Tesis

Korelasi antara stres psikis dengan derajat keparahan psoriasis: kajian skala stres dengan psoriasis area and severity index dan kadar high sensitivity c-reactive protein = The Correlation between Psychological Stress and Psoriasis Severity : A study on Stress Scales with Psoriasis Area and Severity Index (PASI) and High Sensitivity C-Reactive Protein (hs-CRP) Levels.

Latar belakang: Psoriasis adalah penyakit inflamasi kulit kronik yang diperantarai sistem imun, dengan etiologi multifaktor. Stres telah diidentifikasi sebagai penyebab maupun faktor yang memperparah psoriasis. High sensitivity creactive protein (hs-CRP) merupakan suatu penanda sensitif untuk inflamasi. Baik stres maupun psoriasis dapat meningkatkan kadar hs-CRP serum. Penelitian untuk mengetahui data tingkat stres dan kadar hs-CRP serum pada pasien psoriasis terbatas dan belum ada penelitian mengenai korelasi antara stres dengan kadar hs-CRP serum pasien psoriasis Indonesia. Tujuan: Mengetahui hubungan korelasi antara stres dengan derajat keparahan psoriasis dan high sensitivity c-reactive protein. Metode: Penelitian ini merupakan studi potong lintang dengan pemilihan sampel secara consecutive sampling. Derajat keparahan psoriasis diukur dengan skor Psoriasis Area and Severity Index (PASI), penilaian stres menggunakan kuesioner Perceived Stress Scale (PSS), dan kadar hs-CRP serum digunakan sebagai penanda inflamasi. Anamnesis dan pemeriksaan fisis lesi kulit dilakukan oleh peneliti, pengisian kuesioner oleh subjek, kemudian dilanjutkan dengan pemeriksaan kadar hs-CRP serum. Hasil : Didapatkan total 33 subjek dengan rerata usia 40,12 (± 13,04) tahun dan terdiri atas 20 pasien (60,6%) psoriasis derajat ringan dan 13 pasien (39,4%) psoriasis derajat sedang-berat, dengan median skor PASI sebesar 4,7 (0,9-22,4). Didapatkan median nilai stres (skor kuesioner PSS) sebesar 22 (8-30) dan median kadar hs-CRP pada SP sebesar 2,38 (0,53-12,06) mg/L. Ditemukan korelasi bermakna antara stres dengan derajat keparahan psoriasis (r= 0,30;p=0,046) dan derajat keparahan psoriasis dengan kadar hs-CRP serum (r = 0,363; p = 0,019). Tidak didapatkan korelasi yang bermakna antara stres dengan kadar hs-CRP serum (r= 0,236; p= 0,093). Simpulan: Ditemukan korelasi yang bermakna antara stres dengan derajat keparahan psoriasis dan derajat keparahan psoriasis dengan kadar hs-CRP serum. Namun tidak didapatkan korelasi yang bermakna secara statistik antara stres dengan kadar hs-CRP serum. Hasil ini mungkin dikarenakan faktor perancu yang dapat memengaruhi stres maupun kadar hs-CRP serum. Identifikasi dan tatalaksana stres dapat bermanfaat bagi terapi psoriasis. Pasien dengan derajat keparahan psoriasis berat dapat diberikan edukasi mengenai tanda dan gejala klinis gangguan stres.
Kata kunci: Psoriasis, stres, skor PASI, PSS, hs-CRP


Background: Psoriasis is a lifelong immune-mediated chronic inflammatory skin disease, which etiology is multifactorial. Stress has been identified as both a trigger and precipitating factor for psoriasis. High sensitivity c-reactive protein (hs-CRP) is a sensitive marker for inflammation. Both stress and psoriasis may cause an increase in circulating hs-CRP serum. There are limited studies on stress and hs-CRP levels in psoriatic patients in Indonesia and there are no reported studies on the correlation between stress and hs-CRP levels in psoriatic Indonesian patients. Objective: To determine the correlation between stress and psoriasis disease severity and high sensitivity c-reative protein levels. Methods: Sample selection for this cross-sectional study was done by consecutive sampling. The Psoriasis Area and Severity Index (PASI) was used to measure disease severity, the self-reporting Perceived Stress Scale (PSS) was used as a measure for stress, and hs-CRP serum was used as a marker for inflammation. The anamnesis and physical examination was done by the investigator, blood samples were drawn by laboratician and further hs-CRP examinations were done. Results: A total 33 subjects were enrolled to the study, with the median age of 40, 12 (± 13, 04) years old. Subjects consists of 20 patients (60,6%) with mild psoriasis and 13 patients (39,4%) with moderate-severe psoriasis, with a median PASI score of 4,7 (range 0,9-22,4). The median PSS score was 22 (range 8-30) with a median hs-CRP serum level of 2,38 (range 0,53-12,06) mg/L. We found a positif moderate correlation between stress and psoriasis severity (r= 0,30;p=0,046) and a positif moderate correlation between psoriasis severity and hs-CRP serum levels (r = 0,363; p = 0,019). There was no statistically significant correlation between stress and hs-CRP serum levels (r= 0,236; p= 0,093). Conclusion: We found a statistically significant correlation between stress and psoriasis severity and between psoriasis severity and hs-CRP serum levels. However, no statistically significant correlation was found between stress and hsCRP serum levels. This may be caused by confounding factors influencing stress or hs-CRP levels. However, identification and management of stres maybe beneficial for psoriatic patients. It is important for dermatovenereologist to recognize signs of clinical stress. Patients with severe psoriasis maybe given education on the signs and symptoms of stress.
Keywords: Psoriasis, stress, PASI score, PSS, hs-CRP