Division of Dermatology, Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden.
Quantify Research, Stockholm, Sweden.
JAMA Dermatol. 2020 Jul 1;156(7):795-804. doi: 10.1001/jamadermatol.2020.1398.
Psoriasis is a complex systemic disease with skin involvement, somatic comorbidity, and psychiatric illness (PI). Although this view of psoriasis is widely accepted, potential synergies within this triad of symptoms have not been adequately investigated.
To investigate the independent association of skin psoriasis and somatic comorbidity with the development of PI and to assess whether skin psoriasis and somatic comorbidity act synergistically to produce a risk of PI that is greater than the additive associations.
DESIGN, SETTING, AND PARTICIPANTS: Participants were enrolled between January 2005 and December 2010, in this retrospective matched case-control study using secondary (ie, administrative), population-based registry data from Swedish patients in routine clinical care. The dates of analysis were March 2017 to December 2019. Participants were patients with skin psoriasis and control participants without psoriasis matched on age, sex, and municipality, who were all free of preexisting PI.
Presence of skin psoriasis and somatic comorbidity (captured through the Charlson Comorbidity Index and the Elixhauser Comorbidity Index).
Risk of PI onset (composite of depression, anxiety, and suicidality) is shown using Kaplan-Meier curves stratified by the presence of skin psoriasis and somatic comorbidity. Adjusted associations of skin psoriasis and somatic comorbidity with the development of PI were analyzed using Cox proportional hazards regression models, including interactions to assess synergistic associations. The 3 components of PI were also assessed individually.
A total of 93 239 patients with skin psoriasis (mean [SD] age, 54 [17] years; 47 475 men [51%]) and 1 387 495 control participants (mean [SD] age, 54 [16] years; 702 332 men [51%]) were included in the study. As expected, patients with skin psoriasis were more likely to have somatic comorbidity and PI than control participants. Compared with those without skin psoriasis or somatic comorbidity, patients with psoriasis without somatic comorbidity had a 1.32 times higher risk of PI onset (hazard ratio [HR], 1.32; 95% CI, 1.27-1.36; P < .001), whereas patients with psoriasis with somatic comorbidity had a 2.56 times higher risk of PI onset (HR, 2.56; 95% CI, 2.46-2.66; P < .001). No synergistic associations of skin psoriasis and somatic comorbidity with the development of PI were found (HR, 0.93; 95% CI, 0.81-1.04; P = .21).
This study found that somatic comorbidity appeared to alter PI onset even more than skin psoriasis. The observed association of skin psoriasis and somatic comorbidity with the development of PI reinforces the need for proactive, holistic treatment of patients with psoriasis.
银屑病是一种复杂的全身性疾病，涉及皮肤、躯体合并症和精神疾病（PI）。尽管这种对银屑病的看法已被广泛接受，但这三种症状之间的潜在协同作用尚未得到充分研究。
研究皮肤银屑病和躯体合并症与 PI 发展的独立关联，并评估皮肤银屑病和躯体合并症是否协同作用，产生大于累加关联的 PI 风险。
设计、地点和参与者：本回顾性匹配病例对照研究于 2005 年 1 月至 2010 年 12 月间使用来自瑞典常规临床护理中患者的二级（即行政）人群登记数据进行，参与者于 2017 年 3 月至 2019 年 12 月间进行分析。参与者包括患有皮肤银屑病的患者和无银屑病的对照参与者，按年龄、性别和市匹配，且均无先前存在的 PI。
皮肤银屑病和躯体合并症的存在（通过 Charlson 合并症指数和 Elixhauser 合并症指数捕捉）。
使用 Kaplan-Meier 曲线分层分析皮肤银屑病和躯体合并症的存在，显示 PI 发病风险（抑郁、焦虑和自杀的复合结局）。使用 Cox 比例风险回归模型分析皮肤银屑病和躯体合并症与 PI 发展的调整关联，包括评估协同关联的交互作用。还单独评估了 PI 的 3 个组成部分。
共纳入 93239 例皮肤银屑病患者（平均[SD]年龄 54[17]岁，47475 名男性[51%]）和 1387495 名对照参与者（平均[SD]年龄 54[16]岁，702332 名男性[51%]）。如预期的那样，患有皮肤银屑病的患者比对照参与者更有可能患有躯体合并症和 PI。与无皮肤银屑病或躯体合并症的患者相比，无躯体合并症的银屑病患者发生 PI 的风险高 1.32 倍（HR，1.32；95%CI，1.27-1.36；P<0.001），而患有躯体合并症的银屑病患者发生 PI 的风险高 2.56 倍（HR，2.56；95%CI，2.46-2.66；P<0.001）。未发现皮肤银屑病和躯体合并症与 PI 发展之间存在协同关联（HR，0.93；95%CI，0.81-1.04；P=0.21）。
本研究发现，躯体合并症似乎比皮肤银屑病更能改变 PI 的发病。皮肤银屑病和躯体合并症与 PI 发展之间的观察到的关联强调了对银屑病患者进行积极、全面治疗的必要性。
