Sarcoidosis in Patients with Psoriasis: A Population-Based Cohort Study

Abstract

PurposePsoriasis is a chronic inflammatory disease characterized by a systemic immunological response which is mainly driven by activated T helper (Th) 1 and Th17 lymphocytes. Like psoriasis, sarcoidosis is a chronic inflammatory disorder with Th1/Th17-driven inflammation. Therefore, we investigated the risk of sarcoidosis in patients with psoriasis compared to the background population in a nationwide cohort.MethodsThe study included the entire Danish population aged ≥10 years followed from 1st January 1997 until diagnosis of sarcoidosis, death or 31st December 2011. Patients with a history of psoriasis and/or sarcoidosis at baseline were excluded. Information on comorbidity and concomitant medication was identified by individual-level linkage of administrative registers. Incidence rates of sarcoidosis were calculated and adjusted hazard ratios (HRs) were estimated by multivariable Cox regression models adjusted for age, gender, comorbidity, medications and socioeconomic status.ResultsA total of 6,043,518 subjects were eligible for analysis. In the study period 70,125 patients with new-onset psoriasis, including 11,834 patients with severe psoriasis, were identified. The overall incidence rates of sarcoidosis were 1.18, 2.22, and 4.06 per 10,000 person-years for the reference population (9,717 cases), mild psoriasis (78 cases) and severe psoriasis (22 cases), respectively. Compared to the reference population, the age- and gender-adjusted HRs for sarcoidosis were increased in patients with psoriasis with HR 1.49 (95% confidence interval [CI] 1.18–1.87) and HR 2.51 (CI 1.64–3.85) for those with mild and severe disease, respectively.ConclusionIn this nationwide cohort, psoriasis was associated with a disease severity-dependent increased risk of sarcoidosis.

Comorbid autoimmune diseases in patients with sarcoidosis: A nationwide case–control study in Taiwan

“…Our analysis showed that sarcoidosis patients could have been likely to develop SLE (aOR, 2.98), but the small case number rendered the statistical evaluation insignificant. The association between sarcoidosis and psoriasis was demonstrated in a large Denmark cohort study; however, there were only a few Asian people, two Japanese cases, reported in the English‐language published work to show coexistence of both diseases . The discrepancy in the comorbidity profiles of sarcoidosis patients may, at least partially, result from different genetic backgrounds and environmental factors that await additional studies to clarify the aforesaid association.…”

“…The association of sarcoidosis with several other autoimmune comorbid diseases as frequently reported before was not demonstrated in our analysis, such as celiac disease, autoimmune hepatitis, inflammatory bowel disease, MS, systemic sclerosis, SLE and psoriasis. 5,9,11,[15][16][17][18][20][21][22][23]35 There were marked racial differences in the prevalence of the first five diseases as mentioned above with the Westerners being more predisposed to those autoimmune comorbidities than the Asian people. [36][37][38][39][40] Hence, the different comorbidity profiles disclosed in our analysis may be attributed to the low prevalence of those diseases in the Taiwanese.…”

“…5 However, the correlation between autoimmune diseases and sarcoidosis has been reported frequently, including systemic lupus erythematosus (SLE), autoimmune hepatitis, celiac disease, systemic sclerosis, rheumatoid arthritis (RA), Sj€ ogren's syndrome (SS), ankylosing spondylitis (AS), hypothyroidism and Graves' disease. 2,[6][7][8][9][10][11][12][13][14][15][16][17][18][19][20][21][22][23] Nevertheless, most of these studies fall into the category of either case reports 8,10,[13][14][15][16][17][18][19][20][21][22] or small to medium hospital-based studies, 6,7,9 and the clinical significance of the association remains unclear. The main objective of this nationwide population-based case-control study in Taiwan is to clarify the autoimmune profiles in sarcoidosis patients.…”

Cutaneous Sarcoidosis

“…The coexistence of sarcoidosis and psoriasis also has been reported in both case series and population-based cohorts, which is hypothesized to occur as a result of overlapping pathogenetic mechanisms. [58][59][60] Lichenoid sarcoidosis can present as small, flattopped, skin-colored to erythematous papules; however, it can be differentiated from lichen planus by a lack of overlying white lacy marks (Wickham striae). This cutaneous presentation has been reported most often in children, can be localized or extensive, and can be eruptive in nature.…”

Asociación psoriasis-sarcoidosis: 2 entidades y una vía patogénica común

“…Existen pocos casos documentados de asociación psoriasissarcoidosis 2-4 , aunque recientemente se ha observado un mayor riesgo de padecer sarcoidosis en pacientes diagnosticados de psoriasis respecto a la población general, siendo además esta asociación severidad-dependiente 5 .…”