Psoriasis y su relación con el síndrome metabólico

La psoriasis es una enfermedad crónica con un gran impacto en la calidad de vida de quienes la padecen. En numerosos estudios se ha demostrado que, a pesar de contar con múltiples opciones terapéuticas, los pacientes con psoriasis no siempre reciben el tratamiento óptimo necesario para mejorar sus manifestaciones clínicas y prevenir el efecto que tienen las enfermedades concomitantes asociadas sobre su calidad de vida. Es considerable el uso insuficiente de tratamientos efectivos y es probable que existan vacíos en el conocimiento de la enfermedad que impiden tomar mejores decisiones en el manejo de la psoriasis. El entendimiento de la psoriasis como una condición compleja y multifactorial tiene un gran impacto en la disminución de la morbimortalidad asociada y ofrece a los pacientes la oportunidad de recibir una atención integral, que abarque los fenómenos biológicos propios de la enfermedad, pero que pueden ser vistos en el contexto que implica la asociación con numerosas enfermedades que se traducen en un deterioro de la capacidad física y el desarrollo personal y, por ende, afectan el bienestar de los individuos con psoriasis. Este artículo pretende explorar las implicaciones fisiopatogénicas que explican las relaciones de causalidad entre la psoriasis y el síndrome metabólico y, de esta forma, argumentar con suficiente información la necesidad real que tienen los pacientes con psoriasis de ser contemplados dentro del espectro de una enfermedad sistémica y la oportunidad de que sean adecuadamente tratados por un grupo multidisciplinario que garantice el más completo abordaje diagnóstico y terapéutico.Psoriasis is a chronic disease with a major impact on patient quality of life. Despite there being multiple treatment options, numerous studies have shown that patients with psoriasis do not always receive the optimal treatment necessary to improve their clinical manifestations, and to prevent the associated comorbidities that impact on quality of life. The gaps in knowledge and the underuse of effective treatments prevent better decisions to be made in the management of psoriasis. The understanding of psoriasis as a complex and multifactorial condition has a major impact on reducing associated morbidity and mortality, and offers patients the opportunity to receive comprehensive care that encompasses the biological phenomena characteristics of the disease, which can be observed in the context of the psoriasis, its association with multiple diseases, the deterioration in physical and personal abilities, thus affecting the well-being of the patient. This article examines the physiopathogenic implications, explaining the causal relation ships between psoriasis and the metabolic syndrome, and argues the real need for psoriasis patients to be considered within the spectrum of a systemic disease, and to have the opportunity to be properly treated by a multidisciplinary team to ensure the most comprehensive diagnostic and therapeutic approach

Psoriasis and Vascular Disease—Risk Factors and Outcomes: A Systematic Review of the Literature

BACKGROUND: Psoriasis afflicts 2-3% of the world’s population. Affected patients commonly have risk factors for cardiovascular disease (CVD). In addition, psoriasis is independently associated with CVD and mortality. PURPOSE: To determine which CVD risk factors are associated with psoriasis independent of confounders, whether psoriasis is associated with CVD independent of CVD risk factors, and whether there is increased mortality among patients with psoriasis. DATA SOURCES: MEDLINE, Embase, and Cochrane Collaborations from inception through October 2009. We reviewed bibliographies of retrieved articles for additional references. STUDY SELECTION: Cross-sectional, cohort-based, case-control, and randomized controlled trials which involved patients with psoriasis. DATA EXTRACTION: Two investigators independently reviewed studies and resolved any discrepancies by consensus. DATA SYNTHESIS: Of the 2,303 articles identified by literature search, 90 studies met inclusion criteria for this review; 15 were cohort-based studies, 45 were case-control, and 30 were cross-sectional. LIMITATIONS: The quality of evidence was limited by study heterogeneity and lack of large scale prospective studies with long-term follow-up. CONCLUSIONS: Patients with psoriasis demonstrate a higher prevalence of cardiovascular risk factors and appear to be at increased risk for ischemic heart disease, cerebrovascular disease, and peripheral arterial disease. This increase in vascular disease may be independent of shared risk factors and may contribute to the increase in all-cause mortality. Future research should aim to more confidently distinguish between a true causal relationship or merely an association resulting from multiple shared risk factors. Physicians should screen for and aggressively treat modifiable risk factors for CVD in patients with psoriasis