Uric acid as a marker of clinical severity and comorbidities in plaque psoriasis

Abstract

Introduction: Hyperuricemia is common in patients with psoriasis. Uric acid elevation in psoriasis has been suggested to be strongly associated with cardiovascular morbidity. Objective: To determine the relationship between uric acid levels and clinical severity as measured by the Psoriasis Area Severity Index (PASI), body surface area (BSA) and static Physician's Global Assessment (sPGA) in patients with plaque psoriasis and nail comorbidities and psoriatic arthritis. Method: Determination of serum uric acid in 45 patients with plaque psoriasis and 45 controls matched by gender, age and body mass index; measurement of patient clinical severity indices and presence of nail and joint manifestations. Results: Patients with psoriasis had higher levels of uric acid (7.03 ± 1.47 versus 5.32 ± 1.17, p < 0.01), and higher prevalence of asymptomatic hyperuricemia than controls (68% versus 17.8%, p < 0.01). There was significant proportional correlation between PASI-determined severity and uric acid (r 2 = 0.70), and between joint manifestations and hyperuricemia in patients with plaque psoriasis (p < 0.01; OR = 2.85, 95% CI = 1.52-5.33). Conclusions: Serum uric acid levels had a proportional correlation with PASI and were associated with joint manifestations in patients with plaque psoriasis.

Updated Evidence of the Association Between Elevated Serum Uric Acid Level and Psoriasis

“…Analysis of the seven studies (15,17,18,29,33,36,41) included in the second part of the meta-analysis showed that the risk of hyperuricemia was high in psoriasis patients. Two studies that performed a subgroup analysis based on sex (33,36) indicated a significant difference in the prevalence of hyperuricemia between the psoriasis and control groups.…”

“…Unfortunately, no cardiovascular disease was mentioned by any of the included studies. Psoriasis is reportedly an independent risk factor for cardiovascular diseases (29,41). However, the relationship between SUA levels and cardiovascular events in psoriasis is unknown.…”

“…The metaanalysis consisted of two parts based on the type of response variable. The first part included the 27 studies (10,11,(14)(15)(16)(17)(18)(25)(26)(27)(28)(29)(30)(31)(32)(33)(34)(35)(36)(37)(38)(39)(40)(41)(42)(43)(44) that used continuous SUA as the response variable. These studies consisted of 31,314 participants (2,951 with psoriasis and 28,363 controls).…”

“…These studies consisted of 31,314 participants (2,951 with psoriasis and 28,363 controls). The second part included seven studies (15,17,18,29,33,36,41) that had dichotomous hyperuricemia as the response variable. These studies included a total of 2,082 participants (958 with psoriasis and 1,124 controls) who met the inclusion criteria for the dichotomous variables of the systematic review.…”

“…High inter-study heterogeneity existed in the meta-analysis of hyperuricemia occurrences among psoriasis patients and controls from the European and American regions and East Asia (I 2 = 73%, P = 0.003). The pooled ORs from the randomeffects analysis for seven studies (15,17,18,29,33,36,41) from European and American countries and East Asia, which revealed significant differences in hyperuricemia prevalence between psoriasis patients and controls, was 5.39 (95% CI 1.88-15.40, P = 0.002) (Figure 5).…”