Global Prevalence and Bidirectional Association Between Psoriasis and Inflammatory Bowel Disease—A Systematic Review and Meta-analysis

Alinaghi, Farzad; Tekin, Hasan Göcker; Burisch, Johan; Wu, Jashin J.; Thyssen, Jacob P.; Egeberg, Alexander

doi:10.1093/ecco-jcc/jjz152

Cited by 77 publications

(95 citation statements)

References 104 publications

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“…Likewise, dysregulation of IL-23-Th17 pathway has been proposed to be the key player in the pathogenesis of certain autoimmune diseases, such as ankylosing spondylitis, psoriasis, and psoriatic arthritis. One recent meta-analysis has demonstrated a bidirectional association between IBD and psoriasis, highlighting the shared inflammatory pathogenesis in both diseases 34 . Involvement of IL-17 signaling pathway in autoimmune bullous diseases, including pemphigus, BP, and dermatitis herpetiformis has been proposed 35 – 37 .…”

Section: Discussionmentioning

confidence: 99%

Association between inflammatory bowel disease and bullous pemphigoid: a population-based case–control study

Chen

Juan

Chang

et al. 2020

Sci Rep

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The coexistence of inflammatory bowel disease (IBD) and bullous pemphigoid (BP) has been reported. No large-scale study to date has explored the relationship between these diseases. This populationbased case-control study examined the association between IBD and BP by using a nationwide database. A total of 5,263 BP patients and 21,052 age-and gender-, hospital visit number-matched controls were identified in the National Health Insurance Research Database of Taiwan (1997-2013). Demographic characteristics and comorbidities including IBD were compared. Logistic regression was conducted to examine the predicting factors for BP. The mean age at diagnosis was 74.88 years and 54.3% of subjects were male. BP patients tended to have more cardiovascular risk factors, autoimmune and neurologic comorbidities, and hematologic cancers than matched controls. There were 20 cases of IBD (0.38%), mostly ulcerative colitis (N = 17, 0.32%) among BP patients, compared to 33 IBD cases (0.16%) among controls (p < 0.001). Ulcerative colitis was found to be significantly associated with BP [adjusted odds ratio (OR) 3.60, 95% confidence interval (CI) 1.91-6.77, p < 0.001] on multivariate analysis. Treatment for IBD was not associated with BP development. Information about diet, lifestyle, alcohol consumption, and smoking habit was not available. We concluded that UC is independently associated with BP. Bullous pemphigoid (BP) is the most common autoimmune bullous disease. It mainly affects the elderly and is characterized by recurrent bullous lesions on trunk and limbs, with high morbidity and mortality. It is associated with autoantibodies against BPAG1 (also called BP 230/dystonin) and BPAG2 (BP180/type XVII collagen). The binding of autoantibodies to their targets activates inflammatory cascades that result in disruption of skin basement membrane integrity and subsequent subepidermal bullae formation 1. The incidence is estimated to be 2.4-23 cases per million people in the general population but rises exponentially to 190-312 cases per million in the over 80 population 2. A large body of evidence has suggested a strong association between BP and neurodegenerative diseases including dementia, cerebrovascular events, epilepsy, multiple sclerosis, and Parkinson's disease 2-6. The molecular link between BP and neurodegenerative disorders has been hypothesized to be based on cross-reactivity with shared autoantibodies of BP 230 and BP180 expressed in neuronal and epithelial tissues 4. Cardiovascular comorbidities have also been observed 3,6,7. The potential mechanisms involve inhibited fibrinolysis and coagulation activation in BP patients and shared expression of BP230 in cardiac muscle and skin 8. Advanced age at onset and frequent medical attention given to BP patients might also contribute to higher detection rates for comorbidities 4 .

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Section: Discussionmentioning

confidence: 99%

Association between inflammatory bowel disease and bullous pemphigoid: a population-based case–control study

Chen

Juan

Chang

et al. 2020

Sci Rep

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“…A previous incidence of IBD increased the risk of psoriasis (OR 1.80, 95% 1.50-2.20), and primary studies detected that this association was bidirectional [34] . When stratified by IBD type, CD and UC were both associated with a higher risk of psoriasis (OR 2.00, 95% CI 1.40-2.90 and OR 1.80, 95% CI 1.50-2.20, respectively) [34] . Some evidence showed that IBD is significantly associated with a 1.66 times risk of rosacea [35] .…”

Section: Other Health Outcomesmentioning

confidence: 99%

Inflammatory bowel diseases and the risk of adverse health outcomes: Umbrella review of meta-analyses of observational studies

Shen

Wan

Zhao

et al. 2021

Digestive and Liver Disease

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Background and Aim: Accumulating evidence indicates a plausible association between inflammatory bowel diseases and the risk of adverse health outcomes. However, the conclusions are inconsistent. We aimed to perform an umbrella review of meta-analyses to appraise and grade the evidence of the association between inflammatory bowel diseases and the risk of adverse health outcomes. Methods: Meta-analyses of observational studies that examined the associations between inflammatory bowel disease and the risk of adverse health outcomes in PubMed, EMBASE, and Web of Science were screened. Results: This umbrella review identified 25 meta-analyses, which yielded 123 effect estimates for 60 unique putative health outcomes. Patients with inflammatory bowel diseases had a higher risk of adverse health outcomes, including multiple cancers, cardiovascular disease, adverse pregnancy outcomes, adverse oral outcomes, and other adverse events. Moreover, inflammatory bowel diseases caused greater harm to health based on the presented evidence. However, none of the evidence was classified as "high" quality, only 15% was classified as "moderate," and 65% of outcomes were rated as "very low." Conclusion: Patients with inflammatory bowel diseases had a higher risk of adverse health outcomes and further studies should be conducted to draw firmer conclusions.

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“…Psoriasis and psoriatic arthritis have been associated with inflammatory bowel disease and several other immune‐mediated conditions, including coeliac disease, alopecia areata, vitiligo, rheumatoid arthritis, autoimmune thyroid disease, and systemic sclerosis . Studies demonstrated that psoriasis and inflammatory bowel disease have a significant bidirectional association and share several genetic susceptibility loci . The prevalence of Crohn disease and ulcerative colitis in patients with psoriasis was 0.7% and 0.5% respectively .…”

Section: Inflammatory Bowel Disease and Other Immune‐mediated Diseasesmentioning

confidence: 99%

“…Studies demonstrated that psoriasis and inflammatory bowel disease have a significant bidirectional association and share several genetic susceptibility loci . The prevalence of Crohn disease and ulcerative colitis in patients with psoriasis was 0.7% and 0.5% respectively . The incidence of Crohn disease and ulcerative colitis was 1.55 and 3.17 per 10 000 person‐years among patients with psoriasis respectively .…”

Section: Inflammatory Bowel Disease and Other Immune‐mediated Diseasesmentioning

confidence: 99%

Beyond skin deep: addressing comorbidities in psoriasis

Kovitwanichkanont

Chong

Foley

2020

Medical Journal of Australia

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Summary Psoriasis is a chronic inflammatory disease that is commonly encountered in primary care and is associated with significant morbidity that extends beyond the skin manifestations. Psoriasis is associated with an elevated risk of psoriatic arthritis, cardiovascular disease, obesity, insulin resistance, mental health disorders, certain types of malignancy, inflammatory bowel disease and other immune‐related disorders, and hepatic and renal disease. Enhanced recognition of these comorbidities may lead to earlier diagnosis and potentially better overall health outcomes. Psoriatic nail involvement, severe skin disease and obesity are associated with a greater risk of psoriatic arthritis. Individuals with psoriasis should be routinely screened for psoriatic arthritis to allow for early intervention to improve long term prognosis. Life expectancy is reduced in people with psoriasis due to a variety of causes, with cardiovascular disease and malignancy being the most common aetiologies. Psoriasis affects several factors that contribute to worsened quality of life and increased risk of depression and anxiety. Effective therapies are now available that have been shown to concurrently improve skin disease, quality of life and psychiatric symptoms. As the concordance between psychosocial impact and objective disease severity does not always correlate, it is essential to tailor management strategies specifically to the needs of each individual. Cigarette smoking and excess alcohol consumption are among the most important modifiable risk factors that increase the likelihood of psoriasis development and severity of skin disease. This provides a compelling rationale for smoking cessation and limiting alcohol intake in people with psoriasis beyond their traditional harmful health consequences.

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Global Prevalence and Bidirectional Association Between Psoriasis and Inflammatory Bowel Disease—A Systematic Review and Meta-analysis

Cited by 77 publications

References 104 publications

Association between inflammatory bowel disease and bullous pemphigoid: a population-based case–control study

Association between inflammatory bowel disease and bullous pemphigoid: a population-based case–control study

Inflammatory bowel diseases and the risk of adverse health outcomes: Umbrella review of meta-analyses of observational studies

Beyond skin deep: addressing comorbidities in psoriasis

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