Peds Metabolic Syndrome in Psoriasis

Adult patients with psoriasis, especially those who are young and with severe disease, have
an increased prevalence of myocardial infarction and metabolic syndrome, and increased
mortality. Tumor Necrosis Factor (TNF) and other inflammatory cytokines are felt to play an
important role not only in the pathogenesis of psoriasis and psoriatic arthritis, but in the
pathogenesis of the metabolic syndrome and increased cardiovascular mortality and morbidity.

However, the prevalence of metabolic syndrome and surrogate markers of increased
cardiovascular risk, such as lower flow-mediated dilation (FMD) during reactive hyperemia,
measured by high-resolution brachial artery ultrasound, lower hyperemia-induced, pulse wave
amplitudes as measured by finger plethysmograph peripheral artery tonometry, and elevated
blood CRP levels, in children with psoriasis, are unknown.

We will use the definition of metabolic syndrome described by de Ferranti: Participants are
defined as having metabolic syndrome if they meet or exceed the criteria for 3 or more of
the following 5 variables: 1) triglycerides ≥1.1 mmol/L; 2) HDL cholesterol <1.3 mmol/L; 3)
fasting blood glucose ≥6.1 mmol/L; 4) waist circumference (cm) >75th percentile for age and
sex; and 5) systolic or diastolic blood pressure (mm Hg) >90th percentile for age, sex, and
height.

The following two noninvasive procedures will be used to assess additional cardiovascular
risk: flow mediated dilation (FMD) and finger plethysmography peripheral artery tonometry
(PAT). These procedures have been used extensively to measure adults for clinical study
purposes for many years.

As a control group, we will compare children with psoriasis to age-, race-,and
gender-matched children with warts.

Inclusion Criteria:

- 10-17 year old children with either moderate to severe psoriasis or with warts

- For psoriasis patients, body surface area covered must be 5% or more or must have had
a documented history of 5% or more body surface area involvement

- Ability to understand and sign an age-appropriate consent form

- Parent or Guardian over 18 years old able to understand and sign consent form

Exclusion Criteria:

- Psoriasis or wart patient younger than 10 or 18 years or older

- For psoriasis patients, body surface area covered less than 5% or have not had a
documented history of 5% or more body surface area involvement

- Inability of child or adult parent/guardian to understand or sign consent

- Pregnant or lactating females.