The current issue of the American Journal of Cardiology contains a consensus document by dermatologists and cardiologists regarding the increased risk of cardiovascular disease in patients with psoriasis. The relationship between heart disease and psoriasis has been noted since 1961. Large epidemiological studies done since then have added support to the idea that psoriasis patients are indeed at risk for heart disease.

The consensus statement recommends that two groups of psoriasis patients be evaluated for vascular disease: those with moderate to severe psoriasis; and those with mild psoriasis plus a recognized risk factor for vascular disease such as abdominal obesity or hypertension.

A really interesting study from Turkey looked at serum homocysteine levels in patients with psoriasis. Elevated homocysteine levels are a recognized risk factor for heart disease. More recently, psoriasis itself has been proposed as an independent risk factor for heart disease. Two interesting finding from the study should be mentioned. Firstly, overally homocysteine levels did not differ significantly between psoriasis patients and controls. Second, and of possible clinical importance to patients is that homocysteine levels did correlate with the severity of psoriasis. Once conclusion that could possibly be raised by such data is that reducing the severity of psoriasis may in fact reduce the severity of heart disease. Although this has not been studied in and of itself, it may change the risk/benefit profiles of many treatments. The side effects of some psoriasis treatments may be more acceptable if in fact heart disease risk is also being mitigated.

Sometimes guttate psoriasis responds to antibiotics. The rational is that the guttate flare was triggered by a strep infection, possibly a strep throat. Researchers in Bulgaria tested the antibiotic rifampin in 52 patients with guttate psoriasis. Over 60 days they noted about 2/3 improvement in PASI scores. The improvement was similar whether or not the patients had a strep infection. Their hypothesis is that in this instance, the antibiotic rifampin may have acted as a mild immunosuppressant.

The FDA has decided to review information on ustekinumab due to concerns about risks the drug may pose. Of course all biologics have their risks - most of them may increase the chance of infection of malignancy. No additional research will be needed to help the FDA with its approval decision, rather a more extensive review of the existing data is underway. Until they're convinced that ustekinumab is safe enough to use (benefits outweigh risks) then we'll just have to keep waiting. It shouldn't be long now.