Jacob Dreiher

Psoriasis associated with ulcerative colitis and Crohn's disease

Background  Numerous reports have demonstrated the epidemiological, pathogenic, and genetic association between psoriasis and Crohns disease. Nevertheless, the association between psoriasis and ulcerative colitis was rarely described.

Coeliac disease associated with psoriasis

Background  Psoriasis is a chronic inflammatory disorder of the skin reported to be associated with systemic comorbidities.

Psoriasis and chronic obstructive pulmonary disease: a case–control study

Background  Previous reports have demonstrated an association between psoriasis and the metabolic syndrome. Chronic obstructive pulmonary disease (COPD) has also been associated with the metabolic syndrome.

Psoriasis and hypertension: a case-control study.

In recent years, numerous reports have demonstrated an association between psoriasis and metabolic syndrome. However, some studies failed to demonstrate an association between psoriasis and hypertension. The aim of the present study was to examine the association between psoriasis and hypertension. Psoriasis patients of a health-maintenance organization were compared with enrollees without psoriasis regarding the prevalence of hypertension in a case-control study. The study included 12,502 psoriasis patients over the age of 20 years and 24,285 age- and sex-frequency-matched controls. The prevalence of hypertension was significantly higher in psoriasis patients than controls (38.8%, 29.1%, respectively, p<0.001). In a multivariate analysis, hypertension was associated with psoriasis after controlling for age, sex, smoking status, obesity, diabetes, non-steroidal anti-inflammatory drugs (NSAIDs) and use of Cox-2 inhibitors (odds ratio: 1.37, 95% confidence interval: 1.29-1.46). The results of this study support the previously noted association between psoriasis and hypertension. We suggest that patients with psoriasis should be routinely screened for the presence of hypertension.

Antipsychotics and Diabetes: An Age-Related Association

Background Previous studies have reported an association between antipsychotic medications and diabetes. Objective To explore the association between antipsychotic medications and diabetes in patients of different ages. Methods A retrospective analysis of a large health maintenance organizations drug claim database (3.7 million members) was performed. All patients treated with antipsychotic drugs during 1998–2004 were identified. Patients with diabetes were defined by a record of antidiabetic drug uso during 2004. The prevalence of diabetes in different age groups treated with antipsychotics was compared with the prevalence of diabetes among enrollees in the same age groups not treated with antipsychotics. Results: Among 82,754 patients treated with antipsychotics, the association between diabetes and consumption of antipsychotics was strongest in the younger age groups and decreased with increasing age: for patients aged 0–24 years, OR 8.9 (95% CI 7.0 to 11.3); 25–44 years, OR 4.2 (95% CI 3,8 to 4.5); 45–54 years, OR 1.9 (95% CI 1.8 to 2.1); 55–64 years, OR 1.3 (95% CI 1.2 to 1.4); and 65 years or older, OR 0.93 (95% CI 0.9 to 1.0). However, the risk associated with atypical antipsychotics was lower than the risk associated with typical antipsychotics, with ORs ranging from 0.7 in patients 0–24 years old to 0.3 in those 65 years or older. Conclusions: Antipsychotic drug use was associated with diabetes mellitus. This association was stronger in younger patients. In older adults, the difference was much smaller and, in some cases, there was no association. A lowor risk was associated with atypical agents, as compared with typical antipsychotics. Clinicians should bo aware that young adults treated with antipsychotics are at increased risk for diabetes.

Lichen planus and dyslipidaemia: a case–control study

Background  Previous reports have demonstrated an association between psoriasis and dyslipidaemia.

Psoriasis and Osteoporosis: A Sex-Specific Association?

Previous reports showed associations between psoriasis and chronic diseases. Little is known about the association between osteoporosis and psoriasis. The goal of the study was to assess the association between psoriasis and osteoporosis in a population-based case-control study, utilizing the database of a large health-care provider organization in Israel, Clalit Health Services. Patients (aged 51-90 years) diagnosed with psoriasis were compared with a sample of age- and sex-matched enrollees without psoriasis regarding the prevalence of osteoporosis. Data on health-related lifestyles and other comorbidities were collected. The study included 7,936 psoriasis cases and 14,835 controls. The prevalence of osteoporosis was significantly greater in males with psoriasis compared with the control group (3.1 vs 1.7%, P<0.001, odds ratio (OR)=1.86, 95% confidence interval (CI): 1.44-2.39) and slightly greater in females with psoriasis (22.3 vs 20.2%, P=0.008, OR=1.13, 95% CI: 1.03-1.25). A multivariate logistic regression model demonstrated that after controlling for confounders, psoriasis was significantly associated with osteoporosis in males (adjusted OR=1.70, 95% CI: 1.31-2.19, P<0.001). The weak association between psoriasis and osteoporosis in females lost statistical significance in a multivariate model (adjusted OR=1.09, 95% CI: 0.98-1.21, P=0.100). Psoriasis was found to be associated with osteoporosis among males, but not among females.

Non-Hodgkin Lymphoma and Pesticide Exposure: 25 Years of Research

Over the past 40 years, a substantial rise in the incidence of non-Hodgkin lymphoma (NHL) has been observed. Epidemiologic studies aimed at understanding this rise have revealed some association with occupational exposure. NHL is common among farmers, where pesticides have been described as the culprit. The association between pesticides and NHL has been demonstrated mainly in case-control studies, while retrospective cohorts have been less convincing. Pesticides including chlorphenol and phenoxyacetic acid herbicides, organochlorines, and organophosphate insecticides, carbamates, and fungicides have been associated with NHL. Although the causality has not been clearly proven, both genotoxic and nongenotoxic mechanisms for lymphomagenesis have been proposed. The leveling-off of NHL incidence in certain countries may be the result of a favorable change in pesticide usage patterns. Future studies, such as the Agricultural Health Study, may clarify the uncertainties regarding this issue.

Systemic Therapy for Psoriasis and the Risk of Herpes Zoster: A 500 000 Person-year Study

IMPORTANCE The risk for herpes zoster (HZ) in patients with psoriasis treated with biologic medications or other systemic treatments has been given little attention to date. OBJECTIVE To describe the risk for HZ in patients with psoriasis and its relation to treatment. DESIGN, SETTING, AND PARTICIPANTS A cohort study was performed using the administrative database of Clalit Health Services, the largest public health care provider organization in Israel, in the setting of general community clinics, primary care and referral centers, and ambulatory and hospitalized care. We extracted information for all patients who received a psoriasis diagnosis from January 2002 to June 2013. Follow-up was conducted until the end of July 2013. The study included 95,941 patients with psoriasis in the analysis, with 522,616 person-years of follow-up. Incidence of HZ events was calculated for each systemic antipsoriatic medication provided, during a follow-up period of 11 years and 7 months. We used a generalized estimating equation Poisson regression model to examine the effect of each systemic treatment for psoriasis on HZ incidence, adjusting for age, sex, psoriasis severity, Charlson comorbidity index, steroid treatment, and socioeconomic status. MAIN OUTCOMES AND MEASURES Incidence of HZ associated with systemic therapies. RESULTS In a multivariate analysis, it was observed that treatment with phototherapy (rate ratio [RR], 1.09 [95% CI, 0.62-1.93]; P = .99), methotrexate (RR, 0.98 [95% CI, 0.78-1.23]; P = .83), cyclosporine (RR, 1.16 [95% CI, 0.48-2.80]; P = .49), and biologic medications as a single agent (RR, 2.67 [95% CI, 0.69-10.3]; P = .14) was not associated with HZ. The use of combination treatment with biologic medications and methotrexate was significantly associated with an increased incidence of HZ (RR, 1.66 [95% CI, 1.08-2.57]; P = .02). The use of acitritin was associated with decreased incidence of HZ (RR, 0.69 [95% CI, 0.49-0.97]; P = .004). CONCLUSIONS AND RELEVANCE Physicians may need to consider offering an HZ preventive vaccine to patients receiving combination treatment with biologic medications and methotrexate, particularly if they have additional risk factors for HZ.

Risk of Herpes zoster in patients with psoriasis treated with biologic drugs.

Background  Little is known about the risk of herpes zoster (HZ), among patients with psoriasis treated with biologic drugs.