Chicken or the egg?

Those of you who get Google alerts for the word psoriasis will have noticed this headline popping up all over this morning - "Psoriasis may reflect systemic inflammation, heart disease".

The article this headline links to is on the American Medical News website, and refers to a key theme from the American Academy of Dermatology meeting in San Francisco in March. At this annual meeting, several forums focused on whether psoriasis should be considered a systemic disease (a disease which affects multiple parts of the body, instead of just the skin), and especially considered cardiac risks in people with psoriasis. The article states:

This meeting is the latest to highlight a burgeoning body of scientific literature, data and expert opinion that psoriasis is related to more than a lower quality of life. Like other inflammatory conditions, it is linked to a shorter lifespan and a range of significant health problems. The theory is that inflammation on the skin may be a reflection or cause of additional inflammation throughout the body.

Look at that last sentence of the paragraph I quote above, and note the words "reflection or cause". Those are the key words, right there, and suggest some important questions: Does the skin inflammation cause other portions of the body (like the heart) to experience inflammation? Or is it the reverse - is skin psoriasis the result of other inflammation (like in the heart)? Or, is there a third factor at play that causes both skin and heart inflammation?

This article also did a great job explaining the complexities of of studying psoriasis in humans, especially when you're trying to include how psychology affects these studies. Sometimes we smoke, sometimes we get overweight, sometimes we're non-compliant. Do we act this way because of our disease, or do these behaviors cause the disease?

Watch out, though... here comes my soapbox again. I found NO mention of the ugly stepsister in this article - not one reference to psoriatic arthritis was included. Time for my megaphone: Hello!!! What about the inflammatory disease closely related to psoriasis? We have quality of life issues. We experience depression and obesity due to pain and immobility. Don't forget us!

You know they talked about psoriatic arthritis at the March meeting. But the press didn't pick it up. I find that a bit frustrating.

Ok, soap box is going back in the closet. Check out the article, though. I liked it anyway.