Association of Psoriasis With Inflammatory Bowel Disease: A Systematic Review and Meta-analysis

Abstract

Importance: Patients with psoriasis may experience comorbidities involving cardiovascular diseases, chronic kidney disease, uveitis, psychiatric disturbances, and metabolic syndrome. However, the association between psoriasis and inflammatory bowel disease (IBD) has been largely unclear.

Objective: To investigate the association of psoriasis with IBD.

Data sources: For this systematic review and meta-analysis, MEDLINE, Embase, and the Cochrane Central Register of Controlled Trials were searched for relevant studies from inception to January 17, 2018.

Study selection: Case-control, cross-sectional, or cohort studies that examined either the odds or risk of IBD in patients with psoriasis were included. No geographic or language limitations were used in the search.

Data extraction and synthesis: The PRISMA and MOOSE guidelines were followed for data extraction. The Newcastle-Ottawa Scale was used to evaluate the risk of bias of included studies. Crohn disease and ulcerative colitis were analyzed separately and random-effects model meta-analysis was conducted. A subgroup analysis was performed on psoriatic arthritis.

Main outcomes and measures: The risk and odds of IBD, Crohn disease, and ulcerative colitis in patients with psoriasis.

Results: A total of 5 case-control or cross-sectional studies and 4 cohort studies with 7 794 087 study participants were included. Significant associations were found between psoriasis and Crohn disease (odds ratio, 1.70; 95% CI, 1.20-2.40) and between psoriasis and ulcerative colitis (odds ratio, 1.75; 95% CI, 1.49-2.05). Patients with psoriasis had an increased risk of Crohn disease (risk ratio, 2.53; 95% CI, 1.65-3.89) and ulcerative colitis (risk ratio, 1.71; 95% CI, 1.55-1.89).

Conclusions and relevance: These findings suggest that psoriasis is significantly associated with IBD. Gastroenterology consultation may be indicated when patients with psoriasis present with bowel symptoms.

Conflict of interest statement

Conflict of Interest Disclosures: None reported.

Figures

Figure 1.. PRISMA Study Flowchart

Figure 2.. Risk of Bias of Included Studies

A, Risk of bias of included case-control studies. B, Risk of bias of included cohort studies. A green dot denotes low risk of bias, yellow for unclear risk of bias, and red for high risk of bias.

Figure 3.. Forest Plots of the Association of Psoriasis With Crohn Disease and Ulcerative Colitis, and Subgroup Analysis of Psoriatic Arthritis

A, Case-control studies on the association of psoriasis with Crohn disease. B, Case-control studies on the association of psoriasis with ulcerative colitis. C, Cohort studies on the association of psoriasis with Crohn disease. D, Cohort studies on the association of psoriasis with ulcerative colitis. E, Subgroup analysis of psoriatic arthritis. The size of the data markers reflects the weight. Data were pooled separately by study design type using random-effects models; the inverse variance technique was used for pooling of measures of effect.