title: Severity of Psoriasis Associates With Aortic Vascular Inflammation Detected by FDG PET/CT and Neutrophil Activation in a Prospective Observational Study.
abstract: OBJECTIVE
  To understand whether directly measured psoriasis severity is associated with vascular inflammation assessed by (18)F-fluorodeoxyglucose positron emission tomography computed tomography.
  
  
  METHODS
  In-depth cardiovascular and metabolic phenotyping was performed in adult psoriasis patients (n=60) and controls (n=20). Psoriasis severity was measured using psoriasis area severity index. Vascular inflammation was measured using average aortic target-to-background ratio using (18)F-fluorodeoxyglucose positron emission tomography computed tomography.
  
  
  RESULTS
  Both the psoriasis patients (28 men and 32 women, mean age 47 years) and controls (13 men and 7 women, mean age 41 years) were young with low cardiovascular risk. Psoriasis area severity index scores (median 5.4; interquartile range 2.8-8.3) were consistent with mild-to-moderate skin disease severity. Increasing psoriasis area severity index score was associated with an increase in aortic target-to-background ratio (β=0.41, P=0.001), an association that changed little after adjustment for age, sex, and Framingham risk score. We observed evidence of increased neutrophil frequency (mean psoriasis, 3.7±1.2 versus 2.9±1.2; P=0.02) and activation by lower neutrophil surface CD16 and CD62L in blood. Serum levels of S100A8/A9 (745.1±53.3 versus 195.4±157.8 ng/mL; P<0.01) and neutrophil elastase-1 (43.0±2.4 versus 30.8±6.7 ng/mL; P<0.001) were elevated in psoriasis. Finally, S100A8/A9 protein was related to both psoriasis skin disease severity (β=0.53; P=0.02) and vascular inflammation (β=0.48; P=0.02).
  
  
  CONCLUSIONS
  Psoriasis severity is associated with vascular inflammation beyond cardiovascular risk factors. Psoriasis increased neutrophil activation and neutrophil markers, and S100A8/A9 was related to both skin disease severity and vascular inflammation.
authors.affiliation: From the Cardiovascular and Pulmonary Branch, National Heart, Lung, and Blood Institute (H.B.N., B.N., E.S., H.T., T.S., Q.N., A.A.J., J.D., S.M.R., J.D., M.P.P., N.N.M.), Dermatology Branch, Center for Cancer Research, National Cancer Institute (H.B.N.), Molecular Biomedical Imaging Laboratory (M.A.A.), and Systemic Autoimmunity Branch, National Institute of Arthritis and Musculoskeletal and Skin Diseases (M.J.K.), National Institutes of Health, Bethesda, MD; Englewood Hospital, NJ (P.K.); The Washington Dermatology Center, Rockville, MD (R.B.P.); Department of Dermatology, George Washington Hospital, Washington DC (R.B.P., A.E.); DermAssociates, Silver Spring, MD (B.N.L.); and Department of Dermatology, Department of Biostatistics and Epidemiology, and Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania, Philadelphia (J.M.G.).
authors.forename: Haley B
authors.initials: HB
authors.lastname: Naik
authors.affiliation: From the Cardiovascular and Pulmonary Branch, National Heart, Lung, and Blood Institute (H.B.N., B.N., E.S., H.T., T.S., Q.N., A.A.J., J.D., S.M.R., J.D., M.P.P., N.N.M.), Dermatology Branch, Center for Cancer Research, National Cancer Institute (H.B.N.), Molecular Biomedical Imaging Laboratory (M.A.A.), and Systemic Autoimmunity Branch, National Institute of Arthritis and Musculoskeletal and Skin Diseases (M.J.K.), National Institutes of Health, Bethesda, MD; Englewood Hospital, NJ (P.K.); The Washington Dermatology Center, Rockville, MD (R.B.P.); Department of Dermatology, George Washington Hospital, Washington DC (R.B.P., A.E.); DermAssociates, Silver Spring, MD (B.N.L.); and Department of Dermatology, Department of Biostatistics and Epidemiology, and Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania, Philadelphia (J.M.G.).
authors.forename: Balaji
authors.initials: B
authors.lastname: Natarajan
authors.affiliation: From the Cardiovascular and Pulmonary Branch, National Heart, Lung, and Blood Institute (H.B.N., B.N., E.S., H.T., T.S., Q.N., A.A.J., J.D., S.M.R., J.D., M.P.P., N.N.M.), Dermatology Branch, Center for Cancer Research, National Cancer Institute (H.B.N.), Molecular Biomedical Imaging Laboratory (M.A.A.), and Systemic Autoimmunity Branch, National Institute of Arthritis and Musculoskeletal and Skin Diseases (M.J.K.), National Institutes of Health, Bethesda, MD; Englewood Hospital, NJ (P.K.); The Washington Dermatology Center, Rockville, MD (R.B.P.); Department of Dermatology, George Washington Hospital, Washington DC (R.B.P., A.E.); DermAssociates, Silver Spring, MD (B.N.L.); and Department of Dermatology, Department of Biostatistics and Epidemiology, and Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania, Philadelphia (J.M.G.).
authors.forename: Elena
authors.initials: E
authors.lastname: Stansky
authors.affiliation: From the Cardiovascular and Pulmonary Branch, National Heart, Lung, and Blood Institute (H.B.N., B.N., E.S., H.T., T.S., Q.N., A.A.J., J.D., S.M.R., J.D., M.P.P., N.N.M.), Dermatology Branch, Center for Cancer Research, National Cancer Institute (H.B.N.), Molecular Biomedical Imaging Laboratory (M.A.A.), and Systemic Autoimmunity Branch, National Institute of Arthritis and Musculoskeletal and Skin Diseases (M.J.K.), National Institutes of Health, Bethesda, MD; Englewood Hospital, NJ (P.K.); The Washington Dermatology Center, Rockville, MD (R.B.P.); Department of Dermatology, George Washington Hospital, Washington DC (R.B.P., A.E.); DermAssociates, Silver Spring, MD (B.N.L.); and Department of Dermatology, Department of Biostatistics and Epidemiology, and Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania, Philadelphia (J.M.G.).
authors.forename: Mark A
authors.initials: MA
authors.lastname: Ahlman
authors.affiliation: From the Cardiovascular and Pulmonary Branch, National Heart, Lung, and Blood Institute (H.B.N., B.N., E.S., H.T., T.S., Q.N., A.A.J., J.D., S.M.R., J.D., M.P.P., N.N.M.), Dermatology Branch, Center for Cancer Research, National Cancer Institute (H.B.N.), Molecular Biomedical Imaging Laboratory (M.A.A.), and Systemic Autoimmunity Branch, National Institute of Arthritis and Musculoskeletal and Skin Diseases (M.J.K.), National Institutes of Health, Bethesda, MD; Englewood Hospital, NJ (P.K.); The Washington Dermatology Center, Rockville, MD (R.B.P.); Department of Dermatology, George Washington Hospital, Washington DC (R.B.P., A.E.); DermAssociates, Silver Spring, MD (B.N.L.); and Department of Dermatology, Department of Biostatistics and Epidemiology, and Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania, Philadelphia (J.M.G.).
authors.forename: Heather
authors.initials: H
authors.lastname: Teague
authors.affiliation: From the Cardiovascular and Pulmonary Branch, National Heart, Lung, and Blood Institute (H.B.N., B.N., E.S., H.T., T.S., Q.N., A.A.J., J.D., S.M.R., J.D., M.P.P., N.N.M.), Dermatology Branch, Center for Cancer Research, National Cancer Institute (H.B.N.), Molecular Biomedical Imaging Laboratory (M.A.A.), and Systemic Autoimmunity Branch, National Institute of Arthritis and Musculoskeletal and Skin Diseases (M.J.K.), National Institutes of Health, Bethesda, MD; Englewood Hospital, NJ (P.K.); The Washington Dermatology Center, Rockville, MD (R.B.P.); Department of Dermatology, George Washington Hospital, Washington DC (R.B.P., A.E.); DermAssociates, Silver Spring, MD (B.N.L.); and Department of Dermatology, Department of Biostatistics and Epidemiology, and Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania, Philadelphia (J.M.G.).
authors.forename: Taufiq
authors.initials: T
authors.lastname: Salahuddin
authors.affiliation: From the Cardiovascular and Pulmonary Branch, National Heart, Lung, and Blood Institute (H.B.N., B.N., E.S., H.T., T.S., Q.N., A.A.J., J.D., S.M.R., J.D., M.P.P., N.N.M.), Dermatology Branch, Center for Cancer Research, National Cancer Institute (H.B.N.), Molecular Biomedical Imaging Laboratory (M.A.A.), and Systemic Autoimmunity Branch, National Institute of Arthritis and Musculoskeletal and Skin Diseases (M.J.K.), National Institutes of Health, Bethesda, MD; Englewood Hospital, NJ (P.K.); The Washington Dermatology Center, Rockville, MD (R.B.P.); Department of Dermatology, George Washington Hospital, Washington DC (R.B.P., A.E.); DermAssociates, Silver Spring, MD (B.N.L.); and Department of Dermatology, Department of Biostatistics and Epidemiology, and Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania, Philadelphia (J.M.G.).
authors.forename: Qimin
authors.initials: Q
authors.lastname: Ng
authors.affiliation: From the Cardiovascular and Pulmonary Branch, National Heart, Lung, and Blood Institute (H.B.N., B.N., E.S., H.T., T.S., Q.N., A.A.J., J.D., S.M.R., J.D., M.P.P., N.N.M.), Dermatology Branch, Center for Cancer Research, National Cancer Institute (H.B.N.), Molecular Biomedical Imaging Laboratory (M.A.A.), and Systemic Autoimmunity Branch, National Institute of Arthritis and Musculoskeletal and Skin Diseases (M.J.K.), National Institutes of Health, Bethesda, MD; Englewood Hospital, NJ (P.K.); The Washington Dermatology Center, Rockville, MD (R.B.P.); Department of Dermatology, George Washington Hospital, Washington DC (R.B.P., A.E.); DermAssociates, Silver Spring, MD (B.N.L.); and Department of Dermatology, Department of Biostatistics and Epidemiology, and Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania, Philadelphia (J.M.G.).
authors.forename: Aditya A
authors.initials: AA
authors.lastname: Joshi
authors.affiliation: From the Cardiovascular and Pulmonary Branch, National Heart, Lung, and Blood Institute (H.B.N., B.N., E.S., H.T., T.S., Q.N., A.A.J., J.D., S.M.R., J.D., M.P.P., N.N.M.), Dermatology Branch, Center for Cancer Research, National Cancer Institute (H.B.N.), Molecular Biomedical Imaging Laboratory (M.A.A.), and Systemic Autoimmunity Branch, National Institute of Arthritis and Musculoskeletal and Skin Diseases (M.J.K.), National Institutes of Health, Bethesda, MD; Englewood Hospital, NJ (P.K.); The Washington Dermatology Center, Rockville, MD (R.B.P.); Department of Dermatology, George Washington Hospital, Washington DC (R.B.P., A.E.); DermAssociates, Silver Spring, MD (B.N.L.); and Department of Dermatology, Department of Biostatistics and Epidemiology, and Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania, Philadelphia (J.M.G.).
authors.forename: Parasuram
authors.initials: P
authors.lastname: Krishnamoorthy
authors.affiliation: From the Cardiovascular and Pulmonary Branch, National Heart, Lung, and Blood Institute (H.B.N., B.N., E.S., H.T., T.S., Q.N., A.A.J., J.D., S.M.R., J.D., M.P.P., N.N.M.), Dermatology Branch, Center for Cancer Research, National Cancer Institute (H.B.N.), Molecular Biomedical Imaging Laboratory (M.A.A.), and Systemic Autoimmunity Branch, National Institute of Arthritis and Musculoskeletal and Skin Diseases (M.J.K.), National Institutes of Health, Bethesda, MD; Englewood Hospital, NJ (P.K.); The Washington Dermatology Center, Rockville, MD (R.B.P.); Department of Dermatology, George Washington Hospital, Washington DC (R.B.P., A.E.); DermAssociates, Silver Spring, MD (B.N.L.); and Department of Dermatology, Department of Biostatistics and Epidemiology, and Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania, Philadelphia (J.M.G.).
authors.forename: Jenny
authors.initials: J
authors.lastname: Dave
authors.affiliation: From the Cardiovascular and Pulmonary Branch, National Heart, Lung, and Blood Institute (H.B.N., B.N., E.S., H.T., T.S., Q.N., A.A.J., J.D., S.M.R., J.D., M.P.P., N.N.M.), Dermatology Branch, Center for Cancer Research, National Cancer Institute (H.B.N.), Molecular Biomedical Imaging Laboratory (M.A.A.), and Systemic Autoimmunity Branch, National Institute of Arthritis and Musculoskeletal and Skin Diseases (M.J.K.), National Institutes of Health, Bethesda, MD; Englewood Hospital, NJ (P.K.); The Washington Dermatology Center, Rockville, MD (R.B.P.); Department of Dermatology, George Washington Hospital, Washington DC (R.B.P., A.E.); DermAssociates, Silver Spring, MD (B.N.L.); and Department of Dermatology, Department of Biostatistics and Epidemiology, and Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania, Philadelphia (J.M.G.).
authors.forename: Shawn M
authors.initials: SM
authors.lastname: Rose
authors.affiliation: From the Cardiovascular and Pulmonary Branch, National Heart, Lung, and Blood Institute (H.B.N., B.N., E.S., H.T., T.S., Q.N., A.A.J., J.D., S.M.R., J.D., M.P.P., N.N.M.), Dermatology Branch, Center for Cancer Research, National Cancer Institute (H.B.N.), Molecular Biomedical Imaging Laboratory (M.A.A.), and Systemic Autoimmunity Branch, National Institute of Arthritis and Musculoskeletal and Skin Diseases (M.J.K.), National Institutes of Health, Bethesda, MD; Englewood Hospital, NJ (P.K.); The Washington Dermatology Center, Rockville, MD (R.B.P.); Department of Dermatology, George Washington Hospital, Washington DC (R.B.P., A.E.); DermAssociates, Silver Spring, MD (B.N.L.); and Department of Dermatology, Department of Biostatistics and Epidemiology, and Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania, Philadelphia (J.M.G.).
authors.forename: Julia
authors.initials: J
authors.lastname: Doveikis
authors.affiliation: From the Cardiovascular and Pulmonary Branch, National Heart, Lung, and Blood Institute (H.B.N., B.N., E.S., H.T., T.S., Q.N., A.A.J., J.D., S.M.R., J.D., M.P.P., N.N.M.), Dermatology Branch, Center for Cancer Research, National Cancer Institute (H.B.N.), Molecular Biomedical Imaging Laboratory (M.A.A.), and Systemic Autoimmunity Branch, National Institute of Arthritis and Musculoskeletal and Skin Diseases (M.J.K.), National Institutes of Health, Bethesda, MD; Englewood Hospital, NJ (P.K.); The Washington Dermatology Center, Rockville, MD (R.B.P.); Department of Dermatology, George Washington Hospital, Washington DC (R.B.P., A.E.); DermAssociates, Silver Spring, MD (B.N.L.); and Department of Dermatology, Department of Biostatistics and Epidemiology, and Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania, Philadelphia (J.M.G.).
authors.forename: Martin P
authors.initials: MP
authors.lastname: Playford
authors.affiliation: From the Cardiovascular and Pulmonary Branch, National Heart, Lung, and Blood Institute (H.B.N., B.N., E.S., H.T., T.S., Q.N., A.A.J., J.D., S.M.R., J.D., M.P.P., N.N.M.), Dermatology Branch, Center for Cancer Research, National Cancer Institute (H.B.N.), Molecular Biomedical Imaging Laboratory (M.A.A.), and Systemic Autoimmunity Branch, National Institute of Arthritis and Musculoskeletal and Skin Diseases (M.J.K.), National Institutes of Health, Bethesda, MD; Englewood Hospital, NJ (P.K.); The Washington Dermatology Center, Rockville, MD (R.B.P.); Department of Dermatology, George Washington Hospital, Washington DC (R.B.P., A.E.); DermAssociates, Silver Spring, MD (B.N.L.); and Department of Dermatology, Department of Biostatistics and Epidemiology, and Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania, Philadelphia (J.M.G.).
authors.forename: Ronald B
authors.initials: RB
authors.lastname: Prussick
authors.affiliation: From the Cardiovascular and Pulmonary Branch, National Heart, Lung, and Blood Institute (H.B.N., B.N., E.S., H.T., T.S., Q.N., A.A.J., J.D., S.M.R., J.D., M.P.P., N.N.M.), Dermatology Branch, Center for Cancer Research, National Cancer Institute (H.B.N.), Molecular Biomedical Imaging Laboratory (M.A.A.), and Systemic Autoimmunity Branch, National Institute of Arthritis and Musculoskeletal and Skin Diseases (M.J.K.), National Institutes of Health, Bethesda, MD; Englewood Hospital, NJ (P.K.); The Washington Dermatology Center, Rockville, MD (R.B.P.); Department of Dermatology, George Washington Hospital, Washington DC (R.B.P., A.E.); DermAssociates, Silver Spring, MD (B.N.L.); and Department of Dermatology, Department of Biostatistics and Epidemiology, and Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania, Philadelphia (J.M.G.).
authors.forename: Alison
authors.initials: A
authors.lastname: Ehrlich
authors.affiliation: From the Cardiovascular and Pulmonary Branch, National Heart, Lung, and Blood Institute (H.B.N., B.N., E.S., H.T., T.S., Q.N., A.A.J., J.D., S.M.R., J.D., M.P.P., N.N.M.), Dermatology Branch, Center for Cancer Research, National Cancer Institute (H.B.N.), Molecular Biomedical Imaging Laboratory (M.A.A.), and Systemic Autoimmunity Branch, National Institute of Arthritis and Musculoskeletal and Skin Diseases (M.J.K.), National Institutes of Health, Bethesda, MD; Englewood Hospital, NJ (P.K.); The Washington Dermatology Center, Rockville, MD (R.B.P.); Department of Dermatology, George Washington Hospital, Washington DC (R.B.P., A.E.); DermAssociates, Silver Spring, MD (B.N.L.); and Department of Dermatology, Department of Biostatistics and Epidemiology, and Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania, Philadelphia (J.M.G.).
authors.forename: Mariana J
authors.initials: MJ
authors.lastname: Kaplan
authors.affiliation: From the Cardiovascular and Pulmonary Branch, National Heart, Lung, and Blood Institute (H.B.N., B.N., E.S., H.T., T.S., Q.N., A.A.J., J.D., S.M.R., J.D., M.P.P., N.N.M.), Dermatology Branch, Center for Cancer Research, National Cancer Institute (H.B.N.), Molecular Biomedical Imaging Laboratory (M.A.A.), and Systemic Autoimmunity Branch, National Institute of Arthritis and Musculoskeletal and Skin Diseases (M.J.K.), National Institutes of Health, Bethesda, MD; Englewood Hospital, NJ (P.K.); The Washington Dermatology Center, Rockville, MD (R.B.P.); Department of Dermatology, George Washington Hospital, Washington DC (R.B.P., A.E.); DermAssociates, Silver Spring, MD (B.N.L.); and Department of Dermatology, Department of Biostatistics and Epidemiology, and Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania, Philadelphia (J.M.G.).
authors.forename: Benjamin N
authors.initials: BN
authors.lastname: Lockshin
authors.affiliation: From the Cardiovascular and Pulmonary Branch, National Heart, Lung, and Blood Institute (H.B.N., B.N., E.S., H.T., T.S., Q.N., A.A.J., J.D., S.M.R., J.D., M.P.P., N.N.M.), Dermatology Branch, Center for Cancer Research, National Cancer Institute (H.B.N.), Molecular Biomedical Imaging Laboratory (M.A.A.), and Systemic Autoimmunity Branch, National Institute of Arthritis and Musculoskeletal and Skin Diseases (M.J.K.), National Institutes of Health, Bethesda, MD; Englewood Hospital, NJ (P.K.); The Washington Dermatology Center, Rockville, MD (R.B.P.); Department of Dermatology, George Washington Hospital, Washington DC (R.B.P., A.E.); DermAssociates, Silver Spring, MD (B.N.L.); and Department of Dermatology, Department of Biostatistics and Epidemiology, and Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania, Philadelphia (J.M.G.).
authors.forename: Joel M
authors.initials: JM
authors.lastname: Gelfand
authors.affiliation: From the Cardiovascular and Pulmonary Branch, National Heart, Lung, and Blood Institute (H.B.N., B.N., E.S., H.T., T.S., Q.N., A.A.J., J.D., S.M.R., J.D., M.P.P., N.N.M.), Dermatology Branch, Center for Cancer Research, National Cancer Institute (H.B.N.), Molecular Biomedical Imaging Laboratory (M.A.A.), and Systemic Autoimmunity Branch, National Institute of Arthritis and Musculoskeletal and Skin Diseases (M.J.K.), National Institutes of Health, Bethesda, MD; Englewood Hospital, NJ (P.K.); The Washington Dermatology Center, Rockville, MD (R.B.P.); Department of Dermatology, George Washington Hospital, Washington DC (R.B.P., A.E.); DermAssociates, Silver Spring, MD (B.N.L.); and Department of Dermatology, Department of Biostatistics and Epidemiology, and Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania, Philadelphia (J.M.G.). nehal.mehta@nih.gov.
authors.forename: Nehal N
authors.initials: NN
authors.lastname: Mehta
mesh_terms: D000328:Adult; D001025:Aortitis / Q000097:blood / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000276:immunology; D015415:Biomarkers / Q000097:blood; D016022:Case-Control Studies; D005260:Female; D019788:Fluorodeoxyglucose F18; D006801:Humans; D007113:Immunity, Innate; D018836:Inflammation Mediators / Q000097:blood; D007958:Leukocyte Count; D008297:Male; D008875:Middle Aged; D064847:Multimodal Imaging / Q000379:methods*; D018375:Neutrophil Activation; D009504:Neutrophils / Q000276:immunology*; D049268:Positron-Emission Tomography; D011237:Predictive Value of Tests; D011446:Prospective Studies; D011565:Psoriasis / Q000097:blood / Q000175:diagnosis* / Q000276:immunology; D019275:Radiopharmaceuticals; D012720:Severity of Illness Index; D014057:Tomography, X-Ray Computed
chemical_list: D015415:Biomarkers; D018836:Inflammation Mediators; D019275:Radiopharmaceuticals; D019788:Fluorodeoxyglucose F18
keywords: CT; PET; inflammation; neutrophils; psoriasis; vascular inflammation