Circulating adiponectin levels in Indian patients with psoriasis and its relation to metabolic syndrome.

BACKGROUND: Adiponectin is a cytokine mainly secreted from the adipose tissue, which has insulin-sensitizing effects, antiatherosclerotic actions, and antiinflammatory properties. There are a few studies that have demonstrated that adiponectin is reduced in patients with psoriasis suggesting that this adipocytokine may have a role in the pathogenesis of psoriasis. There have been no studies so far on adiponectin in relation to psoriasis and metabolic syndrome (MetS). OBJECTIVES: This study was performed to analyze serum adiponectin and insulin levels in psoriasis patients with and without MetS and in controls with and without MetS. MATERIALS AND METHODS: We performed a case control study on 60 psoriasis patients, 29 with MetS and 31 without MetS and 40 controls, 20 with and 20 without MetS, matched for age, sex, and body mass index (BMI). Fasting serum insulin and adiponectin levels were measured in all groups. RESULTS: The overall serum adiponectin levels were significantly reduced in psoriasis patients when compared with controls (P = 0.000). A significant reduction was also observed in psoriasis patients with MetS than those without MetS in the same group (P = 0.000). Similar decrease was observed between those with MetS in the psoriasis and control groups (P = 0.001). The lowest mean value of serum adiponectin (6387.9 ng/ml) was observed in psoriasis with MetS group and highest value (12146.3 ng/ml) in controls without MetS. CONCLUSION: Adiponectin levels are decreased in psoriasis patients irrespective of MetS thus indicating a role in its pathogenesis. This study prompts future trials on drugs increasing adiponectin levels in patients with psoriasis.

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.

BACKGROUND: Psoriasis is a chronic inflammatory disease of the skin and joints with an increased cardiovascular risk. Previous studies have shown a higher prevalence of metabolic syndrome (MS) in psoriatic patients. OBJECTIVE: To investigate the prevalence of MS in patients with psoriasis and healthy controls, and to determine the relation between disease severity and the presence of MS. MATERIALS AND METHODS: We performed a hospital-based case-control study on 118 adult patients with psoriasis vulgaris and 120 controls matched for age, sex and body mass index. MS was diagnosed by the presence of three or more of the South Asian Modified National Cholesterol Education Program's Adult Panel III criteria. RESULTS: MS was significantly more common in psoriatic patients than in controls (44.1% vs. 30%, P value = 0.025). Psoriatic patients also had a higher prevalence of triglyceridemia (33.9% vs. 20.8%, P value = 0.011), abdominal obesity (34.7% vs. 32.5%, P value = 0.035) and elevated blood sugar. There was no difference in the high density lipoprotein (HDL) levels and presence of hypertension among patients with psoriasis and normal controls. There was no correlation between the severity and duration of psoriasis with MS. CONCLUSION: MS is frequent in patients with psoriasis. We have found no relationship between disease severity and presence of MS. Hence, we suggest that all patients must be evaluated for the MS, irrespective of the disease severity.

The increased prevalence of non-alcoholic fatty liver disease in psoriatic patients: a study from South India.

BACKGROUND: Psoriasis is an inflammatory disease of the skin and joints. Previous studies have shown a higher prevalence of metabolic syndrome (MS) in psoriatic patients. Recent studies show that non-alcoholic fatty liver disease (NAFLD) is also frequent in psoriasis patients. OBJECTIVES: To investigate the occurrence and severity of NAFLD in South Indian psoriatic patients and healthy controls. METHODS: In phase 1 we performed a case control study on 333 adult psoriasis patients and 330 controls matched by age, sex and body mass index. NAFLD was diagnosed by ultrasonography and liver enzymes after excluding other liver diseases. In phase 2 we compared the NAFLD subgroups in psoriasis patients and controls by determining their fibrosis, steatosis and non-alcoholic steatohepatitis (NASH) scores. RESULTS: The occurrence of NAFLD was higher in psoriasis patients than in controls (17.4 vs 7.9%; P = 0.002). NAFLD patients in the psoriasis group (n = 58) were more likely to have MS (P = 0.03) and diabetes (P = 0.02) than those with psoriasis alone (n = 254). The former group had a longer duration of psoriasis and arthritis (P = 0.003 and 0.005). Psoriasis patients with NAFLD had more severe disease as per the psoriasis area and severity index scores (P = 0.02). Psoriasis patients had more severe NAFLD than controls as reflected by the steatosis, NASH and fibrosis scores (P = 0.001, 0.003, 0.03 respectively). CONCLUSION: NAFLD is the commonest liver disease in Indian psoriatic patients when compared to controls. As NAFLD is more severe in psoriasis patients we suggest routine screening for NAFLD in this group especially when systemic therapy is considered.