Friday, July 11, 2014

Psoriasis and C-Reactive Protein

I was lamenting my high c-reactive protein level while at Twirly Girls recently and Ginger looked at me and said, well psoriasis is inflammation at the cellular level, so that makes sense.


Catch up on the CRP journey below:


Lowering CRP

CRP and Cholesterol

So, I let my teacher, Google, tell me a little bit about psoriasis and inflammation in general.  There's actually a lot out there. 

For example, in THIS study, it discusses CRP, toll-like receptor gene 4 and the development of psoriatic arthritis (I have the full article printed, but I only the abstract is cited in that link).  If I understand the big words properly in this study, although it claims, through citing a previous study, that there is no relationship between elevated CRP gene polymorphisms in psoriasis patients, high CRP levels are common in moderate to severe cases of psoriatic arthritis.  So, at some point, CRP must matter in psoriasis patients. 

In THIS study, they discuss various potential new therapies, but also define it as:

"Psoriasis is a chronic, inflammatory, T-cell-mediated autoimmune disease that affects mainly skin and joints. It is one of the most common inflammatory skin diseases, affecting 2%–3% of the population.

However, psoriasis does not affect skin and joints only. It is a multisystem disease associated with a multitude of comorbidities and thus psoriasis has become increas­ingly important for all medical fields, beyond just dermatology and rheumatology. Psoriasis patients show an increased risk for cardiovascular events. The prevalence of metabolic syndrome – a combination of obesity, dyslipi-demia, impaired glucose regulation, and hypertension – is elevated in psoriasis patients. The prevalence of depression is increased, and psoriasis can have a substantial psycho­logical impact on patients. In addition to this, psoriasis is often associated with other immune-mediated inflammatory disorders. Intriguingly, chronic inflammatory bowel disease, diabetes, and psoriasis have been associated with the same or similar susceptibility genes."

I found a TON of articles talking about psoriasis and various issues: 

Digestive issues, taking probiotics and psoriasis, where CRP was actually lowered in psoriasis patients taking a certain probiotic. 

Adalimumab (known as Humira, a drug I tried but which didn't lessen my plaque psoriasis, so I moved on to Stelara) lowering CRP in psoriasis patients. 

Warnings about watching your blood sugar, which makes sense if sugar adds inflammation on top of inflammation. 

Claims that watching your diet can potentially "heal" your psoriasis, which makes sense if that diet is about reducing or eliminating foods that cause inflammation.  This article doesn't give any clear answers, however, as it seems that people still needed to determine which foods were causing issues in their body.  For some people it was certain vegetables, or meat, for others it was gluten or dairy.  There was no across-the-board food to remove from your diet to be "cured" of psoriasis.  I do know that post-gastric bypass, I enjoyed clear skin for probably six or seven years, and I was essentially eating what I am now, just a lot less of it (and probably a lot less sugar).  The plaques returned a few years ago (as I gained weight) and refused to leave.  As a pole dancer who doesn't use lotion on pole days, I decided to go the route of biologics to clear my skin (which is scary since they are immuno-suppressants). 

Claims that psoriasis increases risk for diabetes and heart disease.  Apparently the longer you have the disease, the higher your risk for collecting these other issues.  Great.  I got psoriasis when I was 5.  And even if the skin is clear, it doesn't mean your psoriasis is in remission.  Your insides can still be inflamed, even if your skin doesn't outwardly show it.  I guess in my case, that would be made clear by the fact that my CRP is so high.  Apparently, taking a drug that blocks TNF-alpha, can also lower the risk for heart attack.  The drug I take doesn't do that.

Explanation of biologics:

"Although they differ in the details of their makeup, Enbrel, Remicade, Humira, and Simponi all target the same piece of the immune system—a molecule called Tumor Necrosis Factor-alpha (TNF-alpha). Hence, these drugs are sometimes referred to as ‘TNF-inhibitors.’ TNF-alpha is an inflammation-promoting substance that is produced abnormally in psoriasis patients.

Stelara targets interleukin-12 (IL-12) and interleukin-23 (IL-23), immune system molecules found in high amounts at sites of active psoriasis."

Exercise is also supposed to be key to treating psoriasis from the inside out.  "Exercise helps you control your weight, which is important to people with psoriasis. 'People with psoriasis are on average 7% heavier than those without the disease,' Menter tells WebMD.  How the two are related is not clear. But one likely link is inflammation. Obesity can lead to chronic inflammation, which may worsen your psoriasis. Also, the body tends to make more fat cells in response to increased inflammation, making it even harder to control weight, says Paul S. Yamauchi, MD, PhD, spokesman for the National Psoriasis Foundation and medical director of the Dermatology Institute and Skin Care Center of Santa Monica, Calif."

I was diagnosed around the age of 12 with psoriasis.  While I may just not remember exactly what we were told to do, I vaguely remember it being described as a liver issue that could be controlled with diet.  I shouldn't eat bread, drink alcohol, etc.  It was also treated with disgusting tar/Vaseline type medications that caused my mom to have to wrap me in saran wrap so I wouldn't get it everywhere.  Now there seems to be a deeper understanding of what the disease is, even if they don't know how to cure it.  In this article, called Psoriasis is More Than Skin Deep, it discusses how psoriasis is not just a cosmetic issue:

"Over the years, multiple studies have found that psoriasis is associated with a number of potentially serious medical conditions, including cardiovascular disease, cancer and lymphoma, obesity and metabolic syndrome (also known as 'Syndrome X'), autoimmune diseases (Crohn's disease and diabetes mellitus I and II, for example), psychiatric diseases (such as depression and sexual dysfunction), psoriatic arthritis, sleep apnea, personal behavior issues, chronic obstructive pulmonary disease (COPD) and even increased mortality. Dr. Menter explained that the majority of these diseases can have a significant impact on a patient's overall health and affect psoriasis patients in different degrees of severity.

'It is important to note that while we are unsure whether psoriasis causes other diseases or that these other diseases cause psoriasis, the fact that an association exists at all is critically important in treating psoriasis patients,' said Dr. Menter.

One recent observational study of 3,236 patients with psoriasis and 2,500 patients without psoriasis who served as the controls concluded that patients with psoriasis experienced an increased incidence of ischemic heart disease (where the blood vessels are blocked leading to the heart), cerebrovascular disease (where the blood vessels are blocked leading to the brain), and peripheral vascular disease (the obstruction of arteries in the arms and legs), and mortality."

In one final article, there is a discussion regarding the immune system and psoriasis:

"A normal immune system protects the body against 'invaders' by destroying bacteria, viruses and other foreign proteins. In the person who has psoriasis, the immune system 'misfires' and inappropriately causes inflammation and an accelerated growth of skin cells.

The skin cells reproduce too quickly and the skin (and the joints in some people) becomes inflamed. Many steps in this misfired immune response are targeted by specific treatments such as systemic and biologic drugs. One goal of treatment is to block or modify the response by focusing on very specific immune cells, thus avoiding widespread effects on the rest of the body."

This has always been interesting to me because I really don't get sick that often.  My body may be falling apart on the inside but I rarely get colds.  I have always thought that my over-active immune system was the reason for that.  Who knows if I'm right but that's what I tell myself.

So there you go, another Google wormhole on a health subject I should know more about.  It is all so interesting to me to figure out how many of my issues are already related.  And that one related item is inflammation. 

I still really hope that after spending the next year eating well, that my numbers show it!  I'm excited for the future!

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