Association of hidradenitis suppurativa disease severity with increased risk for systemic comorbidities

Autor: Martin M. Okun, Alexa B. Kimball, Francisco A. Kerdel, Jan R. Mekkes, Jeffrey J. Crowley, N. Scheinfeld, Murali Sundaram, Christos C. Zouboulis, Yihua Gu
Přispěvatelé: AII - Amsterdam institute for Infection and Immunity, Dermatology
Rok vydání: 2014
Předmět:
Zdroj: The British Journal of Dermatology
British journal of dermatology, 171(6), 1561-1565. Wiley-Blackwell
ISSN: 1365-2133
0007-0963
DOI: 10.1111/bjd.13122
Popis: dear editor, Hidradenitis suppurativa (HS), also known as acne inversa, is a chronic, inflammatory skin disease affecting terminal hair follicles in apocrine-gland-bearing skin.1 Associated comorbidities include depression,2 obesity3 and metabolic syndrome.4 The objective of the current analysis of patients with moderate-to-severe HS was to identify the most common comorbidities, their prevalence according to the level of HS disease burden (high vs. medium) and any association between baseline characteristics and the risk for the comorbidity. These patients, representing one of the largest HS groups to be evaluated to date, were adults from a 52-week, phase 2, randomised, double-blind, placebo-controlled trial of adalimumab treatment,5 who had at least moderate disease [HS Physician's Global Assessment (HS-PGA) grade ≥ 3; 0–5 scale]. Additional inclusion/exclusion criteria were published previously.5 Baseline comorbidities were identified with patient reports and medical histories. The following conditions were defined: hypertension, use of antihypertensive medication and/or self-reported history; uncontrolled hypertension, systolic/diastolic blood pressure (SBP/DBP) ≥ 140/≥ 90 mmHg; depression, Patient Health Questionnaire 9 (PHQ-9) score ≥ 10;6 morbid obesity, body mass index (BMI) ≥ 40 kg m−2; hyperlipidaemia, total cholesterol ≥ 240 mg dL−1; high HS disease burden, HS-PGA > 3 and/or Hurley stage III; and medium HS disease burden, HS-PGA ≤ 3 and Hurley stage II.5 All patients with available baseline values were included in this analysis. All statistical tests were two-sided and significant at 0·05. Associations between the most common comorbidities and baseline characteristics were evaluated by logistic regression. The odds ratio (OR) with 95% Wald confidence interval (CI) was provided. Final models were chosen by stepwise selection with a P-value of 0·15 for both entry and stay. Model selection was conducted per Akaike information criteria and Bayesian information criteria, which confirmed the final models selected by the stepwise selection method. Of the 154 patients in this analysis, 60 (39·0%) had high HS disease burden and 94 (61·0%) had medium burden. Mean high-sensitivity C-reactive protein (CRP) was almost four times higher in the high vs. medium disease burden groups (32·7 mg L−1 vs. 8·7 mg L−1). Combining self-report and medical examination results, 39·6% of patients had hypertension, 38·3% were morbidly obese and 48·1% had depression. The incidence of modifiable cardiovascular risk factors (Table​(Table1)1) revealed that > 50% of patients were smokers, overweight or had hypertension. Other cardiovascular risk factors included hyperlipidaemia (11·7%) and diabetes mellitus (6·5%). Over one-third of patients (35·7%) had two cardiovascular risk factors (Table​(Table11). Table 1 Baseline status of enrolled patients with hidradenitis suppurativa (HS) Of the 40·3% of patients who had and/or were diagnosed with hypertension, or were receiving antihypertensive medication (Fig.​(Fig.1a),1a), 53% had been diagnosed with hypertension, and 31% had been both diagnosed and treated. Of the latter, 53% had reached the treatment goal (SBP/DBP
Databáze: OpenAIRE
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