Cardiovascular morbidity, risk of cancer and alcohol abuse in psoriasis: Systematic literature reviews and expert opinion

摘要

There is an increasing body of evidence indicating that psoriasis should be considered as a systemic disease. In recent years, clear pathophysiological and epidemiological links have been established between psoriasis and others inflammatory conditions. Recent epidemiological studies conducted in automated databases suggest that severe psoriasis is associated with an increased risk of death. It remains to be elucidated if this increased morbidity and mortality in psoriasis results from psoriasis-caused systemic inflammation or from comorbidities. Metabolic disorders (diabetes, dyslipidaemia, obesity), hypertension, smoking and alcohol use have been associated with psoriasis in some studies, although the consistency and the strength of the association remains debated. In addition, depression and addictive behaviour such as alcohol abuse seem more prevalent in psoriasis patients and can influence the therapeutic approach. The effect of psoriasis and its comorbidities on the risk of cardiovascular morbidity and the risk of cancer remains to be elucidated as there is clear heterogeneity in published studies. This year, the French Psoriasis Expert Group chose to propose evidence-based reviews as well as recommendations on the risks of cardiovascular comorbidities, alcohol consumption and cancer in psoriasis patients. The methodology used to elaborate these recommendations followed a rigorous approach previously exposed with definition of research questions based upon Delphi method and systematic literature review of published evidence. Elaboration of the recommendations'was based on critical appraisal of available evidence and expert consensus of a group of dermatologists with expertise in psoriasis. All opinions and recommendations were critically discussed by a diverse expert group including dermatologists from academic institutions, from non-academic hospitals and from private practice. The experts had the opportunity to express their level of agreement and the perceived impact of the recommendations on their daily practice.