Magnitude of metabolic syndrome among psoriasis

patients in alert center from May 2022-Sept 2022

By:Dr. Tsigereda Abera (MD, RIII)
Advisors:- Dr. Amel Beshir, (MD, Ass. Prof in Dermatovenereology)
Dr. Edom Mulubirhan (MD, Ass. Prof in Dermatovenereology)

October 27,2022 
Out-line
 Introduction
 Objective
 Methodology
 Result
 Discussion
 conclusion
 Recommendation
 Acknowledgement
 Reference
Introduction
• Psoriasis is multifactorial chronic inflammatory disease Affecting 2-3 % of world
population
• Although historically considered to be a disease primarily of the skin
• psoriasis patients experience increased morbidity and mortality from a range of
systemic diseases, affecting most major organ systems.
• The most common comorbidities include psoriatic arthritis , anxiety or depression
&metabolic disorders
• metabolic syndrome (MetS) is a cluster of cardiovascular risk factors including
abdominal obesity, hypertension, atherogenic dyslipidemia and glucose
intolerance
• Resulted from genetically determined immune dysregulation resulting in
production of large amount of cytokines and growth factors which promote
atherosclerosis .
Objective of the study

General objective
• To assess magnitude of metabolic syndrome among psoriasis patients visiting alert
center dermatovenerology clinic, Addis Ababa, Ethiopia, from May 2022-Sept 2022

Specific objectives
• To assess magnitude of hypertension among psoriasis patients
• To assess magnitude of central obesity among psoriasis patients
• To assess magnitude of DM among psoriasis patients
• To asses behavioral risk associated with metabolic syndrome among psoriasis
patients
Methods and Material

Study area
The study was conducted ALERT center ADDISE ABEBA, ETHIOPIA.
Study design
• A hospital based, prospective, cross-sectional Study was employed.
Study period
• The study period was from May 2022-Sept 2022
• Source Population
• All psoriasis patients visiting dermatologic clinic ALERT center
Study population
• All psoriasis patients visiting dermatologic clinic ALERT center in the study period
Eligibility criteria

Inclusion criteria
• all adult patients dx to have psoriasis clinically (new& on follow up)

Exclusion Criteria
• Pregnant women
Data collection tools and procedures

• The data will be collected by principal investigator & trained data collectors by self-
formulated structured questioner
•Metabolic syndrome was defined by using harmonized metabolic syndrome criteria (IDF)
criteria
•Participant with 3 of more of the criteria :-waist circumference to define abdominal obesity in
African origin for men ≥94 cm and for women ≥80 cm ,TGA ≥150 MG /DL ,HDL for male ≤40 mg/dl
for women ≤50 mg /dl ,BP systolic/diastolic =≥130/85or hx of hypertension ,FBS >100 mg /dl.
•FBS, TGA, HDL level were measure using standard biochemistry procedure and taking venous blood
sample from patient who had fasted over night for at least 8 hr.
Data processing and analysis

• Data entering, coding and cleaning was performed and statistical analysis was
done using SPSS version 26.
• Frequency distributions percentages, tables , charts were used to show descriptive
results.
• chi-square & binary logistic regression was used to asses association between
variables .
• Finally, the study finding was presented using diagrams, tables and figures.
. Result percentage of psoriasis patients with
comorbidity
Study participants 45.00%
40.00% 38.8%
35.00% 33.10%
30.00% 28.7%
26.3%
25.00% 23.8% 23.1%
78 20.00%
49% 82
51%
15.00%
10.00%
5.00%
0.00% L
e
io
n BS HD
A ity
om ns dF TG s
d r
tr e se w g h be
y n
e ra
i lo Hi al
o
l i cs yp m
in
h
abo bd
o
male female et A
m
Cont.
• Sex distribution of patient with metabolic syndrome

Metabolic syndrome

44.70%
55.30%

male female
 age distribution of study population Age distribution in patients with
Mets
frequancy percent
180
160 age group frequancy percent
160
140 18-29 3 7.9
120
100
30-39 7 18.9
100
80
40-49 11 28.9
60 55 50-59 6 15.8
40
40 33 34.4
60+ 11 28.9
25
20.6 20
20 12 12.5

0
7.5
total 38 100
18-29 30-39 40-49 50-59 60+ t0tal
 Place of residency for psoriasis patients
with Mets
Place of residency for study participant
32
20%

residency frequency percent

Urban 36 94.7
urban rural

128, 80% Rural 2 5.3

 marriage status of patient with
marriage status of study partic-
metabolic syndrome
ipant
120 80
73.7
108
70
100
60

80 50
67.5
40
60
30 28
40 34 20
21.3 10.5 10.5
14 4 4 2 5.3
20 10
8.8
4 2.5 0
0 single Married Divorced Widowed
Single Married Divorced Widowed

frequancy percentage frequancy percentage

 Annual income of individual in study
participant Individual annual income
inpatients with Mets

Annual income frequancy percentage Annual income Frequency percentage

≤720 $ 59 36.8 ≤720 $ 16 42.1

720 $ -7200 $ 97 60.6 720 $ -7200 $ 22 57.9

≥ 7200 $ 1 0.6 ≥ 7200 $ 0 0

No formal income 3 1.9 No formal income 0 0

 Working status of psoriasis patient
with Mets
Working status of study participants
60
working status frequancy percentage
55

50 47
government
frequancy/percentage

40 worker 6 15.8
33 34.4
29.4
30
Farmer 1 2.6
20.6
20 16

10
10 9 private worker 15 39.5
5.6

0
government Farmer private worker on pension other on pension 4 10.5
worker

working status
other 12 31.6
frequancy percentage
 Education status of study Education status of participant with
participants
Mets
education
Education status frequancy percentage status frequancy percentage

primary school 52 32.5 primary school 16 42.1

secondary
secondary school 49 30.6 school 6 15.8
Vocational (TVET) Vocational
Level III Diploma 17 10.6 (TVET) Level III
Diploma 2 5.3
Tertiary 19 11.9 Tertiary 6 15.8
No formal No formal
education 23 14.4 education 8 21.1
 clinical type of psoriasis
100 90
94.7
90
80
70
60
50
40
30
20
10 3.1 2.6 3.8
0 1.2 0 1.9 2.6
0
Plague Pustular Erythrodermic guttate psoriasis Inverse
study participant percentage participant with mets percentage
 Duration of illness
40
35 34.2

30 28.1
26.3
25
25 23.7
21.1
20
15.8
15
11.3
10 9.4

5.3
5
0
≤ 1 years 2-5 years 6-10 years 11-15 years >15 years

study participant patient with mets

 BSA involvement in participant with Mets

BSA involvement in study participant

52.60% 34.20%
13.20%

≤ 5% 5-10% ≥10%

≤ 5% 5-10% ≥10%
Drinking status in study participant Drinking status of participant with Mets

Alcohol drinking
status frequency percentage Alcohol drinking
status frequency percentage
Never 128 80
Never 34 89.5
Currently /former 32 20 Currently /former 4 10.5

Amount of alcohol in Amount of alcohol in

bottle /day frequency percentage bottle /day frequency percentage
< 4 for male,<3 for < 4 for male,<3 for
female 21 13.1 female 3 75
>4 for male, > 3 for >4 for male, > 3 for
female 11 6.93 female 1 25
Smoking status in study participant
Smoking status in psoriasis patient with Mets

smoking status frequancy percentage smoking status frequancy percentage

never 152 95 never 37 97.4

current
/former 8 5 current /former 1 2.6

amount of cigar
in pack /yr frequency percentage
Smoke less than 20 pack /yr.
<20 pack/year 7 87.5

>20pack/year 1 12.5
90.00% 84.20%
80.00%
71.10%
70.00% 68.40%
63.20%
60.00% 57.90%

50.00%

40.00%

30.00%

20.00%

10.00%

0.00%
Hypertension Increased FBS Abdominal Low HDL High TGA
obesity

Proportion of patients with metabolic syndrome get hypertension, increased FBS,

Abdominal obesity, low HDL, and High TGA
 Percenta
Variabl No.Of Psoriasis patients patients with Cumulative Adjusted odd
Group P value P value

 
e
e` per group MetS per odd ratio value
group

18-29 33 3 9.1 Reference      

30-39 40 7 17.5 0.082 0.01 0.26 0.004

Age 40-49 55 11 20 0.174 0.04 0.020 0.001
50-59 12 6 50 0.205 0.005 0.32 0.002
60+ 20 11 55 0.818 0.784 0.690 0.781
Male 82 17 20.7 Reference      
Sex
Female 78 21 26.9 0.71 0.359 0.705 0.601
Residen Urban 128 36 28.1 Reference      
cy Rural 32 2 6.3 5.87 0.019 18.34 0.056
primary
52 16 30.8 Reference      
school
secondar
49 6 12.2 0.833 0.731 0.922 0.935
Educati y school
on Level III
17 2 11.8 2.62 0.030 0.279 0.935
status Diploma
Tertiary 19 6 1.6 0.250 0.111 0.350 0.454

No formal
23 0 34.8 0.865 0.827 2.990 0.436
education
 Cont. Table

Government 33 6 18.2 Reference      

Farmer 16 1 6.3 0.648 0.440 4.067 0.196

working status private 55 1 27.3 0.194 0.131 1.729 0.783

on pension 9 4 44.4 1.094 0.843 3.989 0.119

Others 47 12 25.5 2.333 0.253 0.141 0.153

Plague 144 36 25.0 Reference      

Pustular 5 1 20.0 0.667 0.744 0.370 0.542

Psoriasis
Erythrodermic 6 0 0 0.500 0.676 0.168 0.523
Clinical type
guttate
2 0 0 0 0.999 0.000 0.998
psoriasis
Inverse 3 1 33.3 0 0.999 0.000 0.998

Government 33 6 18.2 Reference      

Farmer 16 1 6.3 0.648 0.440 4.067 0.196

working status private 55 1 27.3 0.194 0.131 1.729 0.783

on pension 9 4 44.4 1.094 0.843 3.989 0.119

Others 47 12 25.5 2.333 0.253 0.141 0.153

 ≤720 $ 59 16 27.1 Reference      

720 $ -
97 22 22.7 60111 0.999 10040903 0.999
Income 7200 $
annual in
≥ 7200 $ 1 0 0 473876 0.999 11903174 0.99
$

No formal
3 0 0 1 1 0.002 1.000
income

≤ 1 years 15 2 13.3 Reference      

2-5 years 45 8 17.8 0.308 0.195 0.188 0.209

duration
of illness 6-10 years 40 9 22.5 0.432 0.186 0.697 0.705
in yrs.
11-15
42 13 31.0 0.581 0.38 0.853 0.864
years

>15 years 18 6 33.3 0.897 0.856 2.417 0.333

 single 34 4 11.8 Reference      

Married 108 28 25.9 0.133 0.075 0.029 0.036

marriage status
Divorced 14 4 28.6 0.350 0.305 0.059 0.039

Widowed 4 2 50.0 0.400 0.430 0.11 0.187

Never 128 34 26.6 Reference      

Alcohol
drinking status Currently
/former
32 4 12.5 2.532 0.104 9.472 0.034

≤5 63 13 20.6 Reference      

Percent of BSA
5-10 41 5 12.2 0.468 0.069 0.379 0.133
involvement

≥10 56 20 35.7 0.250 0.012 0.135 0.023

Never 152 3 37 24.3 Reference      

Smoking status
Current /former 8 1 12,5% 2.252 0.455 0.827 0.923
 Association
Binary Logistic- regression
• Study population who are in age group 30-39(AOR=0.26AND P-
value=0.004) ,40-49 (AOR=0.02 & P-Value =0.001)50-59(AOR=0.205
&P value =0.002),
• BSA involvement >10 % (AOR=0.135, P-value =0.023), marriage status
of married (AOR=0.029 P-value =0.036), divorced (AOR=0.059, P-value
=0.039),
• Those who are alcoholic (AOR=9.472, P-value 0.034) had high risk of
development of metabolic syndrome
DISCUSSION
 Prevalence of metabolic syndrome in psoriasis
patients
• Consistent with research done by
In our study the
Aurora P.Nicola A.et al, 2014- 26.8%
prevalence of • And our study is relatively comparable with
metabolic research done by Nisa N, Qazi MA., 2010-28%
syndrome were • In contrast to study done in south Africa-
52.4%,Tunisia -35.5%,china -14.3%,turkey -12.6%
38 ( 23.8%) • This might be variability in genetic make-up,
environmental factor and lifestyle variability.
 • Comparable to most of studies done.
Sex distribution • South
Africa ,Tunisia ,turkey ,Serbia ,Lebanon,
Afghanistan etc.(
• our study found • How ever study done in Singapore
There were no differences in the
that Mets were prevalence of Mets between men and
more common in women,
female individual • Study done by Meziane, M., Kelati, A.,
21(55.3%). Najdi, A., Berraho, A., Nejjari, C., &
Mernissi, F.-Z. (2015) in Morocco There
was no sex predominance
Age category
Common age range was 40-49 comprising 11(28.9%)and +60 comprizing11(28.9%)
patients.

Which are comparable to study done by Adışen E, Uzun S, Erduran F, Gürer MA,
2018 Turkey were Mets was more common in age group 40-49 and over 60 .
Comparable with the study done in china The prevalence of mets in the psoriasis
group sharply increased in participants aged in their 40s, and peaked in participants
aged in their 60s.
Relatively comparable to study done by Nasheeta Peer , Carl Lombard , Krisela Steyn ,
Naomi Levitt, 2015,Capetown were Mets was more common in age group 55-64 yrs.
  Corresponds to the study done by
THE COMMENEST p.g in Italy which account 96.3%
CLINICLTYPE INPSORIASIS  study done by Ferdinando in Brazil
PATIENT WITH METS WAS 83.5%
CHRONIC PLAGUE  Study done in china plague psoriasis
PSORIASIS 94.7% Psoriasis 83 (67.5)
 Mets vs study variable
 our finding in binary logistic regression
there was significant relation between
age ,%BSA involvement, marriage status. of psoriasis has significant association
Alcohol drinking habit
 there was no significant relation
between smoking status and other
independent variable with mets
• Correspond to study done by auror in
Italy
• Study done by in Afghanistan severity
with Mets .
• However, study done by Chan, W.
et,al2020 in Singapore and states that
there was no significant association
between age group and severity of
psoriasis to Mets .
• Study done by in Serbia
• Significant r/n between two groups of
patients regarding gender, smoking
habits, and severity of disease
Conclusion

 Metabolic syndrome is slightly prevalent

 Metabolic syndrome is more common in female

 Mets is more common in age greater than 40 yrs. Old

 There was significant relationship between age, marriage status, body surface
area involved and alcohol drinking habit and prevalence of Mets psoriasis
patients .
Recommendation

 There should be Regular follow up /checkup for the component of metabolic

syndrome in psoriasis patient

 risk factors should be actively controlled

 Psoriasis patients should be informed about the potential metabolic risks and receive
therapies for behavioral changes besides anti-psoriatic treatment in order to decrease
these risks

 large scale case control studies regarding metabolic syndrome and Further study
including role of dietary factor and physical activity in mets should be encourage
Limitation of the study

 As a cross-sectional study, the association between psoriasis and Mets could not
be determined, as result of smaller sample size and shorter duration of the
study

 Absence of previously done study on the topic in this region was also another
challenge.

 Because of Shortage of time& budget it was difficult to perform extensive study

 In availability of investigation in the hospital compound

Acknowledgement

 AAU DERMATOVENEROLOGY DEPARTMENT

• Dr. Amel Bashir,

•Dr. Edom Mulubirhan

•Dermato -venerology residents

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Thank u .