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DISCUSSION

This prospective study was performed in the 25 new psoriatic patients (Group I)
attending the Dermatology outpatient clinic of Pt. B.D. Sharma PGIMS, Rohtak. These
patients were subjected to various routine investigations along with serum CRP and uric
acid status. Their results were compared with a group of 25 patients with non psoriatic
skin disease (Group II) and with 25 age and sex matched healthy controls (Group III)
recruited from general population.
The results of the above groups were compared with each other. Moreover the
results of the patients of group I before treatment were also compared after 12 weeks of
the treatment.
We observed that the mean age was comparable in the three groups. In psoriatic
patients the mean age of presentation was found to be 35.8 years. When compared with
other groups p values were found to be non significant in different groups i.e. Group I vs.
II, Group II vs. III and Group I vs. Group III, p >0.05 (NS). These different findings are
consistent with the few studies19 performed to date which have shown the mean age of
onset for the presentation of psoriatic skin disease.
Mean Hb and serum electrolytes (Na+ and K+) were also comparable in the three
groups..
As shown in table IV Significant differences were observed regarding mean
value for liver enzymes (SGOT and SGPT) and serum proteins when compared between
different groups.
The mean value for total serum protein concentration was significantly lowered in
patients with group I and II as compared to the controls.This in turn suggests that these
patients had hypoproteinemia.Reduced serum proteins may alter metabolic state of the
body.This in turn may be responsible for higher levels of SGOT and SGPT observed in
these patients.
Above observation suggests some liver dysfunction in patients suffering from skin
disease. Dahi and his coworkers63 studied the liver functions in psoriatic patients.They
reported that slight degree of liver damage occurs in patients with psoriasis.Since liver is
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the major gland regulating the metabolism and homeostasis of the body, it was concluded
that an immuno-inflammatory disease like psoriasis will alter the normal liver function.
There was nearly twenty fold increase in CRP levels in patients with psoriasis
compared with the controls. In patients with nonpsoriatic skin lesions there was not much
significant rise. Whereas the mean value for CRP increased to 44.4±2.16 mg/L in
psoriatic patients, the mean value was 3.0±0.29 mg/L in patients with non psoriatic skin
disease compared to the healthy controls in whom the mean value was 1.9±0.29mg/L.
It is now clear that levels of CRP gives the positive correlation with severity and
extent of disease. Thus CRP is an indicator of the extent of inflammation which should
reduce after treatment . Hence these patients were studied after 12 weeks of standard
treatment. The mean value for CRP was found to be significantly reduced from
44.4±2.16 mg/L to 28.0±1.54 after treatment which indicates the effective response to
treatment
The mean value of CRP after treatment though was found to be significantly
reduced it however remained higher as compared to the controls suggesting acute phase
response persists over prolonged periods. Our studies are in agreement with the studies of
De Clippi et al and Laurent et al.48
Monitoring CRP levels are important because psoriasis is a state where regulatory
septum of inflammation are stimulated beyond the physiological limits, C-reactive
protein level is a marker of systemic inflammation that has been associated with an
increased risk of myocardial infarction, arthritis, and stroke64. Inflammation has also been
hypothesized to play a role in the development of hypertension and arthritis. Higher
levels of CRP increase BP by reducing nitric oxide production in endothelial cells
resulting in vasoconstriction.Marked systemic inflammation is also implicated in the
pathogenesis of arthritis and psoriasis is well known to be associated with arthritis.
Even in the present study nearly 25% of the patients were shown to have serum
uric acid levels 10mg/dl or higher.This inturn indicates that these patients may have
developed psoriatic arthritis.
The mean value for uric acid in psoriatic patients was found to be significantly
higher( 7.0±0.64mg/dl) as compared to controls(4.1±0.19) The rise was nearly 75%.In
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patients with non psoriatic skin disease the mean value was found to be4.9±0.19mg/dl
which was only about 20% higher than the healthy controls.
. Our observations showed that there was significantly raised serum uric acid
levels in psoriatic compared to other groups. Our results are in agreement with the
previous studies done by Moller et al.54
It can be stated that elevated serum uric acid level in psoriatic patients resulted
from accelerated epidermal cell tumors as discussed in the pathogenesis of disease and an
incomplete differentiation in epidermis. Significantly raised serum uric acid levels in
patients with psoriasis suggests arthritis which is related to psoriatic skin disease (5-
10%).
The levels returned towards normal after treatment. The mean value for uric acid
was found to be reduced from 7.0±0.64mg/dl to 6.1±o.40.
Measuring serum uric levels in psoriatic patients may be beneficial. Uric acid is a
strong reducing agent and although our antioxidant excess serum accumulation of uric
acid is after associated with cardiovascular disease and arthritis. This raised the question
of different meaning of excess serum uric acid levels under different circumstances. Thus
although clinical and experimental evidences suggests that uric acid has antioxidant
properties, it is conceivable that under some conditions like psoriasis its antioxidant
property is overcome by the pro-oxidant and pro-inflammatory effects of reactive oxygen
species (ROS) accumulation.65
Thus elevated CRP and serum uric acid levels indicate some inflammatory
disorder involving a large area of body. Also higher values for both the parameters is
associated with increased mortality and morbidity.. As C-reactive protein may function as
pro-atherosclerotic factor and higher serum uric acid levels can be related to development
of oxidative stress leading to oxidative damage to lipids and proteins