Periodontitis: a newly identified comorbidity in psoriasis and psoriatic arthritis

ABSTRACT

Introduction: Psoriasis is a chronic autoimmune skin disease with strong genetic background and environmental triggers. Patients with psoriasis and psoriatic arthritis are at greater risk of developing other chronic and potentially severe comorbidities, such as psoriatic arthritis, hyperlipidemia, type 2 diabetes mellitus, obesity, metabolic syndrome, cardiovascular diseases or depression. Recently, accumulating epidemiologic, genetic and pathogenetic evidence indicates that psoriasis is also associated with periodontitis, a chronic progressive inflammatory disease, which may result in tooth loss without early and adequate therapy.

Areas covered: In this review article we summarize and discuss in detail the available epidemiologic, genetic, microbiological and immunological links between psoriasis and periodontitis.

Expert opinion: Periodontitis, via the immunomodulatory effect of the oral microbiota, may play both a direct and indirect role in the development or exacerbation of psoriasis, and may influence the efficacy of antipsoriatic therapy. These new findings indicate a need for increased awareness, early recognition and focus on prevention of periodontitis for patients with psoriasis.

KEYWORDS:

• Psoriasis
• psoriatic arthritis
• periodontitis
• comorbidity
• oral microbiota
• smoking

Article highlights

• Periodontitis is more common in psoriasis and is correlated with psoriasis severity and presence of psoriatic arthritis.

• Th-17 cells and members of the IL-17 cytokine family are central in both psoriasis and chronic periodontitis pathogenesis.

• Dermatologists and dentist should be aware of the association of psoriasis and chronic periodontitis.

• Multi-disciplinary approach to patients with psoriasis should include care for chronic periodontitis.

• Novel antipsoriatic therapies (such as IL-17 inhibitors) may prove to be beneficial for the treatment of chronic periodontitis, however, periodontal status is currently not a decisive factor when selecting the most appropriate antipsoriatic therapy for a psoriatic patient.

Declaration of interest

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

Reviewer disclosures

One peer reviewer declares they have received research, speaking and/or consulting support from Galderma, GSK/Stiefel, Almirall, Alvotech, Leo Pharma, BMS, Boehringer Ingelheim, Mylan, Celgene, Pfizer, Ortho Dermatology, Abbvie, Samsung, Janssen, Lilly, Menlo, Merck, Novartis, Regeneron, Sanofi, Novan, Qurient, National Biological Corporation, Caremark, Advance Medical, Sun Pharma, Suncare Research, Informa, UpToDate and National Psoriasis Foundation, and they have affiliations with www.DrScore.com and Causa Research. Peer reviewers on this manuscript have no other relevant financial relationships or otherwise to disclose.

Additional information

Funding

This work was performed with the financial support of GINOP-2.3.2-15-2016-00015 (LK), GINOP-2.3.2-15-2016-00050 (RG), and OTKA K-18-128210 (RG).