INVESTIGATING PATIENTS WITH CONCOMITANT INTERSTITIAL LUNG DISEASE AND PSORIASIS

TOPIC: Diffuse Lung Disease TYPE: Original Investigations PURPOSE: From an immunologic standpoint, both psoriasis and interstitial lung disease (ILD) are influenced by effector cytokines produced in the Th-17 pathway, which is involved in skin and lung inflammation. Specifically, derivatives of the cytokine interleukin-17 are involved in keratinocyte proliferation as well as alveolitis and pulmonary fibroblast production. The purpose of this study was to explore the clinical course of patients with ILD and concomitant psoriasis at a tertiary care center. METHODS: We performed retrospective chart review to identify all patients which have ILD and psoriasis documented in their electronic medical record. Patients were included if they were seen by a dermatologist for a diagnosis of psoriasis and seen by a pulmonologist for a diagnosis of ILD. Additional review of pertinent imaging and pathology for these cases by a thoracic radiologist, dermatopathologist, and lung pathologist yielded 34 eligible patients with concomitant diagnoses of psoriasis and ILD. Descriptive data including age, gender, smoking status, comorbid conditions, time of diagnosis with psoriasis and ILD, environmental and medication exposure, baseline pulmonary function testing, and vital status were obtained from the electronic medical record. Type of psoriasis, ILD pattern on imaging, ILD and psoriasis pattern on pathology were confirmed by specialist review. RESULTS: The median age of our patients was 66 years(30,95) with 47%(16) female. 77%(26) of patients had documented psoriasis prior to diagnosis of ILD. 47%(16) of patients had no documented tobacco exposure and 79%(27) of patients had no documented environmental exposures. 65%(22) of patients in our cohort had no documented exposure to immunosuppressants prior to their diagnosis with ILD. Only 8 patients had a prior diagnosis of autoimmune disease: Systemic lupus erythematosus(1), amyopathic myositis(1), polymyositis(3), irritable bowel disease(1), Sjogren's disease(1), mixed connective tissue disease(1). For the 34 patients described in this review, pulmonary function testing mainly exhibited restriction with a mean FVC 69%±23% predicted, a mean DLCO of 54%±17% predicted, and a mean ratio of 107%±9% predicted. Usual interstitial pneumonia(UIP) was the predominant radiographic ILD pattern in 35% of patients. Review of available lung biopsies revealed: UIP(2), Nonspecific interstitial pneumonia(1), Organizing pneumonia(2), Hypersensitivity pneumonitis(2) and Respiratory bronchiolitis(1). Plaque psoriasis was predominant in 38% of patients. CONCLUSIONS: Our case series suggests an association between ILD and psoriasis. Psoriasis was commonly antecedent, and on average within 10 years of ILD diagnosis. Most patients exhibited UIP pattern on imaging and available biopsies were concordant for all but one patient. CLINICAL IMPLICATIONS: The potential association of psoriasis with ILD may alter treatment targets when managing patients with both diseases. DISCLOSURES: No relevant relationships by Andrea Arrossi, source=Web Response No relevant relationships by Ruhani Desai, source=Web Response Consultant relationship with AbbVie Please note: 2017-Present Added 04/23/2021 by Anthony Fernandez, source=Web Response, value=Honoraria Consultant relationship with Novartis Please note: 2017-Present Added 04/23/2021 by Anthony Fernandez, source=Web Response, value=Honoraria Consultant relationship with UCB Please note: 2020-Present Added 04/23/2021 by Anthony Fernandez, source=Web Response, value=Honoraria Speaker/Speaker's Bureau relationship with United Therapeutics Please note: $20001 - $100000 by Kristin Highland, source=Web Response, value=Honoraria Speaker/Speaker's Bureau relationship with actelion Please note: $20001 - $100000 by Kristin Highland, source=Web Response, value=Honoraria Speaker/Speaker's Bureau relationship with bayer healthcare Please note: $5001 - $20000 by Kristin Highland, source=Web Response, value=Honoraria No relevant relationships by Sonya Joshi, source=Web Response No relevant relationships by Sujith Modugula, source=Web Response No relevant relationships by Ruchi Yadav, source=Web Response