番茄社区

BERLIN -- Psoriasis patients have a substantial comorbidity burden that can reduce life expectancy by 10 years or more, according to data presented here.

On average, patients whose psoriasis was diagnosed before age 25 did not live to age 60. In contrast, a psoriasis diagnosis at age 25 or afterward was associated with an average life expectancy greater than 70.

The disparity emphasizes the need to diagnose psoriasis and initiate treatment to clear the disease and possibly increase longevity by avoiding psoriasis-related comorbidity, Wayne Gulliver, MD, said at the European Academy of Dermatology and Venereology meeting.

"There is an intriguing relationship between psoriasis, multiple comorbidities, and loss of longevity," said Gulliver, of NewLab Research in St. John's, Newfoundland.

"It is documented in the literature that individual diseases, such as diabetes, may decrease life expectancy by five or six years, and high blood pressure and heart disease by three to four years. When you start layering all of those comorbid conditions with psoriasis, then, in people who have early age of onset of psoriasis, the loss of longevity may be as high as 20 years. For people with psoriasis at age 25, it's about 10 years."

The findings came from an ongoing study of comorbidity among psoriasis patients living in Newfoundland and Labrador. Gulliver presented data on the nature of psoriasis-associated comorbidities and all-cause mortality in a founder population of psoriasis patients and in patients included in a newer, more contemporary dataset.

An initial comorbidity and mortality study included 3,228 patients who had a new diagnosis of psoriasis from 1989 through 2005. Almost half of the patients (1,494) had one or more acute-care hospitalizations during follow-up.

Conditions most often associated with hospitalization included digestive disorders (27.3%), circulatory disorders (25.8%), genitourinary conditions (20.5%), and respiratory disease (19.7%).

More than half (55%) of the 1,494 psoriasis patients had multiple comorbid conditions, including a third of patients who had three or more comorbidities.

Using provincial and nationwide data sources, Gulliver and colleagues examined causes of death in a founder population of 120 individuals with psoriasis and in a new dataset including 418 psoriasis patients.

In both groups, circulatory diseases were the most common cause of death (39%), followed by cancer (37.5% of the founder population and 28.5% of the more recent group).

Demographic data on patients in the founder population showed that women died at an average age of 73 and men at 67.5. Severity of psoriasis and psoriasis genotype did not significantly affect life expectancy.

However, age at diagnosis of psoriasis did. Patients whose diagnosis occurred at age 25 or earlier had an average age of 59.3 at death compared with 71.2 for patients whose diagnosis occurred after age 25 (P=0.001).

Of particular concern to Gulliver was the proportion of deaths attributed to mental and nervous-system disorders and accidental or other "external causes," such as injury or poisoning.

Deaths due to mental/nervous system disorders increased from 3.4% to 4.3% from the founder population to the newer dataset.

External causes accounted for 2.5% of deaths in the founder population and 3.6% in the newer dataset for psoriasis patients.

"The data suggest that the risk of dying from suicide, injury, or poisoning may be as high as 1 in 600 and the risk of death from cardiovascular disease is approximately 1 in 75," said Gulliver.

"Knowing that the risk of dying from an adverse drug event related to psoriasis treatment is less than 1 in 10,000, and that systemic psoriasis treatment may decrease the risk of cardiovascular comorbidities, it is important that physicians initiate therapy that will clear the psoriasis, improve the quality of life, and potentially decrease the risk of premature death from a psoriasis-related comorbidity," he said.

Comment