Endothelial Dysfunction and the Effects of TNF Inhibitors on the Endothelium in Psoriasis and Psoriatic Arthritis: A Systematic Review
Elizabeth A. Brezinski, Matthew R. Follansbee, Ehrin J. Armstrong and April W. Armstrong
Affiliation: University of California Davis, Department of Dermatology, 3301 C St., Suite 1400 Sacramento, CA 95816, USA.
Background: Epidemiologic data support the association of psoriasis and psoriatic arthritis with adverse cardiovascular outcomes.
Shared pathogenesis in endothelial dysfunction may underlie psoriasis and atherosclerosis. Tumor necrosis factor (TNF) inhibitors
may modulate endothelial dysfunction seen in patients with psoriasis and psoriatic arthritis.
Objective: To perform a systematic review that investigated endothelial function in psoriasis and psoriatic arthritis and the effect of TNF
inhibitors on endothelial function in psoriasis and psoriatic arthritis.
Methods: MEDLINE (1980-October 2012), Web of Science, the EULAR abstract database, and the AAD annual meeting abstract archive
were searched for cross-sectional or longitudinal studies that 1) examined endothelial function in patients with psoriasis or psoriatic
arthritis, or 2) investigated the effect of TNF inhibitor therapy on endothelial function.
Results: Twenty articles and four abstracts with 2261 patients evaluated endothelial function in psoriasis and psoriatic arthritis, which
was measured by pulse wave velocity, flow-mediated dilation, nitroglycerine-induced vasodilation, carotid intima-media thickness, peripheral
arterial tonometry, or aortic stiffness parameters. The majority of the data suggests that patients with psoriasis and psoriatic arthritis
have significantly increased arterial stiffness, impaired endothelial-dependent vasodilation, increased carotid intima-media thickness,
and decreased aortic elasticity compared to the general population. Two out of three studies showed that TNF inhibitors improved
endothelial function in psoriasis and psoriatic arthritis.
Limitations: Measurements of endothelial function were not standardized across studies.
Conclusions: The preponderance of literature suggests that endothelial function is significantly impaired in patients with psoriasis and
psoriatic arthritis compared to the general population. Preliminary evidence suggests that TNF inhibitors may improve endothelial function
in the psoriasis and psoriatic arthritis populations.
Keywords: Psoriasis, psoriatic arthritis, cardiovascular disease, TNF inhibitors, etanercept, adalimumab, infliximab, endothelial dysfunction,
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