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Psoriasis and the Metabolic Syndrome X

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Psoriasis as a disease of Syndrome X or The Metabolic Syndrome

 
Psoriasis is a skin plaque disease that can manifest at any stage in life in both men and woman. However it tends to to first appear after the late teens in most people. Psoriasis is probably a disease of Syndrome X. I will show this in four ways, each way can be taken on its own as a statistical proof and the first is by definition sufficient, but when taken together they reinforce each other and strengthen the case. 

<OL>

<LI>By using an accepted definition of Syndrome X and showing that psoriasis fits this definition.</LI>
<LI>By using the fact that thiazolidinediones are postulated to be used as tools to show diseases of Syndrome X and showing that they clear psoriasis.</LI>
<LI>By showing that among psoriatics there exist an above normal incidence of diseases of Syndrome X and that therefore the psoriatic probably belongs in the Syndrome X group. </LI></OL>

4) By showing that babies of psoriatics mothers have a significantly higher birth weight and that is a marker for Syndrome X and the thrifty-genotype in the mothers.

Syndrome X definition

The current conventional definition of the metabolic syndrome (Insulin Resistance Syndrome,
Syndrome - X) includes the simultaneous presence of hypertension, dyslipidemia, abnormal glucose
metabolism and insulin resistance/hyperinsulinemia, recently the insulin-resistance
syndrome defined to be present in those subjects having at least 3 out of the above mentioned 5 abnormalities. <A HREF="http://www.wonca.ie/a2015.htm">http://www.wonca.ie/a2015.htm</A>

I) Psoriasis and the link to Syndrome X according to the cited definition of Syndrome X

In psoriasis there has been shown to be an endogenous hyperinsulinism , with insulin resistance and hypertriglyceridemia with dislipidemia in statistically significantly elevated values above normal . Also there is abnormal glucose metabolism. 

<A HREF="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=2692339">http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=2692339</A>
<A HREF="http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=2903597">http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=2903597</A>
<A HREF="http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=6994381">http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=6994381</A>
<A HREF="http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=394548">http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=394548</A>
<A HREF="http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=8520522">http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=8520522</A>
<A HREF="http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=836074">http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=836074</A>
<A HREF="http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=8073834">http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=8073834</A>
<A HREF="http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=2609874">http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=2609874</A>
<A HREF="http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=2436408">http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=2436408</A>
<A HREF="http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=999226">http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=999226</A>
<A HREF="http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=189676">http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=189676</A>

 
 
 II) Psoriasis and the link to Syndrome X using the PPAR gene expression and the PPAR activating drugs (Thiazolidinediones)

Psoriasis lesions have a down-regulated PPAR expression and skin without lesions does not.

<A HREF="http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=9856826">http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=9856826</A>

Insulin resistance has down-regulated PPAR expression.

<A HREF="http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=10405788">http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=10405788</A>

 
It has been postulated that clinical improvement in disease using the thiazolidinediones may be a useful method to determine if that disease is a disease of Syndrome X.

<A HREF="http://www.amazon.com/exec/obidos/ASIN/0896035883/o/qid%3D960572449/104-6639628-0983126">http://www.amazon.com/exec/obidos/ASIN/0896035883/o/qid%3D960572449/104-6639628-0983126</A> (from a book review on Syndrome X published in the New England Journal of Medicine)
<A HREF="http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=9803467">http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=9803467</A>

Troglitazone (a thiazolidinedione) clears psoriasis and increases insulin sensitivity

<A HREF="http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=10815854">http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=10815854</A>
<A HREF="http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=10707570">http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=10707570</A>

 
Based on the postulation of thiazolidinediones activity as a useful tool to identify diseases of Syndrome X, psoriasis must be seen to be a disease of Syndrome X.

 
III) Diseases of Syndrome X with above normal co-commitance in psoriatics.

 
Obesity.

<A HREF="http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=7751469">http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=7751469</A>
<A HREF="http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=1200712">http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=1200712</A>

 
Cardiac Disease

<A HREF="http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=7751469">http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=7751469</A>
<A HREF="http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=3887825">http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=3887825</A>
<A HREF="http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=3281046">http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=3281046</A>
<A HREF="http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=3161205">http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=3161205</A>

 
Diabetes Type II

<A HREF="http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=7751469">http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=7751469</A>
<A HREF="http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=1200712">http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=1200712</A>

 
Kidney Disease

<A HREF="http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=3887825">http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=3887825</A>
<A HREF="http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=3281046">http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=3281046</A>

 
<OL START=4 TYPE="I">

<LI>Babies born to psoriatic mothers have a significantly higher than normal birth weight as do those born of mothers with Syndrome X. The possible thrifty-genotype relationship between the two. </LI></OL>

 
Increased birth weight in psoriasis--another expression of a "thrifty genotype" ?
[Increased birth weight in psoriasis vulgaris--an evolutionary advantage]?

<A HREF="http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=3630301">http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=3630301</A>

 
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Steve

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