Infliximab 5 mg/kg

Obesity can be defined as a body mass index (BMI) of 30 or more, while morbid obesity is represented by a BMI of 35 or more (Bremmer et al. 2010). In a study conducted early on by Lindegard evaluating 159,200 Swedish patients over a 10-year period, it was shown that psoriasis was associated with various diseases, including obesity (Lindegard 1986). Multiple subsequent studies also supported this association. For instance, a case-control study evaluating 560 patients psoriatic patients showed that the odds of having psoriasis with a BMI between 26 and 29 or above 30 were 1.6 and 1.9, respectively, compared to non-obese control subjects (Naldi et al. 2005). Furthermore, another prior study showed increased odds of obesity in patients with severe psoriasis (odds ratio [OR] = 1.8) and mild psoriasis (OR = 1.3) compared to control patients without psoriasis (Neimann et al. 2006). As a result, cardiovascular risk factors associated with metabolic syndrome are more prevalent in patients with psoriasis than control subjects, with severe psoriasis patients having a higher odds ratio than mild psoriasis patients (Neimann et al. 2006). A prior case series showed that patients from the Utah Psoriasis Initiative had a higher prevalence of obesity than the general Utah population (34% vs. 18%) as well as non-psoriatic clinic patients (Herron et al. 2005). Moreover, 13% of morbidly obese patients, 11% of obese patients, and 5% of non-obese patients self-reported having inverse psoriasis (Herron et al. 2005). This study also demonstrated that obesity might occur as a consequence of psoriasis, instead of being a risk factor for disease onset (Herron et al. 2005). Research also shows that psoriasis is positively associated with increased incidence of metabolic syndrome, cardiovascular disease, diabetes mellitus, and dyslipidemia (Frieder and Ryan 2016). For instance, a systematic review of 17 articles with 28,939 total patients, of which 3791 suffered from psoriasis, showed that the odds ratio (OR) for metabolic syndrome and psoriasis ranged from 1.39 to 4.49 and the adjusted OR ranged from 1.29 to 5.14. This review also found that psoriatic patients had increased prevalence of the individual components of metabolic syndrome (Singh et al. 2016).

There is debate about which comes first—psoriasis or obesity (Bremmer et al. 2010). “The aforementioned case series of over 500 psoriatic patients found that the majority of obese patients became obese after the diagnosis of psoriasis and were not obese at age 18, thus showing that psoriasis preceded obesity.” (Herron et al. 2005). Psoriasis could pave the way for obesity for a variety of reasons, including isolation from society, unhealthy diet, negative mood, alcohol intake, and reduced physical exercise, often due to psoriatic arthritis (Bremmer et al. 2010). Greater lifetime Dermatology Life Quality Index (DLQI) correlated with a greater discrimination as work and in social settings and a greater likelihood of believing that psoriasis caused weight gain, as impaired self-confidence is linked to obesity (Kim et al. 2015).

There is also literature that shows that obesity serves as a predilection to psoriasis and can double the rate of incidence of psoriasis (Gisondi et al. 2016). Although the exact mechanism causing the association between psoriasis and obesity is unclear, obesity is thought to involve the proliferation of pro-inflammatory cytokines and adipokines (Bremmer et al. 2010; Setty et al. 2007).