Introduction: Psoriasis is an immune-mediated chronic inflammatory disease, affecting approximately 1-3% of the population worldwide. Psoriasis patients are more likely to be diagnosed with cardiovascu- lar diseases and hyperhomocysteinemia; however, it remains elusive weather serum homocysteine levels correlate to disease activity and duration of disease. The aim of this study was to investigate serum levels of homocysteine in young patients with plaque psoriasis naïve for conventional systemic and biologic therapy. An additional aim was to determine correlation of homocysteine levels with disease severity, inflammation, folic acid and vitamin B12 supplies.
Materials and methods: 26 subjects were enrolled to participate in this case-control study, including 13 adult psoriatic patients naïve for systemic therapy, without comorbidities, malignancies and infectious diseases, and 13 healthy unrelated, age and sex-matched volunteers. The disease severity and life quality were assessed using standardized tools – Psoriasis Area and Severity Index (PASI) and Dermatology Life Quality Index (DLQI), respectively. Venous blood was collected and processed for analysis of differential blood count (DBC), erythrocyte sedimentation rate (ESR), C reactive protein (hsCRP), serum levels of homocysteine, vitamin B12 and folic acid in the routine clinical laboratory.
Results Studied cohort consisted of young participants with average age around 35 years. According to the PASI index, disease severity ranged from mild (2.10) to moderate (15.2). There was no significant difference in hsCRP and DBC levels between the groups. Psoriasis patients had significantly higher levels of homocysteine compared to healthy subjects, but there was no evidence of hyperhomocystein- emia related to psoriasis. All subjects had normal serum levels of vitamin B12 and folic acid. A moderate negative correlation was found between plasma homocysteine level and vitamin B12 and folic acid. Furthermore, homocysteine levels did not correlate to hsCRP, total leukocytes, and thrombocytes count, but did significantly positively correlate to ESR.
Conclusions: The risk of cardiovascular diseases should be considered among all psoriasis patients, regardless of age and disease severity, but larger prospective controlled studies are needed to estimate the role of homocysteine in cardiovascular morbidity and mortality in psoriatic patients.Uvod: Psorijaza je imunološki posredovana kronična upalna bolest, koja pogađa otprilike 1-3% populacije u svijetu. Pacijenti oboljeli od psorijaze imaju veću vjerojatnost razvoja kardiovaskularnih bolesti i hiperho- mocisteinemije, međutim, ostaje nejasna povezanost serumske razine homocisteina s aktivnošću i trajanjem bolesti.
Cilj ove studije bio je ispitati serumske vrijednosti homocisteina u mladih bolesnika s plak psorijazom, koji nisu do sada primali sustavnu, ili biološku terapiju. Dodatni cilj bio je utvrditi povezanost serumske razine homocisteina s težinom bolesti, razinom upale te razinom folne kiseline i vitamina B12.
Materijali i metode U ovo istraživanje bilo je uključeno 26 ispitanika, uključujući 13 odraslih bolesnika
s psorijazom naivnih za sustanu terapiju, bez komorbiditeta, malignih oboljenja i zaraznih bolesti te 13 zdravih, nepovezanih, dobno i spolno usklađenih dobrovoljaca. Težina bolesti i kvaliteta života procijenjena je korištenjem standardiziranih testova - Psoriasis Area and Severity Index (PASI) i Dermatološkog indeksa kvalitete života (DLQI). Iz venske krvi ispitanika, u rutinskom kliničkom laboratoriju, određena je diferenci- jalna krvna slika (DKS), brzina sedimentacije eritrocita (SE), C reaktivni protein (hsCRP) te serumske razine homocisteina, vitamina B12 i folne kiseline.
Rezultati Istraživana skupina sastojala se od mladih sudionika, prosječne dobi oko 35 godina. Prema PASI indeksu, težina bolesti bila je u rasponu od blage (2,10) do umjerene (15,2) psorijaze. Nije bilo značajne raz- like u vrijednostima hsCRP-a i DKS-a između ispitivanih skupina. Ispitanici s psorijazom imali su statistički značajno više vrijednosti homocisteina u usporedbi sa zdravim ispitanicima, ali nije bilo dokaza hiperhomo- cisteinemije povezane s psorijazom. Svi ispitanici imali su normalne vrijednosti vitamina B12 i folne kiseline u serumu. Utvrđena je umjerena negativna povezanost između razine homocisteina u serumu i vitamina B12 te razine homocisteina i folne kiseline. Nadalje, serumska razina homocisteina nije bila povezana s hsCRP-om, ukupnim brojem leukocita i trombocita, ali je uočena značajna pozitivna povezanost serumske razine homocisteina i sedimentacije.
Zaključak: Rizik od kardiovaskularnih bolesti treba razmotriti među svim pacijentima oboljelima od psori- jaze, bez obzira na njihovu dob i težinu bolesti. Potrebna su veća prospektivna, kontrolirana ispitivanja kao bi se procijenila uloga homocisteina u razvoju kardiovaskularnih bolesti kod psorijatičnih bolesnika
