Parasramani Shrichand G
Senior Consultant, Department of Dermatology, Lilavati Hospital and Research Center, Bandra Reclamation, Bandra (W), Mumbai, Maharashtra, India.
J Clin Diagn Res. 2017 Jul;11(7):WD01-WD02. doi: 10.7860/JCDR/2017/25490.10300. Epub 2017 Jul 1.
Psoriasis is a chronic, relapsing, inflammatory disease that has been associated with Metabolic Syndrome (MS), a cluster of cardiovascular risk factors mainly hypertension, obesity, diabetes mellitus and hyperlipidemia. A 49-year-old male patient presented with extensive plaque psoriasis from past 13 years. Past medications included methotrexate, PUVA therapy, topical immunosuppressants and corticosteroids. His baseline Psoriasis Area and Severity Index (PASI) score was 39.8. The patient was screened and diagnosed with MS as per Alberti's Criteria (his waist circumference was 100 cm, blood pressure was 160/100 mmHg and High Density Lipoprotein (HDL) was 30 mg/dl). Considering severity of the disease, in this case we used anti-CD6 humanized monoclonal antibody Itolizumab (1.6 mg/kg body weight) to treat psoriasis and concurrent MS. The patient achieved PASI 50 response in six months after treatment of 10 infusions of Itolizumab (First seven doses were given every fortnightly and the last three doses every month). Further, Itolizumab treatment was continued once every three months and PASI 75 response was achieved at the end of 15 months. His PASI score increased to 30.7 after 18 months. Contemplating link between psoriasis and MS due to possibility of overlapping inflammatory pathways, we instructed patient to reduce his weight and prescribed oral tablet metformin 500 mg twice a day. After losing 6 kg weight, his PASI score came down to 22.2 at the end of 21 month. This suggests that MS was a driving factor in worsening of his psoriasis. Psoriatic patients should be checked simultaneously for co-morbid disease conditions. The report indicates direct association of psoriasis and MS.
银屑病是一种慢性、复发性炎症性疾病，与代谢综合征（MS）相关，代谢综合征是一组心血管危险因素，主要包括高血压、肥胖、糖尿病和高脂血症。一名49岁男性患者，13年来一直患有广泛的斑块状银屑病。既往用药包括甲氨蝶呤、补骨脂素紫外线A光疗法（PUVA疗法）、外用免疫抑制剂和皮质类固醇。他的基线银屑病面积和严重程度指数（PASI）评分为39.8。根据阿尔贝蒂标准对该患者进行筛查并诊断为代谢综合征（其腰围为100厘米，血压为160/100毫米汞柱，高密度脂蛋白（HDL）为30毫克/分升）。考虑到疾病的严重程度，在本病例中，我们使用抗CD6人源化单克隆抗体英夫利昔单抗（1.6毫克/千克体重）治疗银屑病和并发的代谢综合征。在输注10次英夫利昔单抗后，患者在6个月时达到了PASI 50反应（前七剂每两周给药一次，最后三剂每月给药一次）。此外，英夫利昔单抗治疗每三个月继续一次，在15个月结束时达到了PASI 75反应。18个月后，他的PASI评分升至30.7。由于炎症途径可能重叠，考虑到银屑病与代谢综合征之间的联系，我们指导患者减轻体重，并开了口服二甲双胍片，每天两次，每次500毫克。体重减轻6千克后，在21个月结束时，他的PASI评分降至22.2。这表明代谢综合征是他银屑病恶化的一个驱动因素。银屑病患者应同时检查是否存在合并疾病。该报告表明银屑病与代谢综合征存在直接关联。
