Níveis séricos da 25-hidroxivitamina d nos pacientes portadores de psoríase em placas com e sem artrite psoriásica e sua correlação com a gravidade da doença

Abstract

Psoriasis is a systemic, immune-mediated disease, characterized by inflammatory manifestations of skin and joint. Analogues of vitamin D and phototherapy are widely used in its treatment. Ultraviolet radiation is necessary for the synthesis of Vitamin D in the epidermis, and this product is later converted into the active metabolites 25- hydroxycholecalciferol and 1, 25-dihydrocholecalciferol, which has antiproliferative, anti-inflammatory and antiangiogenic effects. Vitamin D deficiency is currently considered a pandemic and is associated with various comorbidities, including inflammatory diseases, such as psoriasis and psoriatic arthritis (PAs). Therefore, the objective was to evaluate the prevalence of hypovitaminosis D in patients with plaque psoriasis with and without PsA, as well as to determine the independent predictors of serum 25 (OH) D levels. It was a cross-sectional, retrospective and comparative study at the Psoriasis and General Dermatology Outpatient Clinic of the University Hospital of the Faculty of Medicine of the Federal University of Juiz de Fora, from January 2016 to December 2016. 554 patients, 300 patients with plaque psoriasis and 254 control patients with other dermatoses. Demographic data, as well as clinical variables related to psoriasis such as family history, age at onset, duration of the disease and the severity of the disease (by PASI- Psoriasis Area and Severity Index) and PsA (by CASPAR- Classification Criteria for Psoriatic Arthritis), laboratory and radiographic tests evaluated in the medical record were reviewed. . Correlation tests and linear regression models and binary logistic analyzes were used to evaluate the independent variables of 25 (OH) D. The serum levels of 25 (OH) D were significantly lower in the psoriasis group (24.91 ± 7.16ng / mL) vs control (30.37 ± 8.14ng / mL). Vitamin D deficiency (<20ng / mL) was 25% in patients with psoriasis vs 8.66% in the control group (p <0.001). Hypovitaminosis D (<30ng / mL) was 76.66% in patients with psoriasis vs 53.94% in control patients, and we found a positive effect on the levels of 25 (OH) D in stations with a higher incidence of ultraviolet radiation (UVR) and a negative effect on the highest skin phototypes (V). Of the 300 patients with plaque psoriasis, 73 patients (24.3%) had PsA. Statistically significant differences related to the presence of PsA were: higher mean age, higher frequency of positive family history, longer evolution and higher PASI scores. Vitamin D deficiency (<30ng / mL) was 82.2% in patients with psoriasis without arthritis vs 74.9% in patients with psoriasis and PsA. Multivariate regression analyzes revealed that vitamin D deficiency was associated with disease severity, season and phototype. Binary logistic regression models confirmed a strong association between PASI and vitamin D deficiency (<30ng / mL), after adjusting for confounding factors such as age, sex, season and phototype (OR 1.78 CI: -0.20-0.53 p <0.001).