What Are Common Comorbidities Related to Psoriasis?

Research has shown that people with psoriasis have a greater risk of developing other health conditions, which are also called comorbidities. As a part of the process of diagnosing a patient with psoriasis, healthcare providers screen patients for signs and symptoms of these comorbidities.

Researchers are continuing to study the relationship between psoriasis and these comorbidities in order to find out if:

• psoriasis is the cause of the increased risk of developing the comorbidity
• a comorbid condition causes an increased risk of developing psoriasis, or
• psoriasis and the comorbidity share a common underlying cause or risk factors, including genetic risk factors

What types of comorbidities are linked to psoriasis?

Studies have shown that people with psoriasis have a higher chance of developing the following health conditions^1,2:

• Psoriatic arthritis
• Cardiovascular conditions, such as high blood pressure and heart disease
• Type 2 diabetes
• Obesity and metabolic syndrome
• Inflammatory bowel diseases, including Crohn’s Disease
• Certain types of cancers
• Mental health conditions, such as depression and anxiety

Why is it important to screen people with psoriasis for comorbidities?

Screening people with psoriasis for comorbidities is important for several reasons. Detecting these conditions early can make them much easier to treat, and can reduce the damage they can cause. For instance, if psoriatic arthritis is not treated as soon as possible, it can cause permanent damage to a person’s joints. Most of the other comorbidities can be controlled more quickly and effectively if they are caught in the early stages. Treating comorbidities can also have a positive impact on a person’s psoriasis symptoms and improve the person’s overall quality of life³.

Comorbidities can also affect the way that the patient’s psoriasis is treated. For example, patients who have type 2 diabetes should not be treated for psoriasis with a medicine called methotrexate, because it can cause liver damage. Certain types of medicines can also make comorbidities worse, and some comorbidities can affect the way that psoriasis treatments work. Taking cyclosporine, for instance, can make high blood pressure worse and raise a patient’s cholesterol level. Having high cholesterol can make treatment with retinoid medicines less effective. Your healthcare provider can work with you to determine the best sequence of medications to effectively deal with both conditions.

Older people with psoriasis have a higher risk of developing comorbidities than younger people. Studies suggest that around two-thirds of people with psoriasis who are older than 65 have two or more comorbidities, and around half of those have at least three comorbidities⁴.

The risk of comorbidities is also higher among people who have psoriasis that is severe, compared to those with mild or moderate psoriasis. Women who have severe psoriasis have the highest risk for many comorbidities, although a recent study suggests that men with psoriasis may be at increased risk for abdominal aortic aneurysm⁸.

How are patients screened for comorbidities?

In most cases, healthcare providers can make a diagnosis of psoriasis by carrying out a physical examination and taking the patient’s medical history. The information gathered during this process, along with some other types of diagnostic tools, can be used to help diagnose any other comorbidities that the patient may have¹.

While research based prevalence varies, it is estimated that up to 40% of people with psoriasis will develop psoriatic arthritis, a condition in which inflammation causes symptoms of pain and swelling in the joints, particularly in the fingers, wrists, and toes⁷. To screen for psoriatic arthritis, healthcare providers will ask if the patient has any pain, tenderness, stiffness, or swelling in any joints.

Cardiovascular conditions are among the most common comorbidities for people with psoriasis². For example, people with psoriasis are three times more likely to have a heart attack than people without psoriasis. They are also at a higher risk of having high blood pressure, irregular heartbeat, and stroke. People with psoriasis are also more likely to have metabolic syndrome, a set of conditions that includes high blood pressure, high blood sugar levels, and high cholesterol levels. To screen for cardiovascular conditions, metabolic syndrome, and type 2 diabetes mellitus, healthcare providers may take blood pressure measurements, use an electrocardiogram test, and use blood tests to measure cholesterol levels, blood sugar levels, and other biomarkers. When vascularity or organ involvement is of concern, an ultrasound, or other imaging tests may be used³.

Obesity is linked to psoriasis and several of its comorbidities (including cardiovascular conditions, metabolic syndrome, and type 2 diabetes). Researchers are still working to understand more about the relationship between obesity and these conditions, but many of the symptoms of these conditions improve if a person maintains a healthy body weight⁴. To screen a patient for obesity, healthcare providers measure the patient’s body mass index and waist circumference during the physical examination.

Inflammatory bowel diseases, including Crohn’s disease and ulcerative colitis, are more common among people living with psoriasis than the rest of the population. To screen for these conditions, healthcare providers will ask about any symptoms the patient has related to the digestive system, such as diarrhea, abdominal pain, and cramping⁵.

How is cancer linked to psoriasis?

People with psoriasis have a higher risk of developing certain types of cancers, including lymphoma and non-melanoma skin cancers. Healthcare providers will screen for signs and symptoms of these types of cancers during the physical examination⁶.

Living with psoriasis can make a person more likely to develop mental health conditions such as depression and anxiety. To screen patients for these types of conditions, healthcare provider will ask a series of questions to learn more about the emotional impact that psoriasis has had on the patient’s quality of life.