During her eight-year career, Leila Tolaymat, M.D., a dermatologist, has witnessed an evolution in psoriatic disease. Early on, patients with psoriasis and psoriatic arthritis were treated for their skin and joint problems alone.
Now, Dr. Tolaymat says: “We’re recognizing that they’re underscreened and potentially undertreated for cardiovascular risk factors.”
Dr. Tolaymat, who is affiliated with the Mayo Clinic in Jacksonville, Florida, says the shift can be credited to the recognition that psoriasis and psoriatic arthritis are inflammatory conditions, and that low-grade, systemic inflammation can affect other parts of the body — mainly the vascular system.
“Inflammation in the body increases our risk for cardiovascular events,” she says.
At minimum, Dr. Tolaymat says she recommends that her patients see a primary care physician for cardiovascular screenings.
“I also talk to patients about lifestyle interventions and working toward smoking cessation. One of the things we’re trying to look at: Do [dermatologists] need to make more significant changes to the way we screen patients for cardiovascular risk factors?”
Lihi Eder, M.D., a rheumatologist and researcher based at the Women’s College Hospital in Toronto, thinks so.
In February of 2018, the Journal of Rheumatology published a study authored by Dr. Eder and a fleet of collaborators detailing how patients with psoriasis and psoriatic arthritis are both under-diagnosed and undertreated for cardiovascular risk factors and disease. The wide-ranging analysis, which launched in 2006, studied the health data of 2,254 participants from eight health sites in Canada and the United States and one in Israel.
“The first things that our manuscript highlights are the gaps in care,” Dr. Eder says. “Awareness is the first step. That doesn’t necessarily mean that dermatologists and rheumatologists need to treat these conditions, but they need to check.”
Up to 60 percent of study participants had undiagnosed or untreated high blood pressure or high cholesterol levels. Amongst the already-diagnosed population, 59.2 percent of patients with high blood pressure and 65.5 percent of patients with high cholesterol were undertreated for their disorders. Dr. Eder also found that patients younger than 50 were more likely to be undertreated for cardiovascular risk and disease.
“We tend to concentrate on psoriasis and arthritis and forget these other things,” she says.
To combat this gap in care, Dr. Eder and a colleague have established a combined cardio-rheumatology clinic at the Women’s College Hospital in Toronto.
“We aim to improve the treatment of these risk factors because we realize that these are patients with complex conditions and comorbidities,” she says. “So sometimes it’s hard for family physicians to manage everything.”
The clinic also has a research component. Dr. Eder hopes to publish a report on the clinic’s patient population in the near future. She’s also tracking lifestyle habits within her patient population. She points to diet (one that is high in fruits and vegetables, fish, nuts, and olive oil), weight loss, and physical activity as potential changes that could improve cardiovascular risk and inflammation.
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Psoriasis: A Strong Predictor of Heart Disease?