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Year of grant: 2015 Research Area: Heilsa Project type: Ph.d.verkætlan Project title: Psoriasis - Fenotypur og genotypur – hjá føroyingum – kanning av føroyska fólkinum. Grant number: 0337 Project manager: Ester Weihe Jacobsen Institution/company: Landssjúkrahúsið Other participants: Ole B. V. Pedersen, Gregor B. Jemec, Charlotte Brasch-Andersen Project period: Planned: 01.01.2016-31.12.2018 Final: 01.01.2016-11.03.2020 Total budget: kr. 2.262.435 Grant from the FRC in DKK: kr. 1.000.000 Project description: Original Psoriasis er et kløende udslet, som ledsages af tykke hvide stearinagtige skæl og som antageligt forekommer hos ca. 3 % af den voksne færøske befolkning. I svære tilfælde er sygdommen forbundet med væsentligt nedsat livskvalitet. Formålet med projektet er at bestemme forekomst og sværhedsgrad af sygdomen, dens sociale konsekvenser, samt at finde arveanlæg af betydning for psoriasis. Vi ved fra tvillingundersøgelser at psoriasis alt overvejende skyldes arvelige faktorer. På Færøerne er der med hjemmel i Lov nr. 62 af 17. maj 2005 oprettet et center for forskning i gener (koder i arvemassen for bestemte egenskaber) – Genetic Biobank (GB) – som kortlægger alle færøske familier, deres sygdomme og opretter en biobank. Årsagen til at det er en fordel at forske i gener på Færøerne er, at den færøske befolkning fra at have haft et stabil befolkningstal på ca. 4,000 i århundreder er tidoblet til de nuværende 48,000 beboere indenfor de sidste 200 år. Derfor er det sandsynligt at en større mængde nulevende færinger har arvet de samme genvarianter (evt. sygdomsbærende) fra en relativt nær forfader. Det at færinger således ligner hinanden genetisk set øger den statistiske styrke, når man leder sammenhængen mellem gener og sygdomme Ester Weihe har i perioden 2012 til 2013 som forskningsårsstuderende identificeret alle psoriasistilfælde, som var registreret i forskellige færøske helbredsregistre og hospitalsarkiver. Alle personer, som havde fået diagnosen psoriasis i de forskelliuge arkiver, blev efterfølgende kontaktet for om de ville deltage i denne undersøgelse, med mindre de var emigrerede eller døde. Ud af 1210 identificerede psoriasistilfælde blev 877 inviteret til undersøgelse og hos 711 personer kunne psoriasis diagnosen bekræftes ved klinisk undersøgelse. Der er også blevet oprenset DNA på alle 711 personer med psoriasis. I forlængelse af dette indlende arbejde gennemføres et ph.d. studie om arvelighed af psoriasis. Der er planlagt følgende delstudier: Delstudie 1: Forekomst og sværhedsgrad af psoriasis på Færøerne - en nationalt populationsbaseret undersøgelse. Delstudie 2: Forhold mellem psoriasis og demografiske faktorer, herunder sociale forhold Delstudie 3: Familiestudie af psoriasis Delstudie 4: Genetisk koblingsundersøgelse af psoriasis Delstudie 5: Genetisk association mellem psoriasis og hyppige genmutationer involveret i immunsystemet Studiet omhandler medicinsk sundhed, herunder autoimmunitet og sundhed som et socialt fænomen. Final 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): 0.800.89). 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 (1.785.33) 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: 1.151.27), 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 (1.062.30), 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. Project status: Liðug Project output: PhD thesis defended on 26 april 2022. Title: "Psoriasis The occurrence, familial aggregation, and phenotype of psoriasis in the Faroe Islands" 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. << Back |
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