Association of psoriasis and/or psoriatic arthritis with autoimmune diseases: the experience of two Italian integrated Dermatology/Rheumatology outpatient clinics

Abstract

The new concept of psoriatic disease, focusing on genetic and molecular aspects which are at the basis of the pathogenesis of psoriasis and its related manifestations, extended the traditional idea of a disease confined to skin and joints. In this context, the multidisciplinary assessment of patients in the combined Dermatology/Rheumatology outpatient clinics would allow to identify early clinical and laboratory abnormalities not limited to skin and joint.

Histopathology of the skin in rheumatic diseases

“…Psoriatic arthritis is a chronic inflammatory arthropathy typically associated with psoriasis. Psoriasis is a complex multifactorial disease related to a combination of genetic, environmental and immunological factors, involving both innate and adaptive immune systems (2,3). Keratinocytes play a key role in the recruitment and activation of T cells in psoriatic lesions and T cells are fundamental in the maintenance of the u s e festations.…”

“…Such changes are associated with striking variations in the keratin profile expressed by keratinocytes, with overexpression of keratin 16, indicating hyperproliferation of keratinocytes (9). Immunohistochemistry studies provide evidence that psoriatic lesions contain increased numbers of T cells that are CD3+ CD2+ CD45RO+ CLA+, with a subset having activation markers CD25, HLADR, and CD27; several CD4+ T cells produce IFN-gamma, IL-17, and IL-22; some CD8+ cells and an increased number of BDCA-1 CD11c+ inflammatory dermal dendritic cells (2,3,10).…”

Clinico-dermoscopic features of alopecia areata in patients with psoriasis

“… 7 , 8 Few epidemiologic studies found that patients with psoriasis are at greater risk of AA development. 9 , 10 It is estimated that patients with psoriasis have a 2.5-fold higher risk of AA development and are more likely to have at least 1 other autoimmune disease (odds ratio [OR], 1.6; confidence interval [CI], 1.5-1.7) or even 2 other autoimmune diseases (OR, 1.9; CI, 1.6-2.4). 9 A recent retrospective study found that vitiligo was the most frequent skin autoimmune disease associated with psoriasis, followed by AA and chronic urticaria.…”

“… 9 A recent retrospective study found that vitiligo was the most frequent skin autoimmune disease associated with psoriasis, followed by AA and chronic urticaria. 7 , 10 The most frequent association seems to be scalp psoriasis and AA. 7 , 9 Although some investigators found that psoriatic arthritis (PsA) might represent a protective factor, 9 , 10 others found that patients with AA are more frequently affected by either psoriasis or PsA.…”

“… 7 , 10 The most frequent association seems to be scalp psoriasis and AA. 7 , 9 Although some investigators found that psoriatic arthritis (PsA) might represent a protective factor, 9 , 10 others found that patients with AA are more frequently affected by either psoriasis or PsA. 11 , 12 Several studies also found a high prevalence of comorbid conditions as atopic dermatitis, diabetes, thyroiditis, celiac disorder, psoriasis, and PsA among individuals with AA.…”