Background. Diabetes has been associated with psoriasis, but little is known about the association between psoriatic arthritis and diabetes. Methods. Patients diagnosed with psoriatic arthritis by a rheumatologist were compared to age- and sex-matched patients without psoriatic arthritis regarding the prevalence of diabetes in a population-based cross-sectional study using logistic multivariate models. The study was performed utilizing the medical database of Clalit, the largest healthcare provider organization in Israel. Results. The study included 549 patients with psoriatic arthritis ≥21 years and 1,098 patients without psoriatic arthritis. The prevalence of diabetes in patients with psoriatic arthritis was increased as compared to the prevalence in patients without psoriatic arthritis (15.3%？versus 10.7%, value = 0.008). The difference was prominent among females (18.7%？versus 10.3%, ) but not among males (11.2% in patients with and without psoriatic arthritis, ). In a multivariate analysis, psoriatic arthritis was associated with diabetes among females (OR = 1.60, 95% CI:？1.02–2.52, ) but not among males (OR = 0.71, 95% CI:？0.42–1.22, ). Conclusion. Our study suggests a possible association between psoriatic arthritis and diabetes in women. Women with psoriatic arthritis might be candidates for diabetes screening. 1. Introduction Psoriatic arthritis (PsA) is a chronic inflammatory arthropathy characterized by the combined presence of psoriasis and arthritis. It affects 5–8% of psoriasis patients and 0.05–0.24% of the general Caucasian population [1, 2]. Many patients develop progressive joint damage and disability, with a significant impact on the patient’s functional status and quality of life, and a reduced life expectancy related to cardiovascular and respiratory causes [3, 4]. Psoriasis was reported to be associated with cardiovascular risk factors [1, 5–18]. PsA also appears to be associated with an increased cardiovascular mortality and morbidity. Several factors including smoking, dyslipidemia, hypertension, increased fibrinogen level, hypercoagulability, and decreased physical activity might explain the enhanced cardiovascular risk in patients with PsA. Under-treatment of cardiovascular morbidity also may contribute to the higher cardiovascular risk [19]. Markers of disease activity seem to be associated with increased cardiovascular mortality [4]. Nevertheless, the evidence base to support the hypothesis of increased cardiovascular risk in PsA is much less definitive than in other inflammatory joint diseases such as rheumatoid arthritis
References
[1]
E. Christophers, “Psoriasis—epidemiology and clinical spectrum,” Clinical and Experimental Dermatology, vol. 26, no. 4, pp. 314–320, 2001.
[2]
F. C. Wilson, M. Icen, C. S. Crowson, M. T. McEvoy, S. E. Gabriel, and H. M. Kremers, “Time trends in epidemiology and characteristics of psoriatic arthritis over 3 decades: a population-based study,” Journal of Rheumatology, vol. 36, no. 2, pp. 361–367, 2009.
[3]
C. Han, D. W. Robinson Jr., M. V. Hackett, L. C. Paramore, K. H. Fraeman, and M. V. Bala, “Cardiovascular disease and risk factors in patients with rheumatoid arthritis, psoriatic arthritis, and ankylosing spondylitis,” Journal of Rheumatology, vol. 33, no. 11, pp. 2167–2172, 2006.
[4]
O. Kimhi, D. Caspi, N. M. Bornstein et al., “Prevalence and risk factors of atherosclerosis in patients with psoriatic arthritis,” Seminars in Arthritis and Rheumatism, vol. 36, no. 4, pp. 203–209, 2007.
[5]
T. Henseler and E. Christophers, “Disease concomitance in psoriasis,” Journal of the American Academy of Dermatology, vol. 32, no. 6, pp. 982–986, 1995.
[6]
J. Shapiro, A. D. Cohen, M. David et al., “The association between psoriasis, diabetes mellitus, and atherosclerosis in Israel: A Case-Control Study,” Journal of the American Academy of Dermatology, vol. 56, no. 4, pp. 629–634, 2007.
[7]
B. Lindegard, “Diseases associated with psoriasis in a general population of 159,200 middle-aged, urban, native Swedes,” Dermatologica, vol. 172, no. 6, pp. 298–304, 1986.
[8]
A. L. Neimann, D. B. Shin, X. Wang, D. J. Margolis, A. B. Troxel, and J. M. Gelfand, “Prevalence of cardiovascular risk factors in patients with psoriasis,” Journal of the American Academy of Dermatology, vol. 55, no. 5, pp. 829–835, 2006.
[9]
D. J. Pearce, A. E. Morrison, K. B. Higgins, et al., “The comorbid state of psoriasis patients in a university dermatology practice,” Journal of Dermatological Treatment, vol. 16, no. 5-6, pp. 319–323, 2005.
[10]
D. M. Sommer, S. Jenisch, M. Suchan, E. Christophers, and M. Weichenthal, “Increased prevalence of the metabolic syndrome in patients with moderate to severe psoriasis,” Archives of Dermatological Research, vol. 298, no. 7, pp. 321–328, 2006.
[11]
A. D. Cohen, J. Dreiher, Y. Shapiro et al., “Psoriasis and diabetes: a population-based cross-sectional study,” Journal of the European Academy of Dermatology and Venereology, vol. 22, no. 5, pp. 585–589, 2008.
[12]
F. Sp？h, “Inflammation in atherosclerosis and psoriasis: common pathogenic mechanisms and the potential for an integrated treatment approach,” British Journal of Dermatology, vol. 159, supplement 2, pp. 10–17, 2008.
[13]
A. B. Kimball, D. Robinson Jr., Y. Wu et al., “Cardiovascular disease and risk factors among psoriasis patients in two US healthcare databases, 2001-2002,” Dermatology, vol. 217, no. 1, pp. 27–37, 2008.
[14]
Y. Wu, D. Mills, and M. Bala, “Psoriasis: cardiovascular risk factors and other disease comorbidities,” Journal of Drugs in Dermatology, vol. 7, no. 4, pp. 373–377, 2008.
[15]
L. Mallbris, C. T. Ritchlin, and M. St？hle, “Metabolic disorders in patients with psoriasis and psoriatic arthritis,” Current Rheumatology Reports, vol. 8, no. 5, pp. 355–363, 2006.
[16]
A. B. Gottlieb, F. Dann, and A. Menter, “Psoriasis and the metabolic syndrome,” Journal of Drugs in Dermatology, vol. 7, no. 6, pp. 563–572, 2008.
[17]
A. A. Qureshi, H. K. Choi, A. R. Setty, and G. C. Curhan, “Psoriasis and the risk of diabetes and hypertension: a prospective study of us female nurses,” Archives of Dermatology, vol. 145, no. 4, pp. 379–382, 2009.
[18]
H. Johnsson, I. B. McInnes, and N. Sattar, “Cardiovascular and metabolic risks in psoriasis and psoriatic arthritis: pragmatic clinical management based on available evidence,” Annals of the Rheumatic Diseases, vol. 71, no. 4, pp. 480–483, 2012.
[19]
M. J. Peters, I. E. Van Der Horst-Bruinsma, B. A. Dijkmans, and M. T. Nurmohamed, “Cardiovascular risk profile of patients with spondylarthropathies, particularly ankylosing spondylitis and psoriatic arthritis,” Seminars in Arthritis and Rheumatism, vol. 34, no. 3, pp. 585–592, 2004.
[20]
T. M. Farragher and I. N. Bruce, “Cardiovascular risk in inflammatory rheumatic diseases: loose ends and common threads,” Journal of Rheumatology, vol. 33, no. 11, pp. 2105–2107, 2006.
[21]
S. Armesto, J. Santos-Juanes, C. Galache-Osuna, P. Martinez-Camblor, E. Coto, and P. Coto-Segura, “Psoriasis and type 2 diabetes risk among psoriatic patients in a Spanish population,” Australasian Journal of Dermatology, vol. 53, no. 2, pp. 128–130, 2012.
[22]
C. P. Chung, I. Avalos, A. Oeser et al., “High prevalence of the metabolic syndrome in patients with systemic lupus erythematosus: association with disease characteristics and cardiovascular risk factors,” Annals of the Rheumatic Diseases, vol. 66, no. 2, pp. 208–214, 2007.
[23]
C. P. Chung, A. Oeser, J. F. Solus et al., “Prevalence of the metabolic syndrome is increased in rheumatoid arthritis and is associated with coronary atherosclerosis,” Atherosclerosis, vol. 196, no. 2, pp. 756–763, 2008.
[24]
C. C. Mok, G. T. C. Ko, L. Y. Ho, K. L. Yu, P. T. Chan, and C. H. To, “Prevalence of atherosclerotic risk factors and the metabolic syndrome in patients with chronic inflammatory arthritis,” Arthritis Care and Research, vol. 63, no. 2, pp. 195–202, 2011.
[25]
L. S. Tam, B. Tomlinson, T. T. W. Chu, et al., “Cardiovascular risk profile of patients with psoriatic arthritis compared to controls—the role of inflammation,” Rheumatology, vol. 47, no. 5, pp. 718–723, 2008.
[26]
G. Rennert and Y. Peterburg, “Prevalence of selected chronic diseases in Israel,” Israel Medical Association Journal, vol. 3, no. 6, pp. 404–408, 2001.
[27]
S. Vinker, Y. Fogelman, A. Elhayany, S. Nakar, and E. Kahan, “Usefulness of electronic databases for the detection of unrecognized diabetic patients,” Cardiovascular Diabetology, vol. 2, article 13, 2003.
[28]
B. H. Hahn, J. Grossman, W. Chen, and M. McMahon, “The pathogenesis of atherosclerosis in autoimmune rheumatic diseases: roles of inflammation and dyslipidemia,” Journal of Autoimmunity, vol. 28, no. 2-3, pp. 69–75, 2007.
[29]
D. H. Solomon, T. J. Love, C. Canning, and S. Schneeweiss, “Risk of diabetes among patients with rheumatoid arthritis, psoriatic arthritis and psoriasis,” Annals of the Rheumatic Diseases, vol. 69, no. 12, pp. 2114–2117, 2010.
[30]
F. Franconi, G. Seghieri, S. Canu, E. Straface, I. Campesi, and W. Malorni, “Are the available experimental models of type 2 diabetes appropriate for a gender perspective?” Pharmacological Research, vol. 57, no. 1, pp. 6–18, 2008.
[31]
J. Saltevo, M. Vanhala, H. Kautiainen, E. Kumpusalo, and M. Laakso, “Gender differences in C-reactive protein, interleukin-1 receptor antagonist and adiponectin levels in the metabolic syndrome: A Population-Based Study,” Diabetic Medicine, vol. 25, no. 6, pp. 747–750, 2008.
[32]
W. Gulliver, “Long-term prognosis in patients with psoriasis,” British Journal of Dermatology, vol. 159, supplement 2, pp. 2–9, 2008.
[33]
W. H. Boehncke and S. Boehncke, “Cardiovascular morbidity in psoriasis: epidemiology, pathomechanisms, and clinical consequences,” Giornale Italiano di Dermatologia e Venereologia, vol. 143, no. 5, pp. 307–313, 2008.
[34]
Y. Liu, C. Helms, W. Liao et al., “A genome-wide association study of psoriasis and psoriatic arthritis identifies new disease loci,” PLoS Genetics, vol. 4, no. 4, Article ID e1000041, 2008.
[35]
J. S. Yudkin, “Insulin resistance and the metabolic syndrome—or the pitfalls of epidemiology,” Diabetologia, vol. 50, no. 8, pp. 1576–1586, 2007.
[36]
G. E. Sonnenberg, G. R. Krakower, and A. H. Kissebah, “A novel pathway to the manifestations of metabolic syndrome,” Obesity Research, vol. 12, no. 2, pp. 180–186, 2004.
[37]
J. Channual, J. J. Wu, and F. J. Dann, “Effects of tumor necrosis factor-α blockade on metabolic syndrome components in psoriasis and psoriatic arthritis and additional lessons learned from rheumatoid arthritis,” Dermatologic Therapy, vol. 22, no. 1, pp. 61–73, 2009.
[38]
H. Yoo, S. Kim, Y. Kim, H. Lee, and T. Kim, “Insulin-like growth factor-II regulates the 12-lipoxygenase gene expression and promotes cell proliferation in human keratinocytes via the extracellular regulatory kinase and phosphatidylinositol 3-kinase pathways,” International Journal of Biochemistry and Cell Biology, vol. 39, no. 6, pp. 1248–1259, 2007.
[39]
S. K. Das and S. C. Elbein, “The search for type 2 diabetes susceptibility loci: the chromosome 1q story,” Current Diabetes Reports, vol. 7, no. 2, pp. 154–164, 2007.
[40]
V. Steinthorsdottir, G. Thorleifsson, I. Reynisdottir et al., “A variant in CDKAL1 influences insulin response and risk of type 2 diabetes,” Nature Genetics, vol. 39, no. 6, pp. 770–775, 2007.
[41]
N. Wolf, M. Quaranta, N. J. Prescott et al., “Psoriasis is associated with pleiotropic susceptibility loci identified in type II diabetes and Crohn disease,” Journal of Medical Genetics, vol. 45, no. 2, pp. 114–116, 2008.
[42]
W. H. Boehncke and W. Sterry, “Psoriasis—a systemic inflammatory disorder: clinic, pathogenesis and therapeutic perspectives,” Journal der Deutschen Dermatologischen Gesellschaft, vol. 7, no. 11, pp. 946–952, 2009.
[43]
T. Bongartz, B. Coras, T. Vogt, J. Sch？lmerich, and U. Müller-Ladner, “Treatment of active psoriatic arthritis with the PPARγ ligand pioglitazone: an open-label pilot study,” Rheumatology, vol. 44, no. 1, pp. 126–129, 2005.
