASI, BSA of cases was calculated and BMI, BP, WC of all subjects was measured. Serum lipid profile, FBS, PPBS, insulin level, IL1- β , IL6, TNF- α , high frequency B-mode ultrasound, LFT and fibroscan were done in all subjects.

          Results:

          28(56.0%) cases and 2(6.6%) controls had NAFLD with statistically significant difference. Significantly elevated WC, serum insulin, deranged lipid profile, fatty liver, transaminitis, fibroscan score, liver fibrosis, NAFLD and interleukins were found in cases vs controls. There was a significant association of NAFLD in psoriatic patients with increasing duration of psoriasis, BMI ≥23 Kg/m2, high WC, increasing BSA involved, deranged lipid profile, raised total cholesterol levels and increasing number of risk factors. Nonsignificant but positive association of NAFLD in cases was found with high levels of IL1 – β, IL – 6, TNF-α, FBS and increasing PASI.

          Conclusion:

          Significantly increased interleukin levels and their weak positive correlation with the severity of psoriasis (PASI, BSA) in patients of chronic plaque psoriasis explains the possible role of inflammation in the causation of psoriasis. Screening may be considered in psoriatic patients with increasing duration of psoriasis, high WC, high BSA involved, high BMI, obesity, dyslipidemia and insulin resistance.

          Limitations:

          Small sample size.

          Conflict of Intrest:

          NONE.

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          Most cited references19

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          Diagnosis of fibrosis and cirrhosis using liver stiffness measurement in nonalcoholic fatty liver disease.

          Vincent Wai-Sun Wong, Julien Vergniol, Grace Lai-Hung Wong … (2010)
          Nonalcoholic fatty liver disease (NAFLD) is one of the most common liver diseases in affluent countries. Accurate noninvasive tests for liver injury are urgently needed. The aim of this study was to evaluate the accuracy of transient elastography for the diagnosis of fibrosis and cirrhosis in patients with NAFLD and to study factors associated with discordance between transient elastography and histology. Two hundred forty-six consecutive patients from two ethnic groups had successful liver stiffness measurement and satisfactory liver biopsy specimens. The area under the receiver-operating characteristics curve (AUROC) of transient elastography for F3 or higher and F4 disease was 0.93 and 0.95, respectively, and was significantly higher than that of the aspartate aminotransferase-to-alanine aminotransferase ratio, aspartate aminotransferase-to-platelet ratio index, FIB-4, BARD, and NAFLD fibrosis scores (AUROC ranged from 0.62 to 0.81, P < 0.05 for all comparisons). At a cutoff value of 7.9 kPa, the sensitivity, specificity, and positive and negative predictive values for F3 or greater disease were 91%, 75%, 52%, and 97%, respectively. Liver stiffness was not affected by hepatic steatosis, necroinflammation, or body mass index. Discordance of at least two stages between transient elastography and histology was observed in 33 (13.4%) patients. By multivariate analysis, liver biopsy length less than 20 mm and F0-2 disease were associated with discordance. Transient elastography is accurate in most NAFLD patients. Unsatisfactory liver biopsy specimens rather than transient elastography technique account for most cases of discordance. With high negative predictive value and modest positive predictive value, transient elastography is useful as a screening test to exclude advanced fibrosis. Liver biopsy may be considered in NAFLD patients with liver stiffness of at least 7.9 kPa.
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            Prevalence of cardiovascular risk factors in patients with psoriasis.

            Andrea L. Neimann, Daniel B. Shin, Xingmei Wang … (2006)
            Previous studies suggest that patients hospitalized for psoriasis have an increased frequency of a variety of cardiovascular comorbidities. Limited population-based data exist on this association, and few studies have determined which factors are independently associated with psoriasis. We sought to determine whether the prevalence of the major cardiovascular risk factors was higher in mild and severe psoriasis than in patients without psoriasis. We conducted a population-based study in the United Kingdom using the General Practice Research Database. Patients were classified as having severe psoriasis if they received a code for psoriasis as well as systemic therapy. Patients were defined as having mild psoriasis if they ever received a psoriasis code but no systemic therapy. Control subjects were selected from the same practices and start dates as psoriasis patients. Patients were classified as having risk factors if they received codes for diabetes, hypertension, hyperlipidemia, obesity, or smoking. Analyses were performed by using conditional logistic regression, and adjustments were made considering age, gender, person-years, and all cardiovascular risk factors. We identified 127,706 patients with mild psoriasis and 3854 with severe psoriasis. Respective prevalence rates of risk factors in those with severe psoriasis, mild psoriasis, and in controls were as follows: diabetes (7.1%, 4.4%, 3.3%), hypertension (20%, 14.7%, 11.9%), hyperlipidemia (6%, 4.7%, 3.3%), obesity (20.7%, 15.8%, 13.2%), and smoking (30.1%, 28%, 21.3%). Patients with mild psoriasis had a higher adjusted odds of diabetes (odds ratio [OR], 1.13; 95% confidence interval [CI], 1.08-1.18]), hypertension (OR, 1.03; 95% CI, 1.01-1.06), hyperlipidemia (OR, 1.16; 95% CI, 1.12-1.21), obesity (OR, 1.27; 95% CI, 1.24-1.31), and smoking (OR, 1.31; 95% CI, 1.29-1.34) than controls. Patients with severe psoriasis had a higher adjusted odds of diabetes (OR, 1.62; 95% CI, 1.3-2.01), obesity (OR, 1.79; 95% CI, 1.55-2.05), and smoking (OR, 1.31; 95% CI, 1.17-1.47) than controls. Additionally, diabetes (OR, 1.39; 95% CI, 1.22-1.58) and obesity (OR, 1.47; 95% CI, 1.32-1.63) were more prevalent in those with severe psoriasis than with mild psoriasis. The study was cross-sectional and therefore the directionality of the associations could not be determined. Multiple cardiovascular risk factors are associated with psoriasis. Cardiovascular risk factors that are key components of the metabolic syndrome are more strongly associated with severe psoriasis than with mild psoriasis.
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              Disease concomitance in psoriasis.

              Tilo Henseler, Enno Christophers (1995)
              Psoriasis is a multifactorial disease of unknown origin. Our purpose was to determine the frequency of skin disorders concomitantly seen in patients with psoriasis. We analyzed data from more than 40,000 patients and calculated sex- and age-adjusted ratios of expected and observed incidence rates of associated disorders. The results demonstrate that, compared with age-matched control patients without psoriasis, cutaneous immune disorders such as allergic contact dermatitis, atopic dermatitis, and urticaria are underrepresented in patients with psoriasis. In contrast, certain systemic disorders such as diabetes, heart insufficiency, and obesity occur significantly more often in patients with psoriasis than in control subjects. Increased resistance to cutaneous bacterial infections was noted only in patients with early-onset psoriasis. Our observations show that a distinct pattern of associated diseases exists in patients with psoriasis. Although systemic disorders such as obesity, diabetes, and heart disease may be related to dietary habits and nutritional status, the relative resistance to cutaneous infections together with decreased immune responsiveness suggest a genetically determined selection.
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                Author and article information

                Journal
                Journal ID (nlm-ta): Indian J Dermatol
                Journal ID (iso-abbrev): Indian J Dermatol
                Journal ID (publisher-id): IJD
                Title: Indian Journal of Dermatology
                Publisher: Wolters Kluwer - Medknow (India )
                ISSN (Print): 0019-5154
                ISSN (Electronic): 1998-3611
                Publication date (Print): Jul-Aug 2023
                Volume: 68
                Issue: 4
                Pages: 377-384
                Affiliations
                [1] From the Department of Dermatology and STD, Lady Hardinge Medical College and Sucheta Kriplani Hospital, New Delhi, India
                [1 ] Department of Medicine, Lady Hardinge Medical College and Sucheta Kriplani Hospital, New Delhi, India
                [2 ] Department of Dermatology and STD, University College of Medical Sciences, New Delhi, India
                [3 ] Department of Biochemistry, Lady Hardinge Medical College and Sucheta Kriplani Hospital, New Delhi, India
                Author notes
                Address for correspondence: Dr. Vidya Yadav, House Number 153, Gurgaon Sector 5, Part 3 Haryana, Pin - 122 001, India. E-mail: vidyadermdoc@ 123456gmail.com
                Article
                Publisher ID: IJD-68-377
                DOI: 10.4103/ijd.ijd_1015_22
                PMC ID: 10564203
                PubMed ID: 37822394
                SO-VID: abc76856-1323-4c1b-8db8-9cb1973c7d44
                Copyright © Copyright: © 2023 Indian Journal of Dermatology
                License:

                This is an open access journal, and articles are distributed under the terms of the Creative Commons Attribution-NonCommercial-ShareAlike 4.0 License, which allows others to remix, tweak, and build upon the work non-commercially, as long as appropriate credit is given and the new creations are licensed under the identical terms.

                History
                Date received : December 2022
                Date accepted : April 2023
                Categories
                Subject: Original Article

                ScienceOpen disciplines: Dermatology
                Keywords: bmi (body mass index),bsa (body surface area),chronic plaque psoriasis,dyslipidemia,fbs (fasting blood sugar),fatty liver,fibroscan,il1- β,il-6,liver fibrosis,lft (liver function test),nafld (non-alcoholic fatty liver disease),pasi (psoriasis area severity index),serum insulin level,tnf- α (interleukins),th-1,transaminitis,waist circumference (wc)
                Data availability:
                ScienceOpen disciplines: Dermatology
                Keywords: bmi (body mass index), bsa (body surface area), chronic plaque psoriasis, dyslipidemia, fbs (fasting blood sugar), fatty liver, fibroscan, il1- β, il-6, liver fibrosis, lft (liver function test), nafld (non-alcoholic fatty liver disease), pasi (psoriasis area severity index), serum insulin level, tnf- α (interleukins), th-1, transaminitis, waist circumference (wc)

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