title: Psoriasis comorbidities: results from the National Psoriasis Foundation surveys 2003 to 2011.
abstract: BACKGROUND
  Studies examining comorbidities among psoriasis patients with varying disease severities measured by body surface area (BSA) are lacking.
  
  
  OBJECTIVE
  To examine the association between psoriasis severity and comorbid conditions, including rheumatologic, cardiovascular and other immune-mediated diseases.
  
  
  METHODS
  From 2003 to 2011, the National Psoriasis Foundation conducted surveys among 5,604 psoriasis patients. The combined surveys represented the largest study to date that used BSA as a direct measure of psoriasis severity for comorbidity assessment.
  
  
  RESULTS
  Over 86% of psoriatic arthritis (PsA) patients reported presenting with psoriasis prior to PsA; the diagnosis of psoriasis preceded that of PsA by a mean period of 14.6 years. Compared to those with mild psoriasis, patients with moderate-to-severe psoriasis had significantly increased adjusted odds of PsA (moderate: odds ratio, OR: 1.21, 95% confidence interval, CI: 1.04-1.41; severe: OR: 2.32, 95% CI: 1.98-2.70). Patients with severe psoriasis had increased adjusted odds of diabetes (OR: 1.5, 95% CI: 1.08-2.08) and cardiovascular disease (OR: 1.5, 95% CI: 1.01-2.24) compared to those with mild-to-moderate psoriasis. Odds of rheumatoid arthritis, ankylosing spondylitis, lupus, Crohn's disease and multiple sclerosis were not significantly increased in patients with severe psoriasis.
  
  
  CONCLUSIONS
  Compared to those with mild-to-moderate psoriasis, patients with severe psoriasis are at increased odds of PsA, diabetes and cardiovascular diseases.
authors.affiliation: Department of Dermatology, University of California Davis, Sacramento, CA 95816, USA. aprilarmstrong@post.harvard.edu
authors.forename: April W
authors.initials: AW
authors.lastname: Armstrong
authors.forename: Clayton
authors.initials: C
authors.lastname: Schupp
authors.forename: Bruce
authors.initials: B
authors.lastname: Bebo
mesh_terms: D000328:Adult; D000368:Aged; D015535:Arthritis, Psoriatic / Q000453:epidemiology*; D002318:Cardiovascular Diseases / Q000453:epidemiology*; D015897:Comorbidity; D003920:Diabetes Mellitus / Q000453:epidemiology*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D011565:Psoriasis / Q000453:epidemiology*; D012307:Risk Factors; D012720:Severity of Illness Index