Psoriatic Disease: A Systemic Pathology, Structured by Psoriasis, Psoriatic Arthritis and Comorbidities

Introduction

Louis Aliberti, in 1818, first noted the relationship between psoriasis and arthritis. Pierre Bazin then described “Psoriasis Arthritique” in 1860, followed by Charles Bourdillon in 1888 with “Psoriasis et Arthropathies.” Jeghers and Robinson in 1937 and Vilanova and Piñol in 1951 described psoriatic arthritis (PsA) as a unique entity. PsA was recognized after Verna Wright published a comparative study of rheumatoid arthritis (RA), psoriasis, and arthritis associated with psoriasis in 1956 and 1959. The American College of Rheumatology recognized PsA as a distinct entity in 1964.1

Abstract

While injecting volunteers in Venezuela with a vaccine for prevention of leishmaniasis, we observed 100% clinical remission of a psoriatic lesion in one subject. A single center study evaluated the safety and efficacy of multiple 500 µg doses of AS100 on psoriatic arthritis (PsA). Approximately, 2599 subjects (83%) experienced at least one adverse event, injection site related and including: pain 43%, nodule formation 23%, heat 21%, and erythema 14%. When baseline Psoriasis Area and Severity Index (PASI) values in the group with PsA (n=508) were compared with post-treatment values, clinical remissions were: PASI 100 in 275 (54.1%), PASI 75 in 117 (23%), PASI 50 in 73 (14.4%), and PASI 10 in 43 (8.5%) of subjects, respectively. The number of AS100 doses required to induce 100% remission was 9.9±4.8. Higher percentage frequency in PsA than psoriasis patients was found in hypertension, vascular diseases, intestinal diseases, infections, gastritis, cardiac arrhythmia, gallstones in gallbladder, osteoporosis, hyperuricemia, and epilepsy. Up to 7–8 comorbidities were found in both psoriasis and PsA patients together in the same subject: thus, psoriasis is a systemic disease, induced by cytokines in all body organs, being expressed in each tissue according to genetic and environmental factors due to shared inflammatory pathways. Development of psoriasis and PsA is centered in the blood vessels’ behavior. Both diseases start by proliferation of blood vessels after up-regulation of vascular endothelial growth factor, transforming growth factor β, and other angiogenic factors. Clinical remission in psoriatic lesions also starts by decreased proliferation of blood vessels, after treatment with leishmania antigens.

Keywords

psoriasis systemic disease, psoriasis comorbidities, psoriatic arthritis, psoriasis vascular disease