title: Effect of treatment with methotrexate and coal tar on adipokine levels and indices of insulin resistance and sensitivity in patients with psoriasis vulgaris.
abstract: OBJECTIVE
  Recent studies have implicated adipokines in the pathogenesis of the immune-mediated inflammatory disease, psoriasis and its associated comorbidities. Hence, we undertook to study adipokine levels and indices of insulin resistance and sensitivity in patients with psoriasis vulgaris, in comparison with controls and their association with disease severity and response to therapy.
  
  
  METHODS
  Sixty cases of psoriasis vulgaris and 60 age- and gender-matched healthy controls were included in this study. Severity grading according to psoriasis area severity index scoring was done in all psoriatics. Serum levels of adipokines [leptin, adiponectin, resistin and interleukin-6 (IL-6)] and insulin were estimated in all psoriatics at baseline and at 12 weeks on follow-up and in controls.
  
  
  RESULTS
  Baseline levels of the inflammatory adipokines (leptin, resistin and IL-6) and insulin resistance indices were significantly higher in psoriatics, as compared to controls, while that of the anti-inflammatory adipokine, adiponectin and insulin sensitivity indices were significantly lower in psoriatics, as compared with controls. Baseline inflammatory adipokines, serum insulin level and insulin resistance indices demonstrated a significant positive correlation with the severity of psoriasis, while the anti-inflammatory adipokine, adiponectin and insulin sensitivity indices demonstrated a significant negative correlation with the disease severity. After 12 weeks of therapy (both topical and systemic), there was a significant reduction in the levels of inflammatory adipokines and a significant increase in the levels of anti-inflammatory adipokine-adiponectin. However, a significant decrease in insulin levels and insulin resistance indices were observed only with systemic therapy with methotrexate.
  
  
  CONCLUSIONS
  The present results implicate that adipokines are significantly associated with pathogenesis of psoriasis and hence adequate and early control of psoriasis may contribute to the decreased development of metabolic syndrome, including the risk of cardiovascular disease.
authors.affiliation: Department of Biochemistry, Jawaharlal Institute of Post Graduate Medical Education and Research, Puducherry, India.
authors.forename: M
authors.initials: M
authors.lastname: Rajappa
authors.forename: S
authors.initials: S
authors.lastname: Rathika
authors.forename: M
authors.initials: M
authors.lastname: Munisamy
authors.forename: L
authors.initials: L
authors.lastname: Chandrashekar
authors.forename: D M
authors.initials: DM
authors.lastname: Thappa
mesh_terms: D052242:Adiponectin / Q000097:blood; D000293:Adolescent; D000328:Adult; D000368:Aged; D016022:Case-Control Studies; D003033:Coal Tar / Q000627:therapeutic use*; D005260:Female; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use*; D007333:Insulin Resistance; D015850:Interleukin-6 / Q000097:blood; D007641:Keratolytic Agents / Q000627:therapeutic use*; D020738:Leptin / Q000097:blood; D008297:Male; D008727:Methotrexate / Q000627:therapeutic use*; D008875:Middle Aged; D011446:Prospective Studies; D011565:Psoriasis / Q000097:blood* / Q000188:drug therapy*; D052243:Resistin / Q000097:blood; D012720:Severity of Illness Index; D055815:Young Adult
chemical_list: D052242:Adiponectin; D007166:Immunosuppressive Agents; D015850:Interleukin-6; D007641:Keratolytic Agents; D020738:Leptin; D052243:Resistin; D003033:Coal Tar; D008727:Methotrexate