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Ester Weihe Jacobsen vart ph.d. um psoriasis

Týsdagin 26. apríl vardi Ester Weihe Jacobsen ph.d.-ritgerð sína um psoriasis í Føroyum. Verjan var á Københavns Universitet, har hon hevur verið innskrivað til ph.d.-lestur.

Heitið á ritgerðini er: "Psoriasis The occurrence, familial aggregation, and phenotype of psoriasis in the Faroe Islands".

Ester hevur verið innskrivað á institut for Klinisk Medisin á Københavns Universitet, men hevur í stóran mun arbeitt við verkætlanini á Landssjúkrahúsinum og Ílegusavninum. Harafturat hevur hon arbeitt á Sjællands Universitetshospital.

Vegleiðarar hava verið Ole Birger Vesterager Pedersen, professari, Gregor Borut Ernst Jemec, professari og Claus Thorn Ekstrøm, professari.

Í metingarnevndini vóru Simon Francis Thomsen, professari á Københavns Universitet og deildarleiðari á Bispebjerg Hospital, formaður, Lars Iversen, professari á Aarhus Universitet, og Farida Benhadou, professari á Dr Lowy Dermatology & Laser Practice í Belgia.

Verjan gekk væl. Fyrst legði Ester Weihe Jacobsen fram sítt arbeiði og úrslit. Síðani gjørdi metingarnevndin viðmerkingar og setti spurningar. Tey róstu Ester Weihe Jacobsen fyri arbeiðið og ritgerðina, sum tey mettu vera gott og sera væl skrivað. Eftir á leið tveir tímar tóku tey samanum og kunngjørdu, at Ester Weihe Jacobsen hevði staðið verjuna og harvið skuldi fáa tillutað ph.d.-heitið.

Á myndini frá vinstru: Simon Francis Thomson, Gregor Jemec, Ester Weihe Jacobsen, Ole Birger Vesterager Pedersen og Lars Iversen. Farida Benhadou vantar á myndini, hon var talgilt við til verjuna.

Granskingarráðið hevur stuðlað ph.d.-verkætlanini hjá Ester Weihe Jacobsen. Sí meira um verkætlanina í Stuðulsyvirlitinum og á psoriasis.fo

Summary

Psoriasis is a heterogeneous immune mediated chronic disease manifesting primarily in the skin, nails, and joints. The skin lesions of most common type, psoriasis vulgaris, are characteristic, and consist of sharply delimited red plaques covered with silvery scales, commonly affecting the extensor prominences, the lower back and scalp. The aetiology of psoriasis is multifactorial, and genetics are considered to play a major role. Prevalence is reported to be 2-7 % in the general population, and early studies of psoriasis prevalence in Faroe Islands are widely referred to; thus, establishing precedence for Faroese epidemiology studies in this field.

The thesis includes three papers. In the first paper, we describe the incidence of psoriasis in the Faroe Islands from 1977-2012 and investigate the heritability of psoriasis. In the second and third paper, we describe the patient characteristics for psoriasis with regard to phenotype, lifestyle factors and co-morbidities in a cross-sectional study of all psoriasis patients in the Faroe Islands and looking into the different psoriasis subtypes.

We found an overall psoriasis incidence rate of 0.85 per 1000 person years (95% confidence interval (CI): 0.80-0.89). Incidence rates peaked in age group 25 to 34 with 1.23 per 1000 person years (95% CI: 1.08-1.38). Overall incidence was higher for females than for males, 0.97 per 1000 person years (95% CI: 0.90-1.04) and 0.74 per 1000 person years (95% CI: 0.68-0.80), respectively. We found higher overall incidences in the later time period namely 1977-1995 vs. 1998-2012. When adjusting for time of birth we found a sibling recurrence risk of 0,0610 (95% CI0.0425-0.0868) and a recurrence risk ratio (RRR) of 5.35. Overall, the Faroese RRR estimates decrease with increased genetic distance to affected individual confirming the previously reported family aggregation of this disease.

Comparing the cross-sectional psoriasis cohort with the national Faroese cohort from 2015, we found the psoriasis point prevalence to be 2.20%. When assessing the characteristics of psoriasis patients in this cross-sectional cohort design compared to the national health survey, psoriasis was associated with increased likelihood of smoking and higher body mass index (BMI) with an odds ratio (OR) of 2.28 (95% CI 1.88-2.77) and 1.06 (95% CI: 1.04-1.08), respectively. When adjusted for sex and age, we found that waistline, body mass index and low General health score were associated with metabolic comorbidities. In comparison, systemic treatment or phototherapy, and low General health score, DLQI, early retirement and psoriasis in nails were associated with inflammatory comorbidities. However, when comparing those with inflammatory and metabolic comorbidities to each other the only significant difference was that a higher proportion of patients with inflammatory comorbidities had received systemic treatment or phototherapy and had psoriasis nail involvement.

To further examine the characteristics of psoriasis subtypes depending on the outcome measures and by using multivariable logistic regression analysis, we found that low general self-rated health associated with early retirement, metabolic comorbidities, and inflammatory comorbidities (OR 4.63(95% CI:1.59-14.32), 3.07 (1.78-5.33) and 3.88 (2.26-6.66)).

Dermatology Life Quality Index (DLQI) scores ≥ 6 points associated with high PASI score, smoking at the time of examination, having psoriasis in the nails, inflammatory co-morbidity, age and being female (1.20 (95% CI: 1.15-1.27), 2.13 (95% CI: 1.30-3.52),1.88 (95% CI: 1.13-3.13) 2.14 (95% CI:1.22-3.71), 0.97(95% CI:0.95-0.99) and 1.92(95% CI:1.14-3.30)). A Psoriasis Area and Severity Index (PASI) score > 4.2 points associated with high BMI, early disease onset, current smoking, and psoriasis in the nails (OR 1.06 (1.02-1.10), 2.02 (1.10-3.92), 1.56 (1.06-2.30), and 1.75 (1.19-2.58)).

In conclusion, the point prevalence of psoriasis in the Faroe Islands is 2.20%. Psoriasis runs in families, and those with psoriasis were more likely to smoke and have higher BMI compared to the background population. Our results also indicate that disease severity is correlated to lifestyle factors. We were unable to conclude, that inflammatory or metabolic psoriasis comorbidities were separate disease entities.

These conclusions are based on the data from the nationwide hospital based cross sectional Faroese psoriasis cohort that we identified and validated with this study.

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