Celiac.com 08/05/2024 - Psoriasis is a prevalent chronic inflammatory skin condition characterized by its autoimmune etiology. Affecting both men and women equally, this disease is often associated with other autoimmune disorders, increasing the complexity of its management. This study aims to explore the prevalence of autoimmune diseases in patients diagnosed with psoriasis at King Abdulaziz Medical City in Riyadh, Saudi Arabia. By identifying these associations, the study provides valuable insights into the interconnected nature of autoimmune conditions.

Study Methods and Patient Selection

The research was conducted as a retrospective, cross-sectional chart review. Patients with confirmed psoriasis diagnoses were identified through the dermatology clinic's electronic medical records. The charts were meticulously reviewed to document the presence of other autoimmune diseases, including hypothyroidism, hyperthyroidism, alopecia areata, vitiligo, atopic dermatitis, and inflammatory bowel diseases such as Crohn's disease and celiac disease. Ethical approval was granted by King Abdullah International Medical Research Center's Institutional Review Board.

Key Findings and Demographic Data

A total of 839 patients were included in the study, with a female majority of 56.4%. The age group with the highest prevalence of psoriasis was between 31 and 50 years, comprising 37.1% of the patients. The study found that 6.8% of the patients had hypothyroidism, making it the most common associated autoimmune disease. This was followed by alopecia areata (3.6%) and atopic dermatitis (2.9%). Rheumatoid arthritis, systemic lupus erythematosus, and inflammatory bowel diseases were notably less common in this cohort.

Discussion on the Association Between Psoriasis and Autoimmune Diseases

The study reveals that a significant number of psoriasis patients also suffer from other autoimmune diseases, with thyroid disorders being the most prevalent. The findings are consistent with other research that suggests a higher susceptibility to autoimmune conditions among psoriasis patients. For instance, autoimmune skin disorders such as alopecia areata and vitiligo were frequently observed. The commonality in immune response mechanisms across these diseases might explain their co-occurrence. In particular, the role of T-cell-mediated processes and cytokine release, such as tumor necrosis factor-alpha and interleukins, is critical in both psoriasis and other autoimmune conditions.

Limitations of the Study

Despite its valuable findings, the study has several limitations. Being a single-center, retrospective study, the results might not be generalizable to other populations. Additionally, the reliance on documented diagnoses in medical records could lead to underreporting or missing data. A larger, multicenter approach would provide a more comprehensive understanding of the prevalence and association of autoimmune diseases with psoriasis.

Implications for Celiac Disease Patients

This study underscores the high prevalence of autoimmune diseases among psoriasis patients, with thyroid disorders and skin autoimmune conditions being the most common. For individuals with celiac disease, these findings are particularly relevant. Understanding the interconnected nature of autoimmune disorders can aid in better managing their health and anticipating potential complications. It also highlights the importance of comprehensive care approaches that address multiple autoimmune conditions simultaneously.

By recognizing these associations, healthcare providers can improve diagnostic accuracy and treatment plans, ultimately enhancing the quality of life for patients with celiac disease and other autoimmune disorders. Further research in diverse populations and larger settings is necessary to validate these findings and expand our understanding of autoimmune disease interactions.

Read more: cureus.com

Celiac.com 03/30/2023 - A study recently published in the Journal of the American Academy of Dermatology shows that people with psoriasis have twice the odds of having celiac disease compared to those without psoriasis. 

The study is the work of a research team that included Marina Z. Joel, BS; Ryan Fan, BA; and Jeffrey M. Cohen, MD. They are variously affiliated with the Johns Hopkins University School of Medicine, Baltimore, Maryland; the Yale School of Medicine, and the Department of Dermatology at Yale School of Medicine, New Haven, Connecticut.

The Psoriasis & Celiac Disease Study

For their study, the Ms. Joel and her colleagues examined the association between psoriasis and celiac disease. They used data from 316,166 adults, and found that of the 6,476 patients with psoriasis, 1.65% had celiac disease compared to nearly 0.5% of 309,690 patients without psoriasis. 

The study controlled for various factors such as age, sex, race and ethnicity, smoking status, autoimmune diseases linked to psoriasis and celiac disease, and body mass index (BMI), and found that psoriasis remained significantly associated with celiac disease. 

Study Findings

The authors note that while the exact mechanism behind this association is unclear, genome-wide association studies have found that many susceptibility loci for psoriasis overlap with those for celiac disease:

• “While the pathophysiologic mechanism behind the association between psoriasis and celiac disease is unclear, several explanations have been proposed. Genome-wide association studies have found that many susceptibility loci for psoriasis overlap with those for celiac disease," they write.

They add that "both psoriasis and celiac disease are T-cell driven disorders, there could be shared immunogenic mechanisms between the two conditions." Although more research is needed to fully understand the link between psoriasis and celiac disease, studies that help to document connections between celiac disease and other disorders are very helpful in clarifying the overall celiac disease puzzle.

Read more in Journal of the American Academy of Dermatology

Celiac.com 01/09/2023 - Psoriasis is one of several skin conditions long associated with celiac disease. Several studies have found connections between psoriasis and celiac disease, but so far no study has shown a causal connection between these two autoimmune conditions. A new study shows that celiac disease patients face a higher risk of psoriasis, but not vice versa. Here's what they found.

Genetic Study

A team of researchers recently set out to explore the causal link between psoriasis and celiac disease with bidirectional 2-sample Mendelian Randomization (MR) study. The research team included Lin Li, Lixin Fu, Liwen Zhang & Yanyan Feng. They are affiliated with theDepartment of Dermatology, Chengdu Second People’s Hospital, Chengdu, Sichuan, China.

The Psoriasis-Celiac Disease Connection

The team set out to extract eligible instrument variables with genome-wide significance. To do so, the team used data from the published genome-wide association studies (GWAS) of the European population. They then performed sensitivity, post-MR, and inverse variance weighted (IVW) analyses.

The MR analyses showed that genetically doubling the odds of celiac disease would increase the risk for psoriasis. Subsequent sensitivity analyses reinforced those results. 

Higher Psoriasis Risk for Celiac Patients

However, the team's data showed that genetically determined psoriasis was not connected with the risk for celiac disease. 

This study offers new genetic evidence that celiac patients face an increased risk of psoriasis, while psoriasis patients face no higher celiac risk. 

For this reason, the team advises clinicians to be aware of the connections, and to closely watch for any psoriasis-associated skin symptoms in celiac patients, or in patients with celiac symptoms.

This study offers another valuable insight into the many connections between celiac disease and the risk of other auto-immune conditions, and perhaps supports the idea that all non-genetically determined psoriasis patients should be screened for celiac disease.

Read more at Scientific Reports volume 12, Article number: 21508 (2022)

Celiac.com 12/16/2019 - Psoriasis is a skin condition associated with several immune-mediated inflammatory diseases, including celiac disease. Currently, however, researchers don't have much solid information regarding the chronology of psoriasis development. 

A team of researchers recently set out to investigate the chronology of immune-mediated inflammatory diseases relative to psoriasis. 

The research team included Yuki M.F. Andersen, MD, PhD, Jashin J. Wu, MD, Jacob P. Thyssen, MD, PhD, DMS, and Alexander Egeberg, MD, PhD. They are variously affiliated with the Department of Dermatology and Allergy, Herlev and Gentofte Hospital, University of Copenhagen, Copenhagen, Denmark; the Dermatology Research and Education Foundation, Irvine, California; and the Department of Dermatology and Allergy, Herlev and Gentofte Hospital, University of Copenhagen, Copenhagen, Denmark.

The team reviewed data from Danish nationwide administrative registries to examine the occurrence of immune-mediated inflammatory diseases in 10,923 patients with psoriasis, and in 109,230 control subjects from the general population.

They found that about 20% of psoriasis patients developed one or more immune-mediated inflammatory diseases, with risk that is five times greater than in the general population. 

Most patients received a diagnosis of immune-mediated inflammatory disease, except for psoriatic arthritis, before being diagnosed with psoriasis. Psoriasis patients were far more likely to have multiple immune-mediated inflammatory diseases. They were also far more likely to have human leukocyte antigen B27 positivity.

This study was limited by the unavailability of clinical measurements.

Still, the data show that immune-mediated inflammatory diseases are common in patients with psoriasis, and are usually diagnosed before psoriasis. This information could help researchers to better understand the factors influencing the development of psoriasis.

Read more in the Journal of the American Academy of Dermatology

Celiac.com 01/30/2018 - Numerous clinicians have reported higher levels of celiac disease markers in their patients with psoriasis. A number of researchers believe that some psoriasis patients suffer from asymptomatic celiac disease, and a number of patients have reported symptom improvements with gluten-free diets.

A team of researchers recently set out to determine the prevalence of antigliadin IgA antibodies in psoriasis vulgaris, and to assess the response of seropositive patients to a gluten-free diet.

The research team included Nikolai A Kolchak, Maria K Tetarnikova, Maria S Theodoropoulou, Alexandra P Michalopoulou, and Demetrios S Theodoropoulos. They are variously affiliated with the Department of Hematology, Omsk State Medical Academy, Omsk, Russia; Dermatology Private Practice, Chelyabinsk, Russia; Department of Pharmacy, Trikala General Hospital, Trikala, Greece; Department of Philosophy and Social Studies, School of Philosophy, University of Crete, Rethymnon, Greece; and Allergy Associates of La Crosse, Onalaska, WI, USA.

The team assessed the prevalence of gliadin IgA antibodies among patients with psoriasis in an urban population, along with noting the clinical effects of a strict gluten-free diet.

The team recruited 97 patients with Psoriasis Area and Severity Index greater than 2.4 from a dermatology clinic. They measured gliadin IgA antibodies in all participants and in 91 control subjects. They found elevated gliadin IgA antibodies in 13 patients, and two controls. All 13 patients were placed on a strict gluten-free diet without any other modifications in their ongoing treatment of psoriasis.

Psoriasis patients who do not have celiac disease or non-celiac gluten sensitivity commonly show high levels of antigliadin IgA antibody.

These results show that antigliadin IgA testing can identify psoriasis patients likely to benefit from a gluten-free diet.

Source:

• Journal of Multidisciplinary Healthcare. DOI https://doi.org/10.2147/JMDH.S122256

Celiac.com 05/19/2012 - Because a number of past studies examining the connection between celiac disease and psoriasis have had contradictory findings, researchers wanted to get a better idea of the actual risk of psoriasis in patients with biopsy-verified celiac disease.

The researchers were J.F. Ludvigsson, B. Lindelöf, F. Zingone, and C. Ciacci, with the Department of Pediatrics at Sweden's Örebro University Hospital.

For their study, they used data from 28 pathology departments in Sweden to identified individuals with celiac disease diagnosed between 1969 and 2008. They found 28,958 patients with Marsh 3 villous atrophy.

They then used Cox regression to compare those celiac disease patients with 143,910 sex- and age-matched control subjects, and to assess the risk of psoriasis.

They found that celiac disease was a risk factor for future psoriasis (hazard ratio (HR) = 1.72; 95% confidence interval (CI) = 1.54-1.92. They found that, during follow-up, 401 individuals with celiac disease and 1,139 controls were diagnosed with psoriasis.

They found that the absolute risk of future psoriasis in patients with celiac disease was 135 per 100,000 person-years, with an excess risk of 57 cases per 100,000 person years.

Overall, 42% of the cases of psoriasis in patients with celiac disease could be attributed to celiac disease. Moreover, in children the team saw a strong association between celiac disease and psoriasis (HR = 2.05; 95% CI = 1.62-2.60).

Their results show that the connection between celiac disease and psoriasis seems to be far more than coincidental, as we also found a positive association between celiac disease and psoriasis before celiac diagnosis, with an odds ratio of 1.91; 95% CI = 1.58-2.31).

They conclude that individuals with celiac disease do, in fact, face an increased risk of psoriasis both before and after celiac diagnosis.

Source:

• Open Original Shared Link.

For the study, a team of researchers from Brigham and Women's Hospital, Harvard Medical School, and Boston University enrolled 82,869 women who were not originally diagnosed with psoriasis. They monitored the women for nearly fifteen years, from 1991 through 2005.

During the study period, subjects used the women Nurses' Health Study II to report their regular alcohol consumption, and any diagnosis of psoriasis. The results showed that even relatively small amounts of beer corresponded to an increase psoriasis diagnosis. Women who drank just 2.3 beers a week saw their psoriasis rates rise by almost 80%.

For women who drink five regular beers a week, the risk of developing psoriasis is nearly double that of non-drinkers. Does this mean women shouldn't drink beer? Not exactly.

"We can say that if a woman would like to consume alcohol and if she has a family history of psoriasis or known psoriasis in the past or some other reason she might be predisposed to psoriasis, the alcohol of choice probably should not be nonlight beer," said Dr. Abrar A. Qureshi, lead author of an article on the study published in Archives of Dermatology.

But Bruce Bebo, director of research and medical programs at the National Psoriasis Foundation, says the findings warrant "more investigation to determine whether there's a real connection or not."

Earlier studies have also tied psoriasis rates to alcohol consumption, although the nature of this connection is not well understood. The fact that no other types of alcohol in this study showed the same association with psoriasis was of particular interest to Bebo.

"There is evidence that alcohol consumption can affect immune responses and psoriasis is an autoimmune disease," Bebo said. "There's also some evidence that it can affect the biology of  keratinocytes (certain skin cells). But ... then why would it be nonlight beer, why not wine or other alcohol? Maybe there's something in wine that ... might reverse the effect."

Another study in the same issue of journal reports that people with psoriasis suffer higher rates of depression, anxiety and even suicidal thoughts.

That study, by researchers from the University of Pennsylvania in Philadelphia, found that men with psoriasis suffered from these adverse mental health outcomes more than women.

Source:

• Open Original Shared Link

The team was made up of Paolo Gisondi, Micol Del Giglio, Alessandra Cozzi & Giampiero Girolomoni. They are associated with the Section of Dermatology and Venereology of the Department of Medicine, at the University of Verona, Italy.

Psoriasis is a common chronic inflammatory, immune-mediated skin disease that is often tied to other disorders, including psoriatic arthropathy, chronic inflammatory bowel diseases, and cardio-metabolic disorders.

Additionally, about 50% of all patients patients with psoriasis suffer from non-alcoholic fatty liver disease, from 0.2–4.3% suffer from celiac disease, and about one half of one percent suffer from Crohn's disease.

These associated conditions may have some common genetic traits, as well as common inflammatory pathways, and their presence offers important implications in the global approach to treating psoriasis.

In particular, common systemic antipsoriatic drugs might have a negative affect on associated cardio-metabolic conditions and nonalcoholic fatty liver disease, and may have important interactions with drugs commonly used to treat psoriasis.

Moreover, the team emphasizes the importance of encouraging psoriasis patients to drastically improve their modifiable cardiovascular and liver risk factors, especially obesity, alcohol and smoking intake, because improvements could have positive impact on both the psoriasis and the patient's general well-being.

Source:

• Open Original Shared Link

So, why my intrigue?  Well, I am severely gluten intolerant and have had psoriasis my entire life.  Natural doctors bemoan the fact that my ultra sensitivity to anything and everything (from vitamins and whole-food supplements to Chinese herbs) prevents them from being able to help me.  I wondered if TSLP from damaged psoriatic skin cells had sensitized my gut to react to what would otherwise be harmless food substances. 

A quick search proved quite helpful.  First and foremost, Scott Adams had already reviewed an article that established a link between celiac disease and psoriasis back in November of 2004 (Br.J. Dermatol. 2004 Oct;151(4):891-4) 2004).  Also, a peer-reviewed journal search yielded hundreds of results that showed this was not one isolated study.  So, what about celiac disease and asthma?  Well, once again, a quick search of the celiac.com site showed many bloggers and authors personally discussing this very link. 

Next, I went to the medical literature in the hopes of finding whether or not TSLP could be considered the culprit for hyper sensitizing me to an ever increasing list of food substances—gluten is only the start.  Researchers have proven that elevated T cells (Bulletin of Experimental Biology & Medicine. 2004 Mar; 137(3):302-7) and eosinophils ( Allergy & Asthma Proceedings. 2004 Jul-Aug; 25(4): 253-9) are found in the intestinal mucosa of patients with asthma thus proving a link of lung mucosa to gut mucosa.  If elevated TSLP from damaged skin cells could lead to asthma, and the mucosa of the lungs is linked to the mucosa of the gut, then hypothetically elevated TSLP could lead to a hypersensitive gut. 

In other words, damaged skin cells from psoriasis elevate levels of TSLP and patients with psoriasis often have celiac disease.  There is also a link between TSLP and asthma and a link between asthma and celiac disease.  Thus, it could be argued that the TSLP from damaged skin cells plays a role in sensitizing the gut to previously harmless food substances.  Now if only a researcher out there would design a study to prove me right!

What does this to for me?  Not much at the moment, although, I do find it incredibly interesting.  What can this exercise in possible commutability do for all of us?  Maybe train us to view our bodies as an entire, interrelated system and to take our skin lesions seriously.  What do I do to keep my psoriasis at bay?  I hold fast to the gluten free diet and consume vast quantities of fish oil which, incidentally, also aids in restoring a damaged intestinal lining…

Br J Dermatol. 2004 Oct;151(4):891-4

Celiac.com 11/09/2004 – A study carried out by Irish researchers to determine whether there is an association between celiac disease antibodies and psoriasis activity found that the presence of Antigliadin antibodies (AGA) did increase the severity of the disease. The researchers looked at 130 patients with psoriasis and screened them for serum IgG and IgA AGA, IgA antitransglutaminase and IgA antiendomysial antibodies. The patients were invited to undertake an endoscopy with duodenal biopsy. They found that a significantly higher proportion of psoriasis patients had elevated celiac disease associated antibody levels, and those with elevated antibodies had previously required systemic immunosuppressants or psoralen plus ultraviolet A phototherapy. Out of the 130 patients one new case of celiac disease was diagnosed. The researchers conclude that the presence of celiac disease associated antibodies in psoriasis patients correlates with greater psoriasis activity.