Semin Thromb Hemost 2009; 35(3): 313-324
DOI: 10.1055/s-0029-1222610
© Thieme Medical Publishers

Psoriasis and Atherothrombotic Diseases: Disease-Specific and Non–Disease-Specific Risk Factors

Paolo Gisondi1 , Giampiero Girolomoni1
  • 1Department of Biomedical and Surgical Science, Section of Dermatology and Venereology, University of Verona, Verona, Italy
Further Information

Publication History

Publication Date:
18 May 2009 (online)

ABSTRACT

Psoriasis is a chronic inflammatory, immune-mediated skin disease affecting 2 to 3% of the general population and may cause significant quality-of-life impairment. Psoriasis and psoriatic arthritis are associated with increased atherothrombotic diseases, including myocardial infarction, deep venous thrombosis, and reduced life span. Both disease-specific and non–disease-specific risk factors are likely to fuel one another in deleterious vicious circles. Disease-specific risk factors are those that are a direct consequence of psoriasis inflammation and include hyperhomocysteinemia, elevated C-reactive protein, elevated blood inflammatory cytokines, and platelet hyperactivity. Non–disease-specific risk factors include insulin resistance/diabetes, obesity, dyslipidemia, hypertension, metabolic syndrome, and habitual tobacco smoking. The presence of cardio-metabolic comorbidities has also relevant implication in the therapy and global approach to patients with psoriasis. Traditional systemic antipsoriatic agents frequently negatively affect cardio-metabolic comorbidities and may have important interactions with drugs commonly used by psoriasis patients. Thus, patients with psoriasis should be treated effectively and encouraged to aggressively correct their modifiable cardiovascular risk factors.

REFERENCES

  • 1 Gudjonsson J E, Elder J T. Psoriasis: epidemiology.  Clin Dermatol. 2007;  25 535-546
  • 2 Nestle F O. Psoriasis.  Curr Dir Autoimmun. 2008;  10 65-75
  • 3 Muto M, Ohmura A, Hamamoto Y et al.. Generalized pustular psoriasis: strategy for identification of psoriasis susceptibility gene.  Arch Dermatol Res. 2003;  295(Suppl 1) S60-S62
  • 4 Lowes M A, Bowcock A M, Krueger J G. Pathogenesis and therapy of psoriasis.  Nature. 2007;  445 866-873
  • 5 Ottaviani C, Nasorri F, Bedini C, de Pità O, Girolomoni G, Cavani A. CD56brightCD16(-) NK cells accumulate in psoriatic skin in response to CXCL10 and CCL5 and exacerbate skin inflammation.  Eur J Immunol. 2006;  36 118-128
  • 6 Bachelez H. Immunopathogenesis of psoriasis: recent insights on the role of adaptive and innate immunity.  J Autoimmun. 2005;  25(Suppl) 69-73
  • 7 Mee J B, Johnson C M, Morar N, Burslem F, Groves R W. The psoriatic transcriptome closely resembles that induced by interleukin-1 in cultured keratinocytes: dominance of innate immune responses in psoriasis.  Am J Pathol. 2007;  171 32-42
  • 8 Sa S M, Valdez P A, Wu J et al.. The effects of IL-20 subfamily cytokines on reconstituted human epidermis suggest potential roles in cutaneous innate defense and pathogenic adaptive immunity in psoriasis.  J Immunol. 2007;  178 2229-2240
  • 9 Conrad C, Boyman O, Tonel G et al.. Alpha1beta1 integrin is crucial for accumulation of epidermal T cells and the development of psoriasis.  Nat Med. 2007;  13 836-842
  • 10 Blauvelt A. New concepts in the pathogenesis and treatment of psoriasis: key roles for IL-23, IL-17A and TGF-β1.  Expert Rev Dermatol. 2007;  2 69-78
  • 11 Bettelli E, Oukka M, Kuchroo V KT. T(H)-17 cells in the circle of immunity and autoimmunity.  Nat Immunol. 2007;  8 345-350
  • 12 Albanesi C, Cavani A, Girolomoni G. IL-17 is produced by nickel-specific T lymphocytes and regulates ICAM-1 expression and chemokine production in human keratinocytes: synergistic or antagonist effects with IFN-γ and TNF-α.  J Immunol. 1999;  162 494-502
  • 13 Albanesi C, Scarponi C, Cavani A, Federici M, Nasorri F, Girolomoni G. Interleukin-17 is produced by both Th1 and Th2 lymphocytes, and modulates interferon-γ- and interleukin-4-induced activation of human keratinocytes.  J Invest Dermatol. 2000;  115 81-87
  • 14 Ma H L, Liang S, Li J et al.. IL-22 is required for Th17 cell-mediated pathology in a mouse model of psoriasis-like skin inflammation.  J Clin Invest. 2008;  118 597-607
  • 15 Wolk K, Witte E, Wallace E et al.. IL-22 regulates the expression of genes responsible for antimicrobial defense, cellular differentiation, and mobility in keratinocytes: a potential role in psoriasis.  Eur J Immunol. 2006;  36 1309-1323
  • 16 Li J, Li D, Tan Z. The expression of interleukin-17, interferon-gamma, and macrophage inflammatory protein-3 alpha mRNA in patients with psoriasis vulgaris.  J Huazhong Univ Sci Technolog Med Sci. 2004;  24 294-296
  • 17 Lowes M A, Kikuchi T, Fuentes-Duculan J et al.. Psoriasis vulgaris lesions contain discrete populations of Th1 and Th17 T cells.  J Invest Dermatol. 2008;  128 1207-1211
  • 18 Lee E, Trepicchio W L, Oestreicher J L et al.. Increased expression of interleukin 23 p19 and p40 in lesional skin of patients with psoriasis vulgaris.  J Exp Med. 2004;  199 125-130
  • 19 Krueger G G, Langley R G, Leonardi C CNTO 1275 Psoriasis Study Group et al. A human interleukin-12/23 monoclonal antibody for the treatment of psoriasis.  N Engl J Med. 2007;  356 580-592
  • 20 Papp K A, Langley R G, Lebwohl M PHOENIX 2 Study Investigators et al. Efficacy and safety of ustekinumab, a human interleukin-12/23 monoclonal antibody, in patients with psoriasis: 52-week results from a randomised, double-blind, placebo-controlled trial (PHOENIX 2).  Lancet. 2008;  371 1675-1684
  • 21 Kimball A B, Gordon K B, Langley R G, Menter A, Chartash E K, Valdes J. ABT-874 Psoriasis Study Investigators . Safety and efficacy of ABT-874, a fully human interleukin 12/23 monoclonal antibody, in the treatment of moderate to severe chronic plaque psoriasis: results of a randomized, placebo-controlled, phase 2 trial.  Arch Dermatol. 2008;  144 200-207
  • 22 Albanesi C, De Pità O, Girolomoni G. Resident skin cells in psoriasis: a special look at the pathogenetic functions of keratinocytes.  Clin Dermatol. 2007;  25 581-588
  • 23 Diluvio L, Vollmer S, Besgen P, Ellwart J W, Chimenti S, Prinz J C. Identical TCR beta-chain rearrangements in streptococcal angina and skin lesions of patients with psoriasis vulgaris.  J Immunol. 2006;  176 7104-7111
  • 24 Sugiyama H, Gyulai R, Toichi E et al.. Dysfunctional blood and target tissue CD4 + CD25high regulatory T cells in psoriasis: mechanism underlying unrestrained pathogenic effector T cell proliferation.  J Immunol. 2005;  174 164-173
  • 25 Giustizieri M L, Mascia F, Frezzolini A et al.. Keratinocytes from patients with atopic dermatitis and psoriasis show a distinct chemokine production profile in response to T cell-derived cytokines.  J Allergy Clin Immunol. 2001;  107 871-877
  • 26 Stratis A, Pasparakis M, Rupec R A et al.. Pathogenic role for skin macrophages in a mouse model of keratinocyte-induced psoriasis-like skin inflammation.  J Clin Invest. 2006;  116 2094-2104
  • 27 Lande R, Gregorio J, Facchinetti V et al.. Plasmacytoid dendritic cells sense self-DNA coupled with antimicrobial peptide.  Nature. 2007;  449 564-569
  • 28 Albanesi C, Scarponi C, Pallotta S et al.. Role of chemerin-R23 axis in the recruitment of plasmocitoid dendritic cells in psoriatic skin.  J Exp Med. 2009;  206 243-258
  • 29 Lowes M A, Chamian F, Abello M V et al.. Increase in TNF-α and inducible nitric oxide synthase-expressing dendritic cells in psoriasis and reduction with efalizumab (anti-CD11a).  Proc Natl Acad Sci U S A. 2005;  102 19057-19062
  • 30 Alamanos Y, Voulgari P V, Drosos A A. Incidence and prevalence of psoriatic arthritis: a systematic review.  J Rheumatol. 2008;  35 1354-1358
  • 31 Gisondi P, Girolomoni G, Sampogna F, Tabolli S, Abeni D. Prevalence of psoriatic arthritis and joint complaints in a large population of Italian patients hospitalised for psoriasis.  Eur J Dermatol. 2005;  15 279-283
  • 32 Ozçakar L, Cetin A, Inanici F, Kaymak B, Gürer C K, Kölemen F. Ultrasonographical evaluation of the Achilles' tendon in psoriasis patients.  Int J Dermatol. 2005;  44 930-932
  • 33 Gisondi P, Tinazzi I, El-Dalati G et al.. Lower limb enthesopathy in patients with psoriasis without clinical signs of arthropathy: a hospital-based case-control study.  Ann Rheum Dis. 2008;  67 26-30
  • 34 Husted J A, Tom B D, Farewell V T, Schentag C T, Gladman D D. A longitudinal study of the effect of disease activity and clinical damage on physical function over the course of psoriatic arthritis: does the effect change over time?.  Arthritis Rheum. 2007;  56 840-849
  • 35 McDonald C J, Calabresi P. Psoriasis and occlusive vascular disease.  Br J Dermatol. 1978;  99 469-475
  • 36 Mallbris L, Akre O, Granath F et al.. Increased risk for cardiovascular mortality in psoriasis inpatients but not in outpatients.  Eur J Epidemiol. 2004;  19 225-230
  • 37 Gelfand J M, Neimann A L, Shin D B, Wang X, Margolis D J, Troxel A B. Risk of myocardial infarction in patients with psoriasis.  JAMA. 2006;  296 1735-1741
  • 38 Ludwig R J, Herzog C, Rostock A et al.. Psoriasis: a possible risk factor for development of coronary artery calcification.  Br J Dermatol. 2007;  156 271-276
  • 39 Cassano N, Buquicchio R, Ranieri V, Loconsole F, Vena G A. Is there an association between antiphospholipid antibodies and psoriasis?.  J Biol Regul Homeost Agents. 2008;  22 207-210
  • 40 Eldibany M M, Caprini J A. Hyperhomocysteinemia and thrombosis: an overview.  Arch Pathol Lab Med. 2007;  131 872-884
  • 41 Malerba M, Gisondi P, Radaeli A, Sala R, Calzavara Pinton P G, Girolomoni G. Plasma homocysteine and folate levels in patients with chronic plaque psoriasis.  Br J Dermatol. 2006;  155 1165-1169
  • 42 Karabudak O, Ulusoy R E, Erikci A A, Solmazgul E, Dogan B, Harmanyeri Y. Inflammation and hypercoagulable state in adult psoriatic men.  Acta Derm Venereol. 2008;  88 337-340
  • 43 Vanizor Kural B, Orem A, Cimşit G, Uydu H A, Yandi Y E, Alver A. Plasma homocysteine and its relationships with atherothrombotic markers in psoriatic patients.  Clin Chim Acta. 2003;  332 23-30
  • 44 Weger W, Hofer A, Stanger O et al.. The methylenetetrahydrofolate reductase 677C> T gene polymorphism is not associated with chronic plaque psoriasis.  Exp Dermatol. 2008;  17 748-751
  • 45 Nygård O, Refsum H, Ueland P M, Vollset S E. Major lifestyle determinants of plasma total homocysteine distribution: the Hordaland Homocysteine Study.  Am J Clin Nutr. 1998;  67 263-270
  • 46 Scarpa R, Manguso F, D'Arienzo A et al.. Microscopic inflammatory changes in colon of patients with both active psoriasis and psoriatic arthritis without bowel symptoms.  J Rheumatol. 2000;  27 1241-1246
  • 47 Rozen R. Molecular genetic aspects of hyperhomocysteinemia and its relation to folic acid.  Clin Invest Med. 1996;  19 171-178
  • 48 Casas J P, Shah T, Hingorani A D, Danesh J, Pepys M B. C-reactive protein and coronary heart disease: a critical review.  J Intern Med. 2008;  264 295-314
  • 49 Montecucco F, Mach F. New evidences for C-reactive protein (CRP) deposits in the arterial intima as a cardiovascular risk factor.  Clin Interv Aging. 2008;  3 341-349
  • 50 Ridker P M, Buring J E, Cook N R, Rifai N. C-reactive protein, the metabolic syndrome, and risk of incident cardiovascular events: an 8-year follow-up of 14,719 initially healthy American women.  Circulation. 2003;  107 391-397
  • 51 Zacho J, Tybjaerg-Hansen A, Jensen J S, Grande P, Sillesen H, Nordestgaard B G. Genetically elevated C-reactive protein and ischemic vascular disease.  N Engl J Med. 2008;  359 1897-1908
  • 52 Chodorowska G, Wojnowska D, Juszkiewicz-Borowiec M. C-reactive protein and alpha2-macroglobulin plasma activity in medium-severe and severe psoriasis.  J Eur Acad Dermatol Venereol. 2004;  18 180-183
  • 53 Rocha-Pereira P, Santos-Silva A, Rebelo I, Figueiredo A, Quintanilha A, Teixeira F. The inflammatory response in mild and in severe psoriasis.  Br J Dermatol. 2004;  150 917-928
  • 54 Ohtsuka T. The relation between high-sensitivity C-reactive protein and maximum body mass index in patients with psoriasis.  Br J Dermatol. 2008;  158 1141-1143
  • 55 Sergeant A, Makrygeorgou A, Chan W C, Thorrat A, Burden D. C-reactive protein in psoriasis.  Br J Dermatol. 2008;  158 417-419
  • 56 Ohtsuka T. The correlation between response to oral cyclosporin therapy and systemic inflammation, metabolic abnormality in patients with psoriasis.  Arch Dermatol Res. 2008;  300 545-550
  • 57 Strober B, Teller C, Yamauchi P et al.. Effects of etanercept on C-reactive protein levels in psoriasis and psoriatic arthritis.  Br J Dermatol. 2008;  159 322-330
  • 58 Serwin A B, Wasowicz W, Chodynicka B. Selenium supplementation, soluble tumor necrosis factor-alpha receptor type 1, and C-reactive protein during psoriasis therapy with narrowband ultraviolet B.  Nutrition. 2006;  22 860-864
  • 59 Kasperska-Zajac A, Brzoza Z, Rogala B. Platelet function in cutaneous diseases.  Platelets. 2008;  19 317-321
  • 60 Berrettini M, Parise P, Constantini V, Grasselli S, Nenci G G. Platelet activation in psoriasis.  Thromb Haemost. 1985;  53 195-197
  • 61 Tamagawa-Mineoka R, Katoh N, Ueda E, Masuda K, Kishimoto S. Elevated platelet activation in patients with atopic dermatitis and psoriasis: increased plasma levels of thromboglobulin and platelet factor 4.  Allergol Int. 2008;  57 391-396
  • 62 Ludwig R J, Schultz J E, Boehncke W H et al.. Activated, not resting, platelets increase leukocyte rolling in murine skin utilizing a distinct set of adhesion molecules.  J Invest Dermatol. 2004;  122 830-836
  • 63 Vila L, Cullaré C, Solá J, Puig L, de Castellarnau C, de Moragas J M. Cyclooxygenase activity is increased in platelets from psoriatic patients.  J Invest Dermatol. 1991;  97 922-926
  • 64 Vila L, Solá J, Puig L, de Castellarnau C, de Moragas J M. Exogenous arachidonic acid metabolism in platelets from psoriatic patients.  Acta Derm Venereol. 1990;  70 110-114
  • 65 Hayashi S, Shimizu I, Miyauchi H, Watanabe S. Increased platelet aggregation in psoriasis.  Acta Derm Venereol. 1985;  65 258-262
  • 66 Kragballe K, Fallon J D. Increased aggregation and arachidonic acid transformation by psoriatic platelets: evidence that platelet-derived 12-hydroxy-eicosatetraenoic acid increases keratinocyte DNA synthesis in vitro.  Arch Dermatol Res. 1986;  278 449-453
  • 67 Libby P. Role of inflammation in atherosclerosis associated with rheumatoid arthritis.  Am J Med. 2008;  121(10, Suppl 1) S21-S31
  • 68 Nickoloff B J, Xin H, Nestle F O, Qin J Z. The cytokine and chemokine network in psoriasis.  Clin Dermatol. 2007;  25 568-573
  • 69 Croce K, Libby P. Intertwining of thrombosis and inflammation in atherosclerosis.  Curr Opin Hematol. 2007;  14 55-61
  • 70 Späh F. Inflammation in atherosclerosis and psoriasis: common pathogenic mechanisms and the potential for an integrated treatment approach.  Br J Dermatol. 2008;  159(Suppl 2) 10-17
  • 71 Gisondi P, Fantin F, Del Giglio M et al.. Chronic plaque psoriasis is associated with increased arterial stiffness.  Dermatology. 2009;  218 110-113
  • 72 Ucak S, Ekmekci T R, Basat O, Koslu A, Altuntas Y. Comparison of various insulin sensitivity indices in psoriatic patients and their relationship with type of psoriasis.  J Eur Acad Dermatol Venereol. 2006;  20 517-522
  • 73 Boehncke S, Thaci D, Beschmann H et al.. Psoriasis patients show signs of insulin resistance.  Br J Dermatol. 2007;  157 1249-1251
  • 74 Kaye J A, Li L, Jick S S. Incidence of risk factors for myocardial infarction and other vascular diseases in patients with psoriasis.  Br J Dermatol. 2008;  159 895-902
  • 75 Shapiro J, Cohen A D, David M et al.. The association between psoriasis, diabetes mellitus, and atherosclerosis in Israel: a case-control study.  J Am Acad Dermatol. 2007;  56 629-634
  • 76 Neimann A L, Shin D B, Wang X, Margolis D J, Troxel A B, Gelfand J M. Prevalence of cardiovascular risk factors in patients with psoriasis.  J Am Acad Dermatol. 2006;  55 829-835
  • 77 Cohen A D, Dreiher J, Shapiro Y et al.. Psoriasis and diabetes: a population-based cross-sectional study.  J Eur Acad Dermatol Venereol. 2008;  22 585-589
  • 78 Wolf N, Quaranta M, Prescott N J et al.. Psoriasis is associated with pleiotropic susceptibility loci identified in type II diabetes and Crohn disease.  J Med Genet. 2008;  45 114-116
  • 79 Wakkee M, Thio H B, Prens E P, Sijbrands E J, Neumann H A. Unfavorable cardiovascular risk profiles in untreated and treated psoriasis patients.  Atherosclerosis. 2007;  190 1-9
  • 80 Rocha-Pereira P, Santos-Silva A, Rebelo I, Figueiredo A, Quintanilha A, Teixeira F. Dislipidemia and oxidative stress in mild and in severe psoriasis as a risk for cardiovascular disease.  Clin Chim Acta. 2001;  303 33-39
  • 81 Mallbris L, Granath F, Hamsten A, Ståhle M. Psoriasis is associated with lipid abnormalities at the onset of skin disease.  J Am Acad Dermatol. 2006;  54 614-621
  • 82 Campalani E, Allen M H, Fairhurst D et al.. Apolipoprotein E gene polymorphisms are associated with psoriasis but do not determine disease response to acitretin.  Br J Dermatol. 2006;  154 345-352
  • 83 Chang C F, Lin C C, Chen J Y et al.. Lipoprotein glomerulopathy associated with psoriasis vulgaris: report of 2 cases with apolipoprotein E3/3.  Am J Kidney Dis. 2003;  42 E18-E23
  • 84 Herron M D, Hinckley M, Hoffman M S et al.. Impact of obesity and smoking on psoriasis presentation and management.  Arch Dermatol. 2005;  141 1527-1534
  • 85 Naldi L, Chatenoud L, Linder D et al.. Cigarette smoking, body mass index, and stressful life events as risk factors for psoriasis: results from an Italian case-control study.  J Invest Dermatol. 2005;  125 61-67
  • 86 Lindegård B. Diseases associated with psoriasis in a general population of 159,200 middle-aged, urban, native Swedes.  Dermatologica. 1986;  172 298-304
  • 87 Setty A R, Curhan G, Choi H K. Obesity, waist circumference, weight change, and the risk of psoriasis in women: Nurses' Health Study II.  Arch Intern Med. 2007;  167 1670-1675
  • 88 Johnston A, Arnadottir S, Gudjonsson J E et al.. Obesity in psoriasis: leptin and resistin as mediators of cutaneous inflammation.  Br J Dermatol. 2008;  159 342-350
  • 89 Naldi L, Addis A, Chimenti S et al.. Impact of body mass index and obesity on clinical response to systemic treatment for psoriasis. Evidence from the Psocare project.  Dermatology. 2008;  217 365-373
  • 90 Gisondi P, Del Giglio M, Di Francesco V, Zamboni M, Girolomoni G. Weight loss improves the response of obese patients with moderate-to-severe chronic plaque psoriasis to low-dose cyclosporine therapy: a randomized, controlled, investigator-blinded clinical trial.  Am J Clin Nutr. 2008;  88 1242-1247
  • 91 Grundy S M, Brewer Jr H B, Cleeman J I, Smith Jr S C, Lenfant C. American Heart Association . Definition of metabolic syndrome: report of the National Heart, Lung, and Blood Institute/American Heart Association conference on scientific issues related to definition.  Circulation. 2004;  109 433-438
  • 92 National Institute of Health .Third Report of the National Cholesterol Education Program Export Panel on Detection, Evaluation, and Treatment of High Blood cholesterol in Adults (Adult Treament Panel III). Executive Summary. Bethesda, MD; National Institute of Health, National Hearth, Lung and Blood Institute 2001 NIH Publ. No. 01–3670
  • 93 Gisondi P, Tessari G, Conti A et al.. Prevalence of metabolic syndrome in patients with psoriasis: a hospital-based case-control study.  Br J Dermatol. 2007;  157 68-73
  • 94 Sommer D M, Jenisch S, Suchan M, Christophers E, Weichenthal M. Increased prevalence of the metabolic syndrome in patients with moderate to severe psoriasis.  Arch Dermatol Res. 2006;  298 321-328
  • 95 Levi M, Nieuwdorp M, van der Poll T, Stroes E. Metabolic modulation of inflammation-induced activation of coagulation.  Semin Thromb Hemost. 2008;  34 26-32
  • 96 Nieuwdorp M, Stroes E S, Meijers J C, Büller H. Hypercoagulability in the metabolic syndrome.  Curr Opin Pharmacol. 2005;  5 155-159
  • 97 Naldi L. Cigarette smoking and psoriasis.  Clin Dermatol. 1998;  16 571-574
  • 98 Bø K, Thoresen M, Dalgard F. Smokers report more psoriasis, but not atopic dermatitis or hand eczema: results from a Norwegian population survey among adults.  Dermatology. 2008;  216 40-45
  • 99 Favato G. High incidence of smoking habit in psoriatic patients.  Am J Med. 2008;  121 e17
  • 100 ISTAT .Health for all. Available at: http://www.istat.it/sanita/Health Accessed February 20, 2009
  • 101 Setty A R, Curhan G, Choi H K. Smoking and the risk of psoriasis in women: Nurses' Health Study II.  Am J Med. 2007;  120 953-959
  • 102 Prodanovich S, Prodanowich S, Ma F et al.. Methotrexate reduces incidence of vascular diseases in veterans with psoriasis or rheumatoid arthritis.  J Am Acad Dermatol. 2005;  52 262-267
  • 103 Warren R B, Griffiths C E. Systemic therapies for psoriasis: methotrexate, retinoids, and cyclosporine.  Clin Dermatol. 2008;  26 438-447
  • 104 Antoniou C, Dessinioti C, Katsambas A, Stratigos A J. Elevated triglyceride and cholesterol levels after intravenous antitumour necrosis factor-alpha therapy in a patient with psoriatic arthritis and psoriasis vulgaris.  Br J Dermatol. 2007;  156 1090-1091
  • 105 Stinco G, Piccirillo F, Patrone P. Hypertriglyceridaemia during treatment with adalimumab in psoriatic arthritis.  Br J Dermatol. 2007;  157 1273-1274
  • 106 Dixon W G, Watson K D, Lunt M, Hyrich K L, Silman A J, Symmons D P. British Society for Rheumatology Biologics Register Control Centre Consortium . Reduction in the incidence of myocardial infarction in patients with rheumatoid arthritis who respond to anti-tumor necrosis factor alpha therapy: results from the British Society for Rheumatology Biologics Register.  Arthritis Rheum. 2007;  56 2905-2912
  • 107 Bosello S, Santoliquido A, Zoli A et al.. TNF-alpha blockade induces a reversible but transient effect on endothelial dysfunction in patients with long-standing severe rheumatoid arthritis.  Clin Rheumatol. 2008;  27 833-839

Dr. Paolo Gisondi

Department of Biomedical and Surgical Science, Section of Dermatology and Venereology

University of Verona, Piazzale A. Stefani, 1, 37126 Verona, Italy

Email: paolo.gisondi@univr.it

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