DOI: http://dx.doi.org/10.18203/issn.2455-4529.IntJResDermatol20190442

High sensitivity C-reactive protein, a predictor of cardiovascular mortality and morbidity, and psoriasis: a case control study

Surinder Gupta, Preeti Garg, Nikita Gupta, Nakul Gupta

Abstract


Background: Psoriasis, a chronic inflammatory disease, is associated with systemic comorbidities. The blood levels of various inflammatory markers are increased in psoriasis. One of them is high sensitivity C-reactive protein (hs-CRP). The serum level of hs-CRP is increased in many inflammatory diseases like psoriasis, cardio vascular diseases, infections, arthritis and others. The objectives of the study were to determine serum level of hs-CRP in psoriasis in relation to its PASI score, which is a subjective method to determine severity of the disease, whereas hs-CRP is an objective and more reliable method. And to have a better idea of systemic inflammatory process caused by psoriasis, serum level of hs-CRP was evaluated in psoriasis patients.

Methods: A case control study was conducted including 38 patients of chronic plaque psoriasis from dermatology outpatient department of Maharaja Agrasen Medical College (MAMC), Agroha, India, and 38 healthy controls.

Results: The serum level of hs-CRP was significantly raised in psoriasis patients (p<0.001). The mean hs-CRP level in psoriasis patients was 6.824±8.562 mg/l whereas it was 1.072±0.929 mg/l in controls. Two observations were noticed, one, the increase in hs-CRP level correlated with PASI score and second, it was much higher in psoriatic patients as compared to controls.

Conclusions: The much higher hs-CRP levels in psoriasis as compared to controls and its correlation with severity of psoriasis has led us to propose that this much high hs-CRP is a biomarker of systemic inflammatory process of psoriasis as well as inflamed cutaneous lesions.

 


Keywords


Psoriasis, High sensitivity C-reactive protein (hs-CRP), Cardiovascular disease

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References


Parisi R, Symmons DP, Griffiths CE, Ashcroft DM. Global epidemiology of psoriasis: A systematic review of incidence and prevalence. J Investig Dermatol. 2013;133:377–85.

Griffiths CE, Barker JN. Pathogenesis and clinical features of psoriasis. Lancet. 2007;370:263–71.

Mantovani A, Gisondi P, Lonardo A, Targher G. Relationship between Non-Alcoholic Fatty Liver Disease and Psoriasis: A Novel Hepato-Dermal Axis? Int J Mol Sci. 2016;17:217.

Lowes MA, Bowcock AM, Krueger JG. Pathogenesis and therapy of psoriasis. Nature. 2007;445:866-73.

Vandevoorde V, Haegeman G, Fiers W. TNF- mediated IL6 gene expression and cytotoxicity are co-inducible in TNF- resistant L929 cells. FEBS Lett. 1992;302:235-8.

Gottlieb AB, Chao C, Dann F. Psoriasis comorbidities. J Dermatol Treat. 2008;19:5-21.

Sommer DM, Jenisch S, Suchan M, Christophers E, Weichenthal M. Increased prevalence of the metabolic syndrome in patients with moderate to severe psoriasis. Arch Dermatol Res. 2006;298:321-8.

Gisondi P, Tessari G, Conti A, Piaserico S, Schianchi S, Peserico A, et al. Prevalence of metabolic syndrome in patients with psoriasis: A hospital-based case-control study. Br J Dermatol. 2007;157:68-73.

Mallbris L, Akre O, Granath F, Yin L, Lindelöf B, Ekbom A, et al. Increased risk for cardiovascular mortality in psoriasis inpatients but not in outpatients. Eur J Epidemiol. 2004;19:225-30.

Gelfand JM, Neimann AL, Shin DB, Wang X, Margolis DJ, Troxel AB. Risk of myocardial infarction in patients with psoriasis. JAMA. 2006;296:1735-41.

Tamagawa-Mineoka R, Katoh N, Veda E, Masuda K, Kishimoto S. Elevated platelet activation in patients with atopic dermatitis and psoriasis: increased plasma levels of thromboglobulin and platelet factor 4. Allergol Int. 2008;57:391-6.

Malerba M, Gisondi P, Radaeli A, Girolomoni G. Psoriasis and risk of myocardial infarction. JAMA. 2007;297:361-2.

Malerba M, Gisondi P, Radaeli A, Sala R, Calzavara Pinton PG, Girolomoni G. Plasma homocysteine and folate levels in patients with chronic plaque psoriasis. Br J Dermatol. 2006;155:1165-9.

Sergeant A, Makrygeorgou A, Chan WC, Thorrat A, Burden D. C-reactive protein in psoriasis. Br J Dermatol. 2008;158:417-9.

Lowes MA, Suarez-Farinas M, Krueger JG. Immunology of psoriasis. Annu Rev Immunol. 2014;32:227–55.

Durham LE, Kirkham BW, Taams LS. Contribution of the IL-17 pathway to psoriasis and psoriatic arthritis. Curr Rheumatol Rep. 2015: 17.

Casas JP, Shah T, Hingorani AD, Danesh J, Pepys MB. C-reactive protein and coronary heart disease: a critical review. J Intern Med. 2008;264:295-314.

Ridker PM, Buring JE, Cook NR, Rifai N. C-reactive protein, the metabolic syndrome, and risk of incident cardiovascular events: an 8-year follow-up of 14,719 initially healthy American women. Circulation. 2003;107:391-7.

Gisondi P, Malerba M, Malara G, Guerra AP, Sala R, Radaeli A, et al. C-reactive protein and markers for thrombophilia in patients with chronic plaque psoriasis. Int J Immunopathol Pharmacol. 2010;23(4):1195-202.

Rocha-Pereira P, Santos-Silva A, Rebelo I, Figueiredo A, Quintanilha A, Teixeira F. The inflammatory response in mild and in severe psoriasis. Br J Dermatol. 2004;150:917-28.

Ohtsuka T. The relation between high-sensitivity C-reactive protein and maximum body mass index in patients with psoriasis. Br J Dermatol. 2008;158:1141-3.

Sergeant A, Makrygeorgou A, Chan WC, Thorrat A, Burden D. C-reactive protein in psoriasis. Br J Dermatol 2008;158:417-9.

Karabudak O, Ulusoy RE, Erikci AA, Solmazgul E, Dogan B, Harmanyeri Y. Inflammation and hypercoagulable state in adult psoriatic men. Acta Derm Venereol. 2008;88:337-40.

Murari K. Serum C-reactive Protein in Psoriasis Vulgaris: A Case-control Study in a Tertiary Care Hospital from Southern India. IJBCRR. 2017;17(1):1-5.

Vadakayil AR, Dandekeri S, Kambil SM, Ali NM. Role of C-reactive protein as a marker of disease severity and cardiovascular risk in patients with psoriasis. Indian Dermatol Online J. 2015;6:322-5.

Ibrahimbaş Y, Polat M, Serin E, Parlak AH. Cellular Immune Response in Patients with Chronic Plaque Type Psoriasis: Evaluation of Serum Neopterin, Procalcitonin, Anti-Streptolysin O and C Reactive Protein Levels. J Clin Exp Dermatol Res. 2010;1:107.