Impact of Bariatric Surgery on Moderate to Severe Psoriasis: A Retrospective Nationwide Registry Study
DOI:
https://doi.org/10.2340/00015555-3825Keywords:
psoriasis, bariatric surgery, body mass index, Swedish National Register for Systemic Treatment of Psoriasis, Scandinavian Obesity Surgery Registry, Psoriasis Area Severity Index;, Dermatology Life Quality Index; obesityAbstract
Studies of the effects of bariatric surgery on psoriasis are few, with conflicting results. By linking the Swedish National Register for Systemic Treatment of Psoriasis (PsoReg) with the Scandinavian Obesity Surgery Registry (SOReg), individuals with psoriasis who had undergone bariatric surgery in Sweden during 2008 to 2018 were identified, and matched with data for patients with psoriasis in PsoReg. Psoriasis Area Severity Index (PASI) and Dermatology Life Quality Index (DLQI) were compared between the groups. Altogether, 50 operated individuals (median body mass index (BMI) 38.7 kg/m2]) and 91 non-operated individuals (median BMI 33.0 kg/m2) were included. Control of disease at baseline was good in both groups. Linear mixed models showed no significant difference in psoriasis disease burden, measured as changes in mean PASI (ΔPASI) (–1.2, p = 0.43) and DLQI (ΔDLQI) (–2.2, p = 0.34). In summary, this study demonstrated no significant effect of bariatric surgery on psoriasis disease burden in patients with relatively well-controlled moderate to severe psoriasis.
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References
Schon MP, Boehncke WH. Psoriasis. N Engl J Med 2005; 352: 1899-1912.
DOI: https://doi.org/10.1056/NEJMra041320
Sbidian E, Chaimani A, Afach S, Doney L, Dressler C, Hua C, et al. Systemic pharmacological treatments for chronic plaque psoriasis: a network meta-analysis. Cochrane Database Syst Rev 2020; 1: CD011535.
DOI: https://doi.org/10.1002/14651858.CD011535.pub3
Mrowietz U, Kragballe K, Reich K, Spuls P, Griffiths CE, Nast A, et al. Definition of treatment goals for moderate to severe psoriasis: a European consensus. Arch Dermatol Res 2011; 303: 1-10.
DOI: https://doi.org/10.1007/s00403-010-1080-1
Smith CH, Jabbar-Lopez ZK, Yiu ZZ, Bale T, Burden AD, Coates LC, et al. British Association of Dermatologists guidelines for biologic therapy for psoriasis 2017. Br J Dermatol 2017; 177: 628-636.
DOI: https://doi.org/10.1111/bjd.15665
Langan SM, Seminara NM, Shin DB, Troxel AB, Kimmel SE, Mehta NN, et al. Prevalence of metabolic syndrome in patients with psoriasis: a population-based study in the United Kingdom. J Invest Dermatol 2012; 132: 556-562.
DOI: https://doi.org/10.1038/jid.2011.365
Cohen AD, Gilutz H, Henkin Y, Zahger D, Shapiro J, Bonneh DY, et al. Psoriasis and the metabolic syndrome. Acta Derm Venereol 2007; 87: 506-509.
DOI: https://doi.org/10.2340/00015555-0297
Eckel RH, Grundy SM, Zimmet PZ. The metabolic syndrome. Lancet 2005; 365: 1415-1428.
DOI: https://doi.org/10.1016/S0140-6736(05)66378-7
Sutherland JP, McKinley B, Eckel RH. The metabolic syndrome and inflammation. Metab Syndr Relat Disord 2004; 2: 82-104.
DOI: https://doi.org/10.1089/met.2004.2.82
Kumar S, Han J, Li T, Qureshi AA. Obesity, waist circumference, weight change and the risk of psoriasis in US women. J Eur Acad Dermatol Venereol 2013; 27: 1293-1298.
DOI: https://doi.org/10.1111/jdv.12001
Wolk K, Mallbris L, Larsson P, Rosenblad A, Vingard E, Stahle M. Excessive body weight and smoking associates with a high risk of onset of plaque psoriasis. Acta Derm Venereol 2009; 89: 492-497.
DOI: https://doi.org/10.2340/00015555-0711
Armstrong AW, Harskamp CT, Armstrong EJ. The association between psoriasis and obesity: a systematic review and meta-analysis of observational studies. Nutr Diabetes 2012; 2: e54.
DOI: https://doi.org/10.1038/nutd.2012.26
Wolfe BM, Kvach E, Eckel RH. Treatment of obesity: weight loss and bariatric surgery. Circ Res 2016; 118: 1844-1855.
DOI: https://doi.org/10.1161/CIRCRESAHA.116.307591
Higa-Sansone G, Szomstein S, Soto F, Brasecsco O, Cohen C, Rosenthal RJ. Psoriasis remission after laparoscopic Roux-en-Y gastric bypass for morbid obesity. Obes Surg 2004; 14: 1132-1134.
DOI: https://doi.org/10.1381/0960892041975569
de Menezes Ettinger JE, Azaro E, de Souza CA, dos Santos Filho PV, Mello CA, Neves M, Jr., et al. Remission of psoriasis after open gastric bypass. Obes Surg 2006; 16: 94-97.
DOI: https://doi.org/10.1381/096089206775221998
Farias MM, Achurra P, Boza C, Vega A, de la Cruz C. Psoriasis following bariatric surgery: clinical evolution and impact on quality of life on 10 patients. Obes Surg 2012; 22: 877-880.
DOI: https://doi.org/10.1007/s11695-012-0646-8
Romero-Talamás H, Aminian A, Corcelles R, Fernandez AP, Schauer PR, Brethauer S. Psoriasis improvement after bariatric surgery. Surg Obes Relat Dis 2014; 10: 1155-1159.
DOI: https://doi.org/10.1016/j.soard.2014.03.025
Hossler EW, Wood GC, Still CD, Mowad CM, Maroon MS. The effect of weight loss surgery on the severity of psoriasis. Br J Dermatol 2013; 168: 660-661.
DOI: https://doi.org/10.1111/j.1365-2133.2012.11211.x
Egeberg A, Sorensen JA, Gislason GH, Knop FK, Skov L. Incidence and prognosis of psoriasis and psoriatic arthritis in patients undergoing bariatric surgery. JAMA Surg 2017; 152: 344-349.
DOI: https://doi.org/10.1001/jamasurg.2016.4610
Maglio C, Peltonen M, Rudin A, Carlsson LMS. Bariatric surgery and the incidence of psoriasis and psoriatic arthritis in the Swedish Obese Subjects Study. Obesity (Silver Spring) 2017; 25: 2068-2073.
DOI: https://doi.org/10.1002/oby.21955
Sako EY, Famenini S, Wu JJ. Bariatric surgery and psoriasis. J Am Acad Dermatol 2014; 70: 774-779.
DOI: https://doi.org/10.1016/j.jaad.2013.11.010
Nowlin N, Solomon H. Letter: Weight loss and psoriasis. Arch Dermatol 1976; 112: 1465.
DOI: https://doi.org/10.1001/archderm.1976.01630340077022
Perez-Perez L, Allegue F, Caeiro JL, Zulaica JM. Severe psoriasis, morbid obesity and bariatric surgery. Clin Exp Dermatol 2009; 34: e421-422.
DOI: https://doi.org/10.1111/j.1365-2230.2009.03406.x
Hjalte F, Carlsson KS, Schmitt-Egenolf M. Sustained Psoriasis Area and Severity Index, Dermatology Life Quality Index and EuroQol-5D response of biological treatment in psoriasis: 10 years of real-world data in the Swedish National Psoriasis Register. Br J Dermatol 2018; 178: 245-252.
DOI: https://doi.org/10.1111/bjd.15757
Nationella kvalitetsregistret för systembehandling av psoriasis. Psoreg:s årsrapport för 2018. 2018.
Paul C, Gourraud PA, Bronsard V, Prey S, Puzenat E, Aractingi S, et al. Evidence-based recommendations to assess psoriasis severity: systematic literature review and expert opinion of a panel of dermatologists. J Eur Acad Dermatol Venereol 2010; 24: 2-9.
DOI: https://doi.org/10.1111/j.1468-3083.2009.03561.x
Fredriksson T, Pettersson U. Severe psoriasis - oral therapy with a new retinoid. Dermatologica 1978; 157: 238-244.
DOI: https://doi.org/10.1159/000250839
Finlay AY, Khan GK. Dermatology Life Quality Index (DLQI) - a simple practical measure for routine clinical use. Clin Exp Dermatol 1994; 19: 210-216.
DOI: https://doi.org/10.1111/j.1365-2230.1994.tb01167.x
Schmitt-Egenolf M. PsoReg - the Swedish registry for systemic psoriasis treatment. The registry's design and objectives. Dermatology 2007; 214: 112-117.
DOI: https://doi.org/10.1159/000098568
Sundbom M, Naslund I, Naslund E, Ottosson J. High acquisition rate and internal validity in the Scandinavian Obesity Surgery Registry. Surg Obes Relat Dis 2020; 10.1016/j.soard.2020.10.017.
DOI: https://doi.org/10.1016/j.soard.2020.10.017
Tao W, Holmberg D, Naslund E, Naslund I, Mattsson F, Lagergren J, et al. Validation of Obesity Surgery Data in the Swedish National Patient Registry and Scandinavian Obesity Registry (SOReg). Obes Surg 2016; 26: 1750-1756.
DOI: https://doi.org/10.1007/s11695-015-1994-y
Puzenat E, Bronsard V, Prey S, Gourraud PA, Aractingi S, Bagot M, et al. What are the best outcome measures for assessing plaque psoriasis severity? A systematic review of the literature. J Eur Acad Dermatol Venereol 2010; 24: 10-16.
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