For US Healthcare Professionals

Learn how the family is immunologically related

Plaque psoriasis (PsO) may be related to psoriatic arthritis (PsA) and inflammatory bowel disease (IBD) by shared underlying systemic inflammation.1-4

Venn diagram showing clinical overlap and shared systemic inflammation statistics between Plaque Psoriasis, PsA, and IBD.
Venn diagram showing clinical overlap and shared systemic inflammation statistics between Plaque Psoriasis, PsA, and IBD.
*Of the total of 25 patients with PsA, 10 patients did not have gut alterations; therefore, 60% (15/25) demonstrated subclinical gut inflammation. Subclinical gut inflammation was characterized by histologic inflammation and Paneth cell hyperplasia. Intestinal biopsy specimens were assessed histologically for the presence of inflammation and classified according to the stage of histologic severity. Lymphoid follicles were identified using CD3/CD19/CD21 immunostaining.

Immunologically related by the IL-23 and IL-17 pathways

PsO, PsA, and IBD are distinct diseases that share overlapping immunologic features, including common inflammatory pathways like interleukin-23 (IL-23) and interleukin-17 (IL-17). These shared inflammatory pathways are key components of the common autoimmune axis and may play a central role in the symptoms associated with PsO, PsA, and IBD.1-4

PsO serves as the visible manifestation of underlying systemic inflammation, with the skin serving as a prominent indicator, providing a critical opportunity for the early detection of systemic risk from PsA.1-4
Consider monitoring all patients with PsO, PsA, and IBD for symptoms of each. Early recognition may result in timely diagnosis and appropriate treatment for your patients.4,11,14,15

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References

  1. Sun Y, Li Y, Zhang J. The causal relationship between psoriasis, psoriatic arthritis, and inflammatory bowel diseases. Sci Rep. 2022;12(1):20526. doi:10.1038/s41598-022-24872-5
  2. Rendon A, Schäkel K. Psoriasis pathogenesis and treatment. Int J Mol Sci. 2019;20(6):1475. doi:10.3390/ijms20061475
  3. Schön MP. Adaptive and innate immunity in psoriasis and other inflammatory disorders. Front Immunol. 2019;10:1764. doi:10.3389/fimmu.2019.01764
  4. Gracey E, Dumas E, Yerushalmi M, Qaiyum Z, Inman RD, Elewaut D. The ties that bind: skin, gut and spondyloarthritis. Curr Opin Rheumatol. 2019;31(1):62-69. doi:10.1097/BOR.0000000000000569
  5. Mease PJ, Gladman DD, Papp KA, et al. Prevalence of rheumatologist-diagnosed psoriatic arthritis in patients with psoriasis in European/North American dermatology clinics. J Am Acad Dermatol. 2013;69(5):729-735. doi:10.1016/j.jaad.2013.07.023
  6. Sanchez IM, Jiang W, Yang EJ, et al. Enteropathy in psoriasis: a systematic review of gastrointestinal disease epidemiology and subclinical inflammatory and functional gut alterations. Curr Dermatol Rep. 2018;7:59-74. doi:10.1007/s13671-018-0213-1
  7. Lowes MA, Suárez-Fariñas M, Krueger JG. Immunology of psoriasis. Annu Rev Immunol. 2014;32:227-255. doi:10.1146/annurev-immunol-032713-120225
  8. Mease PJ, Armstrong AW. Managing patients with psoriatic disease: the diagnosis and pharmacologic treatment of psoriatic arthritis in patients with psoriasis. Drugs. 2014;74(4):423-441. doi:10.1007/s40265-014-0191-y
  9. Garber A, Regueiro M. Extraintestinal manifestations of inflammatory bowel disease: epidemiology, etiopathogenesis, and management. Curr Gastroenterol Rep. 2019;21(7):31. doi:10.1007/s11894-019-0698-1
  10. Suzuki E, Mellins ED, Gershwin ME, Nestle FO, Adamopoulos IE. The IL-23/IL-17 axis in psoriatic arthritis. Autoimmun Rev. 2014;13(4-5):496-502. doi:10.1016/j.autrev.2014.01.050
  11. Levine JS, Burakoff R. Extraintestinal manifestations of inflammatory bowel disease. Gastroenterol Hepatol (N Y). 2011;7(4):235-241.
  12. Ciccia F, Guggino G, Ferrante A, et al. Interleukin-9 overexpression and Th9 polarization characterize the inflamed gut, the synovial tissue, and the peripheral blood of patients with psoriatic arthritis. Arthritis Rheumatol. 2016;68(8):1922-1931. doi:10.1002/art.39649
  13. Arvikar SL, Fisher MC. Inflammatory bowel disease associated arthropathy. Curr Rev Musculoskelet Med. 2011;4(3):123-131. doi:10.1007/s12178-011-9085-8
  14. Felix PAO, Sampaio AL, Silva BL, Viana ALP. Early intervention in psoriasis: where do we go from here? Front Med (Lausanne). 2022;9:1027347. doi:10.3389/fmed.2022.1027347
  15. Noor NM, Sousa P, Paul S, Roblin X. Early diagnosis, early stratification, and early intervention to deliver precision medicine in IBD. Inflamm Bowel Dis. 2022;28(8):1254-1264. doi:10.1093/ibd/izab228