Tesis

Hubungan antara Derajat Keparahan Psoriasis yang Memiliki Lesi Hard-to-Treat dengan Kejadian Sindrom Metabolik = Association between The Severity of Hard-to-treat Psoriasis and The Prevalence of Metabolic Syndrome.

Latar Belakang: Psoriasis merupakan penyakit inflamasi kronik yang diperantarai sistem imun. Lesi psoriasis pada kulit kepala, wajah, lipatan tubuh, kelamin, tangan, kaki, dan kuku seringkali terlambat terdiagnosis, sulit diterapi, dan menyebabkan disabilitas. Predileksi tersebut dikenal sebagai lokasi yang sulit diobati atau hard-to-treat (HTT). Meskipun permukaan lesi pada lokasi tersebut umumnya tidak luas, namun memiliki dampak fisik dan psikososial yang besar serta risiko komorbiditas. Sindrom metabolik (SM) adalah salah satu komorbiditas utama psoriasis. Psoriasis Area Severity Index (PASI) merupakan sistem penilaian derajat keparahan penyakit psoriasis yang paling umum digunakan. Sejumlah penelitian menemukan adanya hubungan antara derajat keparahan psoriasis dengan kejadian SM. Selain itu dilaporkan prevalensi SM lebih tinggi pada beberapa area HTT. Hingga saat ini belum ada studi yang meneliti proporsi SM pada kelompok psoriasis yang memiliki lesi HTT. Tujuan: Mengetahui hubungan antara derajat keparahan psoriasis yang memiliki lesi HTT dengan kejadian SM. Selain itu untuk mengetahui serta proporsi masing-masing komponen kriteria SM, rerata kadar HbA1c, dan hubungan antara jumlah area HTT dengan kejadian SM pada pasien psoriasis yang memiliki lesi HTT. Metode: Penelitian ini merupakan studi observasional analitik dengan disain potong lintang. Pengambilan subjek penelitian (SP) dilakukan secara consecutive sampling dan multicenter. Penelitian dilaksanakan sejak April hingga Oktober 2022. Derajat keparahan psoriasis diukur menggunakan PASI. Nilai p < 0,05 dianggap signifikan secara statistik. Hasil: Di antara 84 SP, sebanyak 42 orang memiliki skor PASI < 10 (derajat ringansedang) dan 42 orang dengan skor PASI > 10 (derajat berat). Prevalensi SM ditemukan sebesar 64,3%. Pasien psoriasis HTT derajat berat memiliki kemungkinan 3,6 kali lebih besar untuk mengalami kejadian SM dibandingkan dengan derajat ringan-sedang (78,6% vs 50%, OR 3,667; IK 95% 1,413-9,514; p=0,006). Tidak terdapat perbedaan prevalensi SM pada keterlibatan satu, dua maupun lebih dari dua area lesi HTT (66,7%; 54,5%; 65,7%; p=0,769). Terdapat perbedaan kejadian hipertensi (p=0,028), penurunan kadar kolesterol high density lipoprotein (p=0,01), rerata kadar gula darah puasa (p=0,018), dan trigliserida (p=0,044) antara psoriasis ringan-sedang dan berat. Kesimpulan: Prevalensi SM pada psoriasis yang memiliki lesi HTT dengan derajat keparahan berat lebih besar dan secara statistik bermakna dibandingkan dengan derajat ringan-sedang. Proporsi komponen kriteria SM secara keseluruhan dari yang terbesar secara berturutan adalah obesitas sentral, penurunan kadar kolesterol HDL, hipertensi, hiperglikemia, dan hipertrigliseridemia.
Kata kunci: psoriasis, hard-to-treat, sindrom metabolik, skor PASI



Background: Psoriasis is a chronic inflammatory disease mediated by the immune system. Psoriatic lesions on the scalp, face, intertriginous, genitals, palms, soles and nails are often delay diagnosed, difficult to treat and cause disability. This predilection is known as hard-totreat (HTT) locations. Despite the small surface area commonly affected by psoriasis in these locations, it has major physical and psychosocial impacts and risks of comorbidities. Metabolic syndrome (MS) is one of the main comorbidities of psoriasis. The Psoriasis Area Severity Index (PASI) is the most commonly used scoring system for the severity of psoriasis. A number of studies have found a relationship between the severity of psoriasis and the incidence of MS. It was reported that the prevalence of MS was higher in some HTT areas. There has been no study examining the proportion of SM in the psoriasis group that has HTT lesions. Objective: This study aims to assess the association of psoriasis severity that has HTT lesions with the incidence of SM. The proportion of each component of the SM criteria, the average HbA1c level, and the relationship between the number of HTT areas and the incidence of SM in psoriasis patients who have HTT lesions were also carried out as an additional results. Method: This study is an analytic observational study with a cross-sectional design. The data retrieval was carried out by consecutive sampling and multicenter. The study was conducted from April to October 2022. The severity of psoriasis was measured using the PASI. The value of p < 0.05 was considered statistically significant. Results: From 84 pastients, 42 had a PASI score < 10 (mild-moderate) and 42 had a PASI score > 10 (severe). The prevalence of SM was found to be 64.3%. Patients with severe HTT psoriasis were 3, 6 times more likely to have SM compare to mild-moderate group (78.6% vs 50%, OR 3.667; 95% CI 1.413-9.514; p=0.006). There was no difference of MS prevalence in the involvement of one, two or more than two HTT lesion areas group (66.7%; 54.5%; 65.7%; p=0.769). There were differences of the incidence of hypertension (p=0.028), decreased levels of high density lipoprotein cholesterol (p=0.01), mean fasting blood sugar levels (p=0.018), and triglycerides (p=0.044) between mild-moderate and severe psoriasis. Conclusion: Prevalence ofMS in severe psoriasis who have HTT lesions is greater and statistically significant compared to mild-moderate group. The components of the criteria for SM from the highest proportion respectively are central obesity, decreased levels of HDL cholesterol, hypertension, hyperglycemia, and hypertriglyceridemia.
Keyword: psoriasis, hard-to-treat, metabolic syndrome, PASI score