Comparison of early and late onset psoriasis regarding systemic i̇nflammatory comorbidities

Psoriasis is divided into two types in terms of age of onset; early onset psoriasis (EOP) and late onset psoriasis (LOP). Psoriasis with an onset below <40 years of age is classified as EOP where psoriasis with an onset above >40 years of age is classified as LOP. EOP and LOP differs regarding genetic background, clinical presentation and course of disease. In this study, comparison of EOP and LOP regarding systemic inflammatory comorbidities which are frequently seen in psoriasis and determination of possible differences is aimed, in addition it is purposed to define different risk groups regarding these comorbidities. A total of 160 plaque psoriasis patients of which 121 with EOP and 39 with LOP were enrolled for the study. Data was collected with face-to-face questionnaire method via questions that are created to query medical and family history, clinical features of psoriasis and presence of associated inflammatory systemic comorbidities. Family history of psoriasis was present in 47.1% (n=57) of EOP patients and 17.9% (n=7) of LOP patients. Positive family history was more frequent in EOP (p=0.001). Scalp was the most frequent initially affected site comprising 39.7% of cases in EOP where extensor surfaces of extremities was the most frequent initial site in LOP comprising 25.6% of the patients. The duration between onset of nail involvement and psoriasis was 9.6 ± 8.5 months in EOP and 2.1 ± 3 months in LOP. Nail involvement occurred more rapidly in LOP compared to EOP (p<0.01). The duration between onset of psoriatic artritis (PsA) and psoriasis was 15.72 ± 10.36 months in EOP and 0.75 ± 7.6 months in LOP. PsA occurred more rapidly in LOP compared to EOP (p<0.01). Frequency was 7.7% in cardiovascular diseases (CVD), 38.5% in hypertension (HT), 33.3% in diabetes mellitus (DM) and 44.7% in metabolic syndrome (MS) in LOP. Frequency was 0.8% in CVD, 14% in HT, 9.9% in DM and 24.8% in MS in EOP. It was found that comorbidities including CVD, HT, DM and MS were more frequent in LOP compared to EOP (p=0.045, p=0.001, p<0.01, p=0.022). During assesment of psoriasis's contribution to systemic comorbidities, LOP was found as an independent risk factor for CVD and DM (p<0.01, R square: 0.036, p<0.01, R square: 0.077). As a result, it was concluded that LOP seems to interact with systemic comorbidities hence generating more severe inflammatory burden and shows a more rapid course. Key words: psoriasis, comorbidity, early onset psoriasis, late onset psoriasis, inflammation