The immune system is the body’s most effective weapon against invading pathogens. If the body’s immune regulation is out of balance, it can affect the body’s immune response and cause disease. With this in mind, it is important to mention psoriasis.
As a systemic disease caused by immune, genetic and environmental factors, psoriasis is not only harmful in terms of skin appearance, but also penetrates into the body, violates the immune system and causes a series of autoimmune diseases. The most common ones are arthritis, vitiligo, Crohn’s disease, etc.
1.Psoriasis and arthritis
The arthritis caused by psoriasis is called psoriatic arthritis, a kind of chronic, inflammatory arthritis and attachment point inflammation associated with psoriasis, accounting for 6-13% of psoriasis patients in China.
Psoriatic arthritis
Its clinical manifestations are complex and varied. In addition to skin and nail lesions, it often involves small joints of hands and feet such as interphalangeal joints, metacarpophalangeal joints and metatarsophalangeal joints, and can also involve wrists, elbows, ankles and knees.
The main pathogenesis of psoriatic arthritis is related to genetic and environmental factors, angiogenesis and other factors. The genes associated with psoriatic arthritis are more complex, and the largest genome-wide association study identified L-23R as the gene most strongly associated with psoriatic arthritis, which is associated with attachment point inflammation in animal models of psoriatic arthritis.
Environmental factors, including trauma, infection, smoking, stress and obesity, all predispose to the development of psoriatic arthritis in genetically susceptible individuals.
Second, in the synovium of patients with psoriatic arthritis, the presence of a large number of immature blood vessels maintaining plasticity can trigger endothelial cell activation and sprouting, while reducing endothelial cell apoptosis, which also increases the chance of arthritis to some extent.
The right remedy for the right condition can work wonders! In recent years, with the development of immunology and genetics, the clinical treatment of psoriatic arthritis has developed rapidly, especially the emergence of biological agents has significantly improved the treatment effect, significantly improved the prognosis, and greatly improved the quality of life of patients.
Traditional drugs: Since the clinical manifestations of psoriatic arthritis involve many aspects, an individualized treatment plan should be formulated according to the area involved in the lesion, combined with the specific overall situation. Commonly used traditional drugs include NSAIDs, methotrexate, salazosulfapyridine and cyclosporine.
Emerging drugs: Treatment options for psoriatic arthritis have been revolutionized by the development of biologic disease-modifying antirheumatic drugs and small-molecule targeted disease-modifying antirheumatic drugs. Although these drugs were originally developed for the treatment of rheumatoid arthritis, they have also shown good efficacy in psoriasis, PsA, and can improve the prognosis of arthritis.
2, psoriasis and vitiligo
Vitiligo is an acquired, depigmented skin mucosal disease. Like psoriasis, vitiligo has a long-lasting course, is easy to diagnose and difficult to treat, recurring, and also can seriously damage the patient’s appearance. The two types of diseases have been studied in depth by some scholars.
Vitiligo
The results prove that both psoriasis and vitiligo are easily combined with other autoimmune diseases, and there is a subtle relationship between these two types of diseases.
In vitiligo patients, the prevalence of psoriasis will be much higher than that of the healthy population. In this regard, foreign scholars also confirmed with a large amount of data that the chances of psoriasis are significantly higher in vitiligo patients, and vitiligo and psoriasis have a common immunological basis.
For psoriasis combined with vitiligo, currently more clinical treatment by UVB, especially with the scientific research in recent years found that the use of narrow UVB (NB-UVB) treatment effect is much higher than the broad UVB.
For psoriasis, broad UV treatment may cause the death of inflammatory cells, while UVB in the UV spectrum has a more powerful penetrating ability, and it has been clinically proven that most of the light can be absorbed by the epidermis.
Therefore, it can more widely induce the death of a large number of T-cell lesions during the treatment of psoriasis and inhibit the activation of Langerhans cells, which eventually has the effect of promoting T-cell apoptosis.
For vitiligo, UVB treatment for vitiligo is a very effective and safe method with good effect and less adverse reactions.
In order to control the safety and avoid causing more damage to the patient, it is appropriate to irradiate 3 times a week with phototherapy, but if in case of time emergency you can also carry out 5 times a week with phototherapy, there is no significant difference in the treatment effect between the two.
3.Psoriasis and Crohn’s disease
Psoriasis and Crohn’s disease also have a very close connection. The mechanism of combined pathogenesis is not yet clear, but it is considered to be related to the complex path disorder of the whole immune system of the organism, and there may be certain similar genetic susceptibility genes or environmental factors between psoriasis and Crohn’s disease.
Crohn’s disease
The commonality in the pathogenesis of these two diseases is the breakthrough for treatment. Some foreign scholars have proposed that drugs such as infliximab, adalimumab, utekinumab and suginumab can be used to treat psoriasis and Crohn’s disease, especially for patients with psoriasis combined with Crohn’s disease. However, the specific use of drugs needs to be decided after taking into account the individual patient’s condition.
There is no complete cure for psoriasis at the moment, so all we can do now is to control the number of recurrences and prevent the emergence of serious co-morbidities. We all know that there is still a long way to go in the fight against psoriasis, but please don’t give up, walk a little more, wait a little more, and maybe the opportunity for a cure is around the next corner.
References
[1]Zhang Hua, Dai Shengming. Advances in the diagnosis and treatment of psoriatic arthritis [J]. Modern Practical Medicine,2021,12(33):1543-1545.
[2]Meng JH,Zhao HT,Chen HY. Research progress on the pathogenesis of psoriatic arthritis[J]. Chinese Journal of Immunology,2021(37):119-121.
[3]Jiang QB. Narrow-spectrum UVB phototherapy for psoriasis and vitiligo[J]. Electronic Journal of Modern Medicine and Health Research,2017,1(06):31-32.
[4]Zhao Yanxia,Jia Tingting,Wang Pengyu,Zhang Junling,Ding Suxian. Current status of research on clinical features of vitiligo[J]. Chinese Journal of Integrative Dermatology and Venereology,2020,19(04):388-390.
[5]Cao R, Su QIANYA, Dong CZB, Wang F. Psoriasis complicated by Crohn’s disease[J]. Journal of Clinical Dermatology,2020,49(02):98-100.
[6]Fang Shu. Psoriasis[M]. Beijing:China Medical Science and Technology Press,2014:38-40.