Cardio-metabolic co-morbidities and psoriasis

Co-morbidity is defined as the co-existence of several diseases in the same patient. The study of co-morbidities does not include the study of socioeconomic factors, lifestyle, or access to care; it only considers disease associations on the individual scale. Not only does psoriasis reduce patients' quality of life, but it also reduces their life expectancy by 3.5-10 years and up to 20 years for patients whose psoriasis began before the age of 25 years. Based on a review of the literature and the follow-up of a cohort of patients with psoriasis in Canada's Newfoundland and Labrador provinces, the reasons for this decrease in life expectancy of psoriasis patients are discussed. These patients have many co-morbidities: metabolic syndrome plays an important role and participates, along with inflammation, in the increase in cardiovascular risk and in particular in the increase in the risk for myocardial infarct, notably in young women with severe psoriasis. Methotrexate and biotherapy treatments seem to reduce the co-morbidities and may lengthen these patients' life expectancy. New therapeutic strategies should be defined taking into account the systemic repercussions of severe psoriasis. (C) 2008 Elsevier Masson SAS. Tous droits reserves.