Inflammatory burden and cardiovascular risk stratification across psoriasis severity stages

Psoriasis is an autoimmune pathology with a pronounced inflammatory component, characterised by hallmark cutaneous symptoms and systemic inflammation that may involve multiple organ systems. Systemic inflammation can be quantified using nonspecific markers, such as erythrocyte sedimentation rate (ESR), fibrinogen levels, C-reactive protein (CRP), and neutrophil count. These markers usually correlate with disease severity. Since disease severity in psoriasis is quantified using the Psoriasis Area and Severity Index (PASI) score, we determined levels of these non-specific inflammatory markers in a convenience sample of patients with psoriasis. We attempted to correlate them with disease severity. There was a significant positive association between ESR levels and disease severity; similarly, fibrinogen was usually elevated in patients with more severe disease compared to those with milder disease, but remained within normal limits. Higher PASI scores were also associated with more severe disease. A non-statistically significant increase in neutrophil counts was observed in patients with more severe forms. Patients with more severe forms of the disease were more likely to have cardiovascular (CV) risk, and, based on our predictive model, increases in PASI score resulted in a quantifiable increase in CV risk. Therefore, taking our results into account, we propose that non-specific inflammation markers can be used to monitor disease severity and progression, and perhaps, response to therapy, and that careful monitoring for adverse CV events may be required in patients with severe psoriasis.