Breaking News
May 26, 2018 - OSU biologist describes ‘restoration ecology’ approach toward patient health
May 26, 2018 - New approach to study brown fat could aid in finding treatments for obesity
May 26, 2018 - Could More Fish in the Diet Boost Sex Lives and Fertility?
May 26, 2018 - NTU Singapore and SERI invent new scope to diagnose glaucoma
May 26, 2018 - Cancer cells co-opt pain-sensing ‘neural channel’ to increase tolerance against oxidative stress
May 26, 2018 - Study uncovers why pesticide exposure increases Parkinson’s disease risk in some people
May 26, 2018 - Study finds link between lead exposure and fertility rates
May 26, 2018 - Delivery of standardized diabetes care could help achieve equitable health outcomes for all patients
May 26, 2018 - FDA authorizes marketing of OsteoDetect software for detecting wrist fractures
May 26, 2018 - Children and adolescents growing up in extreme societal conditions more likely to resort to violence
May 26, 2018 - New study puts forth most comprehensive tree of life for malaria parasites
May 26, 2018 - New research shows why babies need to move in the womb
May 26, 2018 - UK steps forward to tackle global antimicrobial resistance
May 26, 2018 - CRISPR-Cas9-based strategy allows researchers to precisely alter hundreds of different genes
May 26, 2018 - UT Southwestern-led researchers find new way to determine prognosis of invasive kidney cancer
May 26, 2018 - Researchers develop film to prevent bacteria from growing on dental retainers and aligners
May 26, 2018 - Mobile health intervention for people with serious mental illness as effective as clinic-based treatment
May 26, 2018 - Vaginal estradiol tablets outperform moisturizers when treating vulvovaginal problems
May 26, 2018 - Researchers call for new genetic tests for congenital diseases
May 26, 2018 - KHN’s ‘What the Health?’ Campaign promises kept, plus ‘nerd reports’
May 26, 2018 - Lung-on-a-chip technology could streamline drug-testing for pulmonary fibrosis
May 26, 2018 - Researchers work together to solve mystery of motor neuron death in ALS patients
May 26, 2018 - Study finds early antibiotic initiation for majority of premature infants
May 26, 2018 - New environmental monitoring project finds increased numbers of deer ticks in Southern Indiana
May 26, 2018 - Pediatricians Should Advocate for Life Support Training
May 26, 2018 - Cannabidiol significantly reduces seizures in patients with severe form of epilepsy
May 26, 2018 - Allergies can have serious, far-reaching consequences on adolescents
May 26, 2018 - Scientists develop lab-based system to study mechanisms of common liver disease
May 25, 2018 - New guidelines may help pathologists to more accurately classify and diagnose invasive melanoma
May 25, 2018 - Immune cells promote lung cancer metastases by forming clots in tumors, study finds
May 25, 2018 - Can Excess Weight in Toddlers Cause Brain Drain?
May 25, 2018 - Studying insight
May 25, 2018 - Researchers reveal potent new mechanism of action for treatment of IBD
May 25, 2018 - Study shows lack of follow-up care for patients with concussion
May 25, 2018 - Study establishes the importance of haploid cells
May 25, 2018 - Coveted BMJ award bestowed on The Clatterbridge Cancer Center
May 25, 2018 - AACN outlines evidence-based protocols and clinical strategies to manage alarms
May 25, 2018 - Origami inspires researchers to develop new solution for tissue regeneration
May 25, 2018 - Melorheostosis – Genetics Home Reference
May 25, 2018 - Non-addictive pain medication changing therapy for substance use disorders
May 25, 2018 - Delayed lactate measurements in sepsis patients increase risk of in-hospital death
May 25, 2018 - Researchers identify novel epigenetic mutations as cause of neurodevelopmental, congenital disorders
May 25, 2018 - UD researchers examine connection between DNA replication in HPV and cancer
May 25, 2018 - Researchers identify neurons that play key role in aggressive behavior
May 25, 2018 - Snail’s eye inspires new type of RIOCATH urinary catheter
May 25, 2018 - Russian researchers develop high-tech device-transformer for ultrasound examination
May 25, 2018 - Researchers discover unexpected chemosensor pathway for predator odor-evoked innate fear behaviors
May 25, 2018 - Researchers build 3-D printer that offers sweet solution to making detailed structures
May 25, 2018 - Nearly one in three people know someone addicted to opioids
May 25, 2018 - Research suggests link between faulty gene, alcohol, and heart failure
May 25, 2018 - New findings could help fine-tune treatment for cancer patients
May 25, 2018 - New cancer treatment approach targets specific sugar receptors
May 25, 2018 - Skin responsible for uptake of cancer-causing compounds during barbecuing than lungs
May 25, 2018 - Early-onset cannabis use linked to further drug abuse problems
May 25, 2018 - Covered California takes aim at hospital C-section rates
May 25, 2018 - FDA Approves Palynziq (pegvaliase-pqpz) for the Treatment of Adults with Phenylketonuria
May 25, 2018 - Arthritis Glossary
May 25, 2018 - Study links breast cancer to the body’s internal clock
May 25, 2018 - Strenuous exercise in teenage years may protect against height loss later in life
May 25, 2018 - FDA approves novel enzyme therapy for adults with rare and serious genetic disease
May 25, 2018 - New research project aims at developing effective interventions for kids with DLD
May 25, 2018 - Middlemen who save $$ on medicines — but maybe not for you
May 25, 2018 - Study sheds new light on sharp rise in fatal drug overdoses in recent years
May 25, 2018 - Students propose revision of listeriosis guidelines for safer pregnancy
May 25, 2018 - TNFi Exposure In Utero Does Not Up Serious Infection Risk
May 25, 2018 - Organization of cells in the inner ear enables the sense and sensitivity of hearing
May 25, 2018 - Yoga May Be Right Move Against Urinary Incontinence
May 25, 2018 - Drinking recommended amount of milk could protect obese children against metabolic syndrome
May 25, 2018 - New cytokine network can repair tissue damage in the intestine, study finds
May 25, 2018 - Lyme disease researcher dispels misconceptions about ticks and provides prevention tips
May 25, 2018 - Penn researchers find link between social media usage and underage drinking
May 25, 2018 - Unique nanotechnology method to simplify skin disease diagnosis
May 25, 2018 - Study reveals new protective mechanism for tumor cells in breast cancer
May 25, 2018 - FRAME Alternatives Laboratory chosen for major European liver research collaboration
May 25, 2018 - Study shows yogurt may dampen chronic inflammation linked to multiple diseases
May 25, 2018 - Invasive cancers that are born to be bad show detectable differences from harmless tumors
May 25, 2018 - Study identifies new mechanism involved in development of Lou Gehrig’s disease
May 25, 2018 - UAB professor receives award for malaria prevention study in pregnant women in Cameroon
May 25, 2018 - Study provides blueprint of how fruit flies can be used to screen potentially pathogenic human genes
May 25, 2018 - New drug-delivering nanoparticle could offer better way to treat brain tumors
Children with Psoriasis Carry High Comorbidity Risks

Children with Psoriasis Carry High Comorbidity Risks

image_pdfDownload PDFimage_print

Action Points

  • Note that this study of administrative data found that both obesity and psoriasis are risk factors for subsequent comorbidity in children.
  • These two risk factors, however, are additive, not exponential.

Children with psoriasis are significantly more likely to develop obesity, hyperlipidemia, hypertension, diabetes, metabolic syndrome, polycystic ovarian syndrome, liver disease, and elevated liver enzymes than are children without the disease, according to a retrospective review of insurance claims data.

These risks are independent of obesity status: in non-obese children with psoriasis, the risk of comorbidities was 40% to 75% higher than in children without psoriasis, reported Megha M. Tollefson, MD, of the Mayo Clinic in Rochester, MN, and colleagues. But even in children without psoriasis, obesity was a much stronger contributor to comorbidities.

“In recent years, it has become increasingly clear that psoriasis is more than a ‘skin-deep’ condition and that it may frequently be associated with other systemic comorbidities, even in children,” the researchers wrote online in JAMA Dermatology. “While the association in adult patients is well established, the patterns and predictors of the risk of comorbidities in children with psoriasis are still not clear.

“There is mounting evidence that children with psoriasis are more likely to be obese than children without psoriasis, but this finding begs the question of whether the systemic comorbidities that are seen in children with psoriasis are attributable to obesity, or whether psoriasis is actually an independent risk factor for these comorbidities.”

In this study of claims from Optum Laboratories Data Warehouse, a Massachusetts-based Mayo Clinic partner, the researchers studied de-identified records of 29,957 children with psoriasis (affected children) and 29,957 children without psoriasis, matched for age, sex, and race, from 2004 through 2013.

The children, all under age 19, were divided into four groups:

  • Non-obese without psoriasis (reference cohort)
  • Non-obese with psoriasis
  • Obese without psoriasis
  • Obese with psoriasis

The average age of the children was 12.0, and 53.5% of the total were girls. At baseline, more affected children were obese than non-obese (2.9% versus 1.5%; P<0.001).

The average follow-up period for both groups was about 3 years. During this time, pediatric psoriasis patients were significantly more likely to develop comorbidities than those without psoriasis, with non-alcoholic liver disease, diabetes, and hypertension showing the highest risks.

Among non-obese children, the risk of comorbidities was significantly higher in those with psoriasis; these included elevated lipid levels (HR 1.42), hypertension (HR 1.64), diabetes (HR 1.58), metabolic syndrome (HR 1.62), polycystic ovarian syndrome (HR 1.49), non-alcoholic liver disease (HR 1.76), and elevated liver enzyme levels (HR 1.46).

Even in children without psoriasis, obesity was a much stronger contributor to comorbidities, carrying an 18-fold higher risk of non-alcoholic liver disease, a 16-fold higher risk of metabolic syndrome, a seven-fold higher risk of hypertension, a six-fold higher risk of hyperlipidemia, an almost three-fold higher risk of diabetes, and a 2.3-fold higher risk of elevated liver enzyme levels than the reference group; there was also a six-fold higher risk of polycystic ovarian syndrome in girls.

When the researchers analyzed the interaction between obesity and psoriasis, they found none, suggesting that while both obesity and psoriasis contribute to the development of pediatric comorbidities, the effect is additive, not exponential.

Asked for her perspective, Amy Paller, MD, chair of the Department of Dermatology at Northwestern Medicine Feinberg School of Medicine in Chicago, who was not involved with the study, noted that several studies have clearly demonstrated the association of obesity and pediatric psoriasis, and a large recent study also linked a high waist circumference to height ratio to more severe pediatric psoriasis. “The association of a variety of other ‘metabolic syndrome’ comorbidities has been controversial, however, and whether it is the obesity or psoriasis itself that increases the risk remains unknown.

“While there are issues with the use of a claims database, especially given the frequent misdiagnosis of psoriasis by non-dermatologists, several metabolic-related disorders were shown to be significantly increased in risk,” she said, adding that the fact that the associations were seen even among non-obese psoriasis patients suggests that early systemic intervention might lower risks.

The study has several limitations, Tollefson and colleagues noted. For example, it relies on data from administrative claims, and the diagnoses were not confirmed by medical record review. Also of possible concern are undercoding and misclassification of comorbidities. Extremely obese children would be more likely to have a corresponding obesity code than those with a body mass index of 25 to 40, the researchers added. “The lower prevalence of obesity in our cohort than in some others suggests that obesity may have been undercoded as a whole, with the resulting contribution from psoriasis being slightly overestimated.”

In addition, systemic medications used to treat psoriasis potentially might have influenced the risk of some comorbidities.

This study was supported by the Mayo Clinic Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery.

The authors reported having no conflicting interests.

  • Reviewed by
    F. Perry Wilson, MD, MSCE Assistant Professor, Section of Nephrology, Yale School of Medicine and Dorothy Caputo, MA, BSN, RN, Nurse Planner

2018-01-12T11:30:00-0500

Tagged with:

About author

Related Articles