Review Article
Psoriasis and Cardiomyopathy: A Review of the Literature
Abstract
Psoriasis is an idiopathic chronic immune-mediated skin condition in which the body’s immune system undergoes several derangements, including increased antigen presentation by T cells and increased T-helper cell type 1 cytokines, resulting in skin lesions as well as arthritis. Despite that cardiovascular involvement in psoriasis is common and reported in up to 47% of cases, this association is not well recognized by physicians, dermatologists, and cardiologists. Psoriasis is considered the most prevalent autoimmune disease in the United States and affects approximately 7.4 million people. Although its exact etiology is unclear, inflammatory response to infectious agents has been proposed as one of the mechanisms. We present a concise review of the literature associating psoriasis with dilated cardiomyopathy and the proposed pathophysiologic processes for the main goal of increased awareness.This content is limited to qualifying members.
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References
1. Krueger JG, Bowcock A. Psoriasis pathophysiology: current concepts of pathogenesis. Ann Rheum Dis 2005;64( Suppl 2 ):ii30-ii36.
2. Schon MP, Boehncke WH. Psoriasis. N Engl J Med 2005;352:1899-1912.
3. Rachakonda TD, Schupp CW, Armstrong AW. Psoriasis prevalence among adults in the United States. J Am Acad Dermatol 2014;70:512-516.
4. International Federation of Psoriasis Associations. Profile of psoriasis. http://www.worldpsoriasisday.com. Accessed December 24, 2014.
5. Gelfand JM, Gladman DD, Mease PJ, et al. Epidemiology of psoriatic arthritis in the population of the United States. J Am Acad Dermatol 2005;53:573.
6. Zachariae H. Prevalence of joint disease in patients with psoriasis: implications for therapy. Am J Clin Dermatol 2003;4:441-447.
7. Rocha-Pereira P, Santos-Silva A, Rebelo I, et al. The inflammatory response in mild and in severe psoriasis. Br J Dermatol 2004;150:917-928.
8. Chodorowska G, Wojnowska D, Juszkiewicz-Borowiec M. C-reactive protein and alpha2-macroglobulin plasma activity in medium-severe and severe psoriasis. J Eur Acad Dermatol Venereol 2004;18:180-183.
9. Vanizor Kural B, Orem A, Cimsit G, et al. Plasma homocysteine and its relationships with atherothrombotic markers in psoriatic patients. Clin Chim Acta 2003;332:23-30.
10. Hansson GK. Inflammation, atherosclerosis, and coronary artery disease. N Engl J Med 2005;352:1685-1695.
11. Ford ES, Giles WH. Serum C-reactive protein and fibrinogen concentrations and self-reported angina pectoris and myocardial infarction: findings from National Health and Nutrition Examination Survey III. J Clin Epidemiol 2000;53:95-102.
12. Farley E, Menter A. Psoriasis: comorbidities and associations. G Ital Dermatol Venereol 2011;146:9-15.
13. Chen YJ, Shen JL, Wu CY, et al. Elevated plasma osteopontin level is associated with occurrence of psoriasis and is an unfavorable cardiovascular risk factor in patients with psoriasis. J Am Acad Dermatol 2009;60:225-230.
14. Ogdie A, Yu Y, Haynes K, et al. Risk of major cardiovascular events in patients with psoriatic arthritis, psoriasis and rheumatoid arthritis: a population-based cohort study. Ann Rheum Dis 2015;7:326-332.
15. Ahlehoff O, Gislason GH, Charlot M, et al. Psoriasis is associated with clinically significant cardiovascular risk: a Danish nationwide cohort study. J Intern Med 2011;270:147-157.
16. Gelfand JM, Neimann AL, Shin DB, et al. Risk of myocardial infarction in patients with psoriasis. JAMA 2006;296:1735-1741.
17. Horreau C, Pouplard C, Brenaut E, et al. Cardiovascular morbidity and mortality in psoriasis and psoriatic arthritis: a systematic literature review. J Eur Acad Dermatol Venereol 2013;27(Suppl 3):12-29.
18. Polachek A, Touma Z, Anderson M, et al. Risk of cardiovascular morbidity in patients with psoriatic arthritis: A meta-analysis of observational studies. Arthritis Care Res (Hoboken) 2017;69:67-74.
19. Kristensen SL, McInnes I, Sattar N. Psoriasis, psoriatic arthritis and cardiovascular risk: are we closer to a clinical recommendation? Ann Rheum Dis 2015;74:321-322.
20. Pearce DJ, Morrison AE, Higgins KB, et al. The comorbid state of psoriasis patients in a university dermatology practice. J Dermatolog Treat 2005;16:319-323.
21. Badokin VV, Kotel’ GP. [The heart damage in patients with psoriatic
arthritis.]. Ter Arkh 2004;76:56–61. [Article in Russian].
22. Eliakim-Raz N, Shuvy M, Lotan C, et al. Psoriasis and dilated cardiomyopathy: coincidence or associated diseases? Cardiology 2008;111:202-206.
23. Fukuhara K, Urano Y, Akaike M, et al. Psoriatic arthritis associated with dilated cardiomyopathy and Takayasu’ arteritis. Br J Dermatol 1998;138:329-333.
24. Tanabe H, Maki Y, Urabe S, et al. Myopathy in a patient with systemic AA amylodisis possibly induced by psoriasis vulgaris: an autopsy case. Muscle Nerve 2015;52:1113-1117.
25. Pietrzak A, Brzozowska A, Lotti T, et al. Future diagnosis, today’s treatment--cardiomyopathy in the course of psoriasis: a case report. Dermatol Ther 2013;26:489-492.
26. Zhao CT, Yeung CK, Siu CW, et al. Relationship between parathyroid hormone and subclinical myocardial dysfunction in patients with severe psoriasis. J Eur Acad Dermatol Venereol 2014;28:461-468.
27. Wright V. A unifying concept for the spondyloarthropathies. Clin Orthop Relat Res 1979;143:8-14.
28. Kimhi O, Caspi D, Bornstein NM, et al. Prevalence and risk factors of atherosclerosis in patients with psoriatic arthritis. Semin Arthritis Rheum 2007;36:203-209.
29. Lambert JR, Wright V, Rajah SM, et al. Histocompatibility antigens in psoriatic arthritis. Ann Rheum Dis 1976;35:526-530.
30. Hershberger RE, Hedges DJ, Morales A. Dilated cardiomyopathy: the complexity of a diverse genetic architecture. Nat Rev Cardiol 2013;10:531-547.
31. Van Gelder H, Charles-Schoeman C. The heart in inflammatory myopathies. Rheum Dis Clin North Am 2014;40:1-10.
32. Maron BJ. The 2006 American Heart Association classification of cardiomyopathies is the gold standard. Circ Heart Fail 2008;1:72-76.
33. Boehncke WH, Gladman DD, Chandran V. Cardiovascular comorbidities in psoriasis and psoriatic arthritis: pathogenesis, consequences for patient management, and future research agenda: a report from the GRAPPA 2009 annual meeting. J Rheumatol 2011;38:567-571.
34. Redfield MM, Jacobsen SJ, Burnett JC, Jr et al. Burden of systolic and diastolic ventricular dysfunction in the community: appreciating the scope of the heart failure epidemic. JAMA 2003;289:194-202.
35. Mosterd A, Hoes AW, de Bruyne MC, et al. Prevalence of heart failure and left ventricular dysfunction in the general population. The Rotterdam Study. Eur Heart J 1999;20:447-455.
36. Felker GM, Thompson RE, Hare JM, et al. Underlying causes and long-term survival in patients with initially unexplained cardiomyopathy. N Engl J Med 2000;342:1077-1084.
37. Tsioufis C, Stougiannos P, Kakkavas A, et al. Relation of left ventricular concentric remodeling to levels of C-reactive protein and serum amyloid A in patients with essential hypertension. Am J Cardiol 2005;96:252-256.
38. Pieretti J, Roman MJ, Devereux RB, et al. Systemic lupus erythematosus predicts increased left ventricular mass. Circulation 2007;116:419-426.
39. Saricaoglu H, Gullulu S, Bulbul Baskan E, et al. Echocardiographic findings in subjects with psoriatic arthropathy. J Eur Acad Dermatol Venereol 2003;17:414-417.
40. Shang Q, Tam LS, Yip GW, et al. High prevalence of subclinical left ventricular dysfunction in patients with psoriatic arthritis. J Rheumatol 2011;38:1363-1370.
41. Kania G, Blyszczuk P, Muller-Edenborn B, et al. Novel therapeutic options in inflammatory cardiomyopathy. Swiss Med Wkly 2013;143:w13841.
42. Wojnicz R, Nowalany-Kozielska E, Wodniecki J, et al. Immunohistological diagnosis of myocarditis. Potential role of sarcolemmal induction of the MHC and ICAM-1 in the detection of autoimmune mediated myocyte injury. Eur Heart J 1998;19:1564-1572.
43. Mangalam AK, Rajagopalan G, Taneja V, et al. HLA class II transgenic mice mimic human inflammatory diseases. Adv Immunol 2008;97:65-147.
44. Caforio AL, Goldman JH, Haven AJ, et al. Circulating cardiac-specific autoantibodies as markers of autoimmunity in clinical and biopsy-proven myocarditis. The Myocarditis Treatment Trial Investigators. Eur Heart J 1997;18:270-275.
45. Lauer B, Schannwell M, Kuhl U, et al. Antimyosin autoantibodies are associated with deterioration of systolic and diastolic left ventricular function in patients with chronic myocarditis. J Am Coll Cardiol 2000;35:11-18.
46. Muller J, Wallukat G, Dandel M, et al. Immunoglobulin adsorption in patients with idiopathic dilated cardiomyopathy. Circulation 2000;101:385-391.
47. Wolff PG, Kuhl U, Schultheiss HP. Laminin distribution and autoantibodies to laminin in dilated cardiomyopathy and myocarditis. Am Heart J 1989;117:1303-1309.
48. Rangachari M, Mauermann N, Marty RR, et al. T-bet negatively regulates autoimmune myocarditis by suppressing local production of interleukin 17. J Exp Med 2006;203:2009-2019.
49. Valaperti A, Marty RR, Kania G, et al. CD11b + monocytes abrogate Th17 CD4+ T cell-mediated experimental autoimmune myocarditis. J Immunol 2008;180:2686-2695.
50. Nindl V, Maier R, Ratering D, et al. Cooperation of Th1 and Th17 cells determines transition from autoimmune myocarditis to dilated cardiomyopathy. Eur J Immunol 2012;42:2311-2321.
51. Lv H, Havari E, Pinto S, et al. Impaired thymic tolerance to α-myosin directs autoimmunity to the heart in mice and humans. J Clin Invest 2011;121:1561-1573.
52. Ueno A, Murasaki K, Hagiwara N, et al. Increases in circulating T lymphocytes expressing HLA-DR and CD40 ligand in patients with dilated cardiomyopathy. Heart Vessels 2007;22:316-321.
53. Portig I, Sandmoeller A, Kreilinger S, et al. HLA-DQB1* polymorphism and associations with dilated cardiomyopathy, inflammatory dilated cardiomyopathy and myocarditis. Autoimmunity 2009;42:33-40.
54. Taylor JA, Havari E, McInerney MF, et al. A spontaneous model for autoimmune myocarditis using the human MHC molecule HLA-DQ8. J Immunol 2004;172:2651-2658.
55. Kania G, Blyszczuk P, Stein S, et al. Heart-infiltrating prominin-1+/CD133+ progenitor cells represent the cellular source of transforming growth factor beta-mediated cardiac fibrosis in experimental autoimmune myocarditis. Circ Res 2009;105:462-470.
56. Phan SH. The myofibroblast in pulmonary fibrosis. Chest 2002;122( 6 Suppl ):286S-289S.
57. Porter KE, Turner NA. Cardiac fibroblasts: at the heart of myocardial remodeling. Pharmacol Ther 2009;123:255-278.
58. Leipner C, Grun K, Muller A, et al. Imatinib mesylate attenuates fibrosis in coxsackievirus b3-induced chronic myocarditis. Cardiovasc Res 2008;79:118-126.
59. Kwon HJ, Cote TR, Cuffe MS, et al. Case reports of heart failure after therapy with a tumor necrosis factor antagonist. Ann Intern Med 2003;138:807-811.
60. Michels VV, Moll PP, Miller FA, et al. The frequency of familial dilated cardiomyopathy in a series of patients with idiopathic dilated cardiomyopathy. N Engl J Med 1992;326:77-82.
