Study to find-out the correlation of c-reactive protein with the severity of psoriasis in a tertiary care hospital in Bangladesh

Background: Psoriasis is a common, chronic inflammatory skin disease. There is increasing awareness that psoriasis is more than ‘skin deep’ and that it has important systemic manifestations that are shared with other chronic inflammatory diseases, such as rheumatoid arthritis. Dermatologists have been looking for a reliable laboratory technique to evaluate the severity and progression of psoriasis for a very long time. The current clinical choice of method for determining the severity of the illness based on the surface area affected and the degree of redness, induration, and scaliness of the skin lesions is the Psoriasis Area and Severity Index (PASI). However, the method has limited applicability for diseases other than plaque types and is not just time-consuming but can be inaccurate due to its subjective quality. Inflammatory markers, particularly acute phase proteins, have been frequently studied to develop a qualified laboratory tool for severity evaluation and monitoring reasons since the significance of systemic pro-inflammatory cytokines in the etiology of psoriasis has been established. One of the most accurate indicators of inflammation is the C-reactive protein (CRP). Therefore, another area of interest in psoriasis research has been tracking the variations in CRP concentration over the course of the disease. Numerous studies have examined whether and to what extent psoriatic individuals have elevated CRP levels, as well as whether or not the measurement of the marker may be used to determine the severity of the condition. Monitoring CRP plasma levels is not yet thought of as a standard approach in the therapy of psoriatic patients due to some differences among the studies. We think that a thorough analysis of the evidence that already exists in this field may be a necessary first step towards hastening the conversion of research endeavors into clinical practice. The purpose of this study is to figure out the relationship between CRP values and disease severity. Methods: This cross-sectional study was conducted in the department of Dermatology & Venereology, Combined Military Hospital (CMH), Dhaka cantonment, Bangladesh from March 2022 to September 2022. Sample were taken purposively. All patients were given explanation of the study including the potential risks and obtainable benefits. All patients were included in the trial after taking their informed consent. Severely ill and pregnant were not taken in the study. Eighty-four patients with psoriasis, attending the department of Dermatology & Venereology during study period were enrolled in this study according to selection criteria. Data were collected, compiled and tabulated according to key variables. The analysis of different variable was done according to standard statistical analysis. The psoriasis area and severity index (PASI) is a quantitative rating score for measuring the severity of psoriatic lesions based on area coverage and plaque appearance. Score ranges from 0 (no disease) to 72 (maximal disease). In this study PASI score < 10 was considered mild and PASI score ≥ 10 was considered as severe disease. Data were processed and analyzed using software SPSS 25.0. For all analyses level of significance was set at 0.05 and p-value <0.05 was considered as significant. Results: The mean age of the patients was 44.1 ± 9.04 ranging from 22 to 70 years. Majority of the patients were found in the age group of 32–41 years (29.76%). Males (64.28%) were more prevalent than females (35.72%). The male-to-female ratio was 1.8:1. Among the study subjects, 53.57% were free from any co-morbidities. 27.38% had diabetes mellitus, 29.76% had hypertension and 34.53% had positive family history of psoriasis. In this study, the PASI score ( The psoriasis area and severity index ) ranged from 3 to 26, 60.71% had a PASI score of less than 10, while 39.29% had a score greater than or equal to 10. The mean CRP level was 5.71 ± 2.93 mg/L ranged from 2.3 to 14.5 mg/L, with a maximum of 85.71% of participants having a CRP level below 10 mg/L. PASI score had significant positive correlation with CRP (r=0.37; p= 0.001). Conclusion: C - reactive protein (CRP) had significant positive correlation with severity of psoriasis.