title: Erythroid disturbances before and after treatment of Portuguese psoriasis vulgaris patients: a cross-sectional and longitudinal study.
abstract: BACKGROUND
  A few studies in psoriasis vulgaris patients have reported changes suggesting red blood cell (RBC) damage is linked to neutrophil activation, oxidative stress, and psoriasis worsening.
  
  
  OBJECTIVE
  The aim of this study was to evaluate erythroid disturbances in Portuguese psoriasis vulgaris patients, before, during, and after treatment.
  
  
  METHODS
  A cross-sectional study (n = 73 patients vs 40 healthy control subjects) followed by a longitudinal study (n = 47 patients) was performed, with assessments before, and at 3, 6, and 12 weeks of therapy (10 patients started topical treatment, 17 narrow-band UVB, and 20 photochemotherapy [psoralen plus UVA; PUVA]). Evaluations included hematologic data, total bilirubin levels, membrane-bound hemoglobin (MBH), membrane protein band 3 profile, total plasma antioxidant status (TAS), lipid peroxidation (thiobarbituric acid [TBA] assay), elastase, lactoferrin, and C-reactive protein (CRP).
  
  
  RESULTS
  Before treatment, patients presented with higher leukocyte/neutrophil and reticulocyte counts, elastase, lactoferrin, TBA, TBA/TAS, reticulocyte production index, total bilirubin and MBH values, lower RBC and hematocrit, higher percentages of high-molecular-weight aggregates, and lower percentages of band 3 monomer. After treatment, we observed a reversal in most of the parameters. However, patients still presented with values suggestive of accelerated RBC damage, removal, and production, as most of the parameters were still higher than those in the control group; the same occurred with CRP.
  
  
  CONCLUSIONS
  Our data suggest that psoriasis vulgaris triggers an inflammatory response, with release of acute-phase reactants, reactive oxygen species, cationic proteins, and proteases, leading to enhanced RBC damage/aging and, ultimately, to enhanced RBC removal. These assumptions were strengthened by the observation that, with treatment, all of these changes were reversed, the inflammation was reduced, the production of reticulocytes was increased, and the RBCs presented changes usually observed in younger/less damaged RBCs. These erythroid changes were enhanced with PUVA therapy, probably due to the more pronounced clearing of the lesions, as suggested by Psoriasis Area and Severity Index (PASI) scores. Finally, after treatment, a residual inflammation still persisted that might contribute to the observed erythroid disturbances.
authors: Department of Biological Sciences, Biochemistry, University of Porto, Portugal. ssn.coimbra@gmail.com
authors: Susana
authors: S
authors: Coimbra
authors: Hugo
authors: H
authors: Oliveira
authors: Flávio
authors: F
authors: Reis
authors: Luís
authors: L
authors: Belo
authors: Susana
authors: S
authors: Rocha
authors: Alexandre
authors: A
authors: Quintanilha
authors: Américo
authors: A
authors: Figueiredo
authors: Frederico
authors: F
authors: Teixeira
authors: Elisabeth
authors: E
authors: Castro
authors: Petronila
authors: P
authors: Rocha-Pereira
authors: Alice
authors: A
authors: Santos-Silva
mesh_terms: D000328:Adult; D001623:Betamethasone / Q000031:analogs & derivatives / Q000627:therapeutic use; D002117:Calcitriol / Q000031:analogs & derivatives / Q000627:therapeutic use; D003430:Cross-Sectional Studies; D003879:Dermatologic Agents / Q000627:therapeutic use; D041905:Erythroid Cells / Q000473:pathology*; D005260:Female; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D018375:Neutrophil Activation; D018384:Oxidative Stress; D010778:Photochemotherapy; D011565:Psoriasis / Q000097:blood* / Q000276:immunology / Q000473:pathology / Q000628:therapy; D014467:Ultraviolet Therapy
chemical_list: D003879:Dermatologic Agents; C055085:calcipotriene; C011175:betamethasone-17,21-dipropionate; D001623:Betamethasone; D002117:Calcitriol