Increased risk of chronic fatigue syndrome following psoriasis: a nationwide population-based cohort study, 2019, Tsai et al

Andy

Andy

Retired committee member
Background
The onset of chronic fatigue syndrome (CFS) has been shown to be associated with several immunological conditions such as infections or atopy. The aim of this study was to clarify the risk of chronic fatigue syndrome following the diagnosis of psoriasis, an immune-related dermatological disease, by analyzing the National Health Insurance Research Database of Taiwan.

Method
2616 patients aged 20 years or older with newly diagnosed psoriasis during 2004–2008 and 10,464 participants without psoriasis were identified. Both groups were followed up until the diagnoses of CFS were made at the end of 2011.

Results
The relationship between psoriasis and the subsequent risk of CFS was estimated through Cox proportional hazards regression analysis, with the incidence density rates being 2.27 and 3.58 per 1000 person-years among the non-psoriasis and psoriasis populations, respectively (adjusted hazard ratio
 = 1.48, with 95% confidence interval [CI] 1.07–2.06). In the stratified analysis, the psoriasis group were consistently associated with a higher risk of CFS in male sex (HR = 2.05, 95% CI 1.31–3.20) and age group of ≥ 60 years old (HR = 2.32, 95% CI 1.33–4.06). In addition, we discovered that the significantly increased risk of CFS among psoriasis patients is attenuated after they receive phototherapy and/or immunomodulatory drugs.

Conclusions
The data from this population-based retrospective cohort study revealed that psoriasis is associated with an elevated risk of subsequent CFS, which is differentiated by sex and age.
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Open access, https://translational-medicine.biomedcentral.com/articles/10.1186/s12967-019-1888-1

Fukuda selection criteria. I think this is the same group who have published several other similar papers.
 
Problem with all these studies is they most likely predict chronic fatigue not ME. Chronic fatigue is not to be taken lightly but it is not the same and the confusion will not be helpful to anyone.

I can see why a disordered immune system would lead to fatigue and it is an interesting study from that point of view.

I developed psoriasis after decades of ME and have heard this is not unusual though I did not expect it! It gets worse and better in line with my ME.
 
I was diagnosed with scalp eczema a couple of years prior to ME. This seemed to morph into a diagnosis of scalp psoriasis about 10 years after the onset of ME. Fortunately it is intermittent and confined to the scalp.

It seems that people who have psoriasis are more likely to have Crohn's disease. I mention this because a study of the microbiome in MECFS found...
...that the diversity of bacteria was greatly reduced and there were fewer bacterial species known to be anti-inflammatory in ME/CFS patients compared with healthy people, an observation also seen in people with Crohn’s disease and ulcerative colitis. https://solvecfs.org/gut-microbiome-and-mecfs-research-study-conclusion/
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I was also once diagnosed with chronic ulcerative colitis (after ME onset), but it seemed to vanish after a month on sulfasalazine, making the initial diagnosis questionable. On the other hand, my mother developed chronic ulcerative colitis in her 30's and had it for the rest of her life.

I would not be surprised if some imbalance in the microbiome has something to do with all of this, including ME.
 
That pesky immune dysfunction. I recently developed eczema on both hands. I was prescribed steroid ointment for it, and the doctor advised that I wear rubber gloves all the time to keep the ointment from coming off because, you know, it's my hands. I am not doing that because, you know, IT"S MY HANDS.

The tie-in to ME certainly is curious.
 
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Thank you @Andy for this. Added to my ever growing list of ME's possible connection with Liver/Gallbladder issues.

@duncan @Forbin


In yet one more coincidence (?) of connection with ME and disruption of Bile acid metabolism- as found by Dr. Naviaux and Maureen Hanson- it appears that Bile acids may be effective in treating psoriasis :


Is psoriasis a bowel disease? Successful treatment with bile acids and bioflavonoids suggests it is.
Ely PH1.
Author information

Abstract
The gut is the largest lymphoid organ in the body. The human microbiome is composed of trillions of bacteria. The DNA of these bacteria dwarfs the human genome. Diet and ethanol can cause rapid shifts in the number and types of bacteria in the gut. The psoriatic microbiome is similar to that seen in alcoholics; there is a decrease in bacterial diversity and overgrowth of bacteria in the small bowel. Psoriatics often have liver disease and deficiencies in bile acids. Psoriasis is a disease characterized by a leaky gut. All of the comorbidities of this disease are due to systemic endotoxemia. Bacterial peptidoglycans absorbed from the gut have direct toxic effects on the liver and skin. Their absorption, as well as endotoxin absorption, must be eliminated to treat psoriasis successfully. Endotoxin absorption is markedly increased by ethanol and peppers. Bioflavonoids, such as quercetin and citrus bioflavonoids, prevent this absorption. Bile acids, given orally, break up endotoxin in the intestinal lumen. Pathogens, including Helicobacter pylori and Streptococcus pyogenes, must be eliminated with antimicrobial therapy for any treatment to work. A complete protocol for curing psoriasis is provided.
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and


Pathophysiology of psoriasis: coping endotoxins with bile acid therapy.
Gyurcsovics K1, Bertók L.
Author information

Abstract
The authors have tested the hypothesis that the deficiency of bile acids and the consequent endotoxin translocation might play a role in the pathogenesis of psoriasis. Under normal conditions the bile acids act as detergents (physico-chemical defense) and can protect the body against enteric endotoxins by splitting them into nontoxic fragments and thus preventing the consequent release of cytokines [Persp. Biol. Med. 21 (1977) 70]. A total of 800 psoriasis patients participated in the study and 551 were treated with oral bile acid (dehydrocholic acid) supplementation for 1-8 weeks. The efficacy of the treatment was evaluated clinically and also by means of the Psoriasis Area Severity Index (PASI score). During this treatment, 434 patients (78.8%) became asymptomatic. Of 249 psoriatics receiving the conventional therapy, only 62 (24.9%) showed clinical recovery during the same period of time (P<0.05). The curative effect of bile acid supplementation was more pronounced in the acute form of psoriasis (95.1% of the patients became asymptomatic). Two years later, 319 out of the 551 acute and chronic psoriasis patients treated with bile acid (57.9%) were asymptomatic, compared to only 15 out of the 249 patients (6.0%) receiving the conventional treatment (P<0.05). At the end of the 2-year follow-up, only 10 out of 139 acute psoriasis patients (7.2%) receiving the conventional therapy and 147 out of 184 bile acid treated patients (79.9%) were asymptomatic (P<0.01).To conclude, the results obtained suggest that psoriasis can be treated with success by oral bile acid supplementation presumably affecting the microflora and endotoxins released and their uptake in the gut.
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and


Bacterial endotoxins might play a role in developing psoriasis. People with psoriasis have detectable levels of endotoxins in the blood, which can cause or worsen inflammation. Bile deficiency may be the underlying cause, as it allows endotoxin to enter the blood and reach the skin. People with psoriasis also often complain of gut and gallbladder problems [52+].

The buildup of toxins and inflammatory substances in the skin can cause red, itchy, and scaly skin patches in psoriasis. Bile acids can balance the gut microbiome, protect from bacterial gut endotoxins, and reduce inflammation [52+].
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IMHO, several researchers look at the Gut microbiome without wondering why on earth it is disrupted in the first place.


Links :


https://www.ncbi.nlm.nih.gov/pubmed/29908580

https://www.ncbi.nlm.nih.gov/pubmed/14643904

https://selfhacked.com/blog/bile-supplements/
 
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This group has been fishing in this data for positive correlations quite some time, publishing many manuscripts each on one particular finding. As far as I know, their set of hypotheses were not pre-published and if they were, most of these associations would be published in a single manuscript, not spread out over many.

This leads to their papers being uninterpretable since they are just fishing for findings.
 
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