engleski

Vasodilatation in skin microcirculation of psoriasis patients receiving TNF-alpha-blocking therapy

Background: Psoriasis is a chronic, recurrent inflammation-driven skin disease. Similarly as in other systemic autoimmune diseases, persistent systemic inflammation which is evident in psoriasis patients leads to the development of endothelial dysfunction and several other comorbidities (i.e. diabetes, dyslipidemia, hypertension, ) which might further contribute to the occurrence of cardiovascular disease (CVD). Previous studies reported psoriasis as an independent risk factor for CVD, while systemic treatment by methotrexate or biologic drugs reverses CVD risk to levels found in general population. Epidemiologic studies proved beneficial effect of TNF-alpha-blocking therapy on reducing CVD risk, however, data on the TNFalpha-blockade- mediated effects on endothelial (dys)function in psoriasis patients are still lacking. Available data are controversial, which has been attributed to non- selective blockade of TNF- alpha mediated actions trough TNFR1 and TNFR2. Study design: In this preliminary study 9 psoriasis patients and 4 healthy controls were recruited. Of these suffering from psoriasis, 4 were receiving adalimumab for more than 6 months while 5 patients were using only topical corticosteroid preparations. Patients were selected from the register of psoriasis patients and reached by phone. During outpatient visit we have assessed psoriasis area and severity index (PASI) and dermatology life quality index (DLQI) and the blood was taken for the assessment of inflammation parameters (hsCRP and sedimentation rate). Laser Doppler flowmetry (LDF) (MoorVMS- LDF, Axminster, UK) was used to assess microvascular function by evaluation of endothelium-dependent (post-occlusive reactive hyperemia (PORH), acetylcholine (ACh)-induced vasodilation) and endothelium-independent (sodium nitroprusside (SNP)-induced) vasodilation. The drugs were delivered locally by iontophoresis (noninvasive transdermal application of charged substances). LDF measurements were performed at each study visit in a temperature-controlled room (mean ± SD temperature = 23.5 ± 0.5°C). Data collection started 30 minutes after resting in a supine position to acclimatize. The laser Doppler probe was attached to the uninflamed skin of the volar forearm, 13–15 cm from the wrist. The study was approved by the Ethical Committee of the University Hospital Osijek, and all participants signed informed consent. Results: Results of this study did not show statistically significant differences in microvascular reactivity. Vasodilatation in psoriatic patients included both, endothelium- dependent and endothelium independent vasodilation similar to the one found in control subjects. Interestingly, we found significant positive correlation between sedimentation rate and PORH (r=0.703, p=0.023, Persons correlation), and sedimentation rate and ACh- mediated vasodilatation (r=0.730, p=0.16, Persons correlation). Similarly, a positive correlation was also found between fibrinogen and PORH (r=0.601, p=0.05, Persons correlation). Conclusions: This study demonstrated a significant link between chronic inflammation and the skin microvascular reactivity in psoriatic patients. A small number of heterogonous participants requires including higher number of patients to be able to increase the strength of the study.

psoriasis, endothelial function, inflammation

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