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J. Clin. Med. 2019, 8(4), 521;

Systemic Sclerosis Is Linked to Psoriasis and May Impact on Patients’ Survival: A Large Cohort Study

Department of Medicine B and Zabludowicz Center for Autoimmune Diseases, Sheba Medical Center, Tel-Hashomer, Ramat-Gan 5265601, Israel
Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv 6997801, Israel
Section of Musculoskeletal Disease, Leeds Institute of Molecular Medicine, University of Leeds, NIHR Leeds Musculoskeletal Biomedical Research Unit, Chapel Allerton Hospital, Leeds LS7 4SA, UK
Postgraduate School of Public Health, Department of Health Sciences (DISSAL), University of Genoa, 16132 Genoa, Italy
Department of Dermatology, Case Western Reserve University, Cleveland, OH 44124, USA
Young Dermatologists Italian Network, Centro Studi GISED, 24122 Bergamo, Italy
Chief Physician’s Office, Clalit Health Services, Tel-Aviv 6997801, Israel
Siaal Research Center for Family Medicine and Primary Care, Faculty of Health Sciences, Ben Gurion University of the Negev, Beer Sheva 84101, Israel
Authors to whom correspondence should be addressed.
Equally contributed as last authors.
Received: 6 February 2019 / Revised: 2 April 2019 / Accepted: 8 April 2019 / Published: 16 April 2019
(This article belongs to the Special Issue Advanced Analytical Methods in Clinical Diagnosis and Therapy)
PDF [1211 KB, uploaded 21 April 2019]


Although skin manifestations are quite common in systemic sclerosis (SSc), a link between SSc and psoriasis (PsO) has been poorly investigated. We assessed the Clalit medical database in a cohort study to compare the prevalence of PsO between SSc-patients and SSc-free controls. We also evaluated the SSc-related autoantibodies’ role in the co-existence of the two conditions. Survival analysis was performed using both univariate (Kaplan–Meier, log-rank test) and multivariate (Cox proportional-hazards technique) analyses. Our cohort of 2,431 SSc-patients was age- and gender-matched with 12,710 controls (case-control match 1:5.2). There were 150 (1.2%) cases of PsO among controls and 47 (1.9%) among SSc-patients (p = 0.0027). A SSc diagnosis was an independent risk factor for PsO with an odds ratio (OR) of 2.16 (95%CI 1.38–3.39, p = 0.0008). Among SSc-patients, 98.6% with PsO were antinuclear antibodies (ANA)-negative. In terms of survival, the mortality rate in SSc-patients with PsO was lower than SSc without PsO (14.9% vs. 26%, p < 0.0001). At the multivariate-analysis, SSc-patients with PsO compared to SSc-patients without PsO had an OR for death of 0.44 (95%CI 0.19–0.99, p < 0.05). SSc is independently associated with PsO. The cases with concurrent PsO and SSc are almost exclusively ANA-negative and may exhibit a better survival. View Full-Text
Keywords: psoriasis; systemic sclerosis; scleroderma; big data; massive data mining; nation-wide survey psoriasis; systemic sclerosis; scleroderma; big data; massive data mining; nation-wide survey

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Watad, A.; Bragazzi, N.L.; McGonagle, D.; Damiani, G.; Comaneshter, D.; Cohen, A.; Amital, H. Systemic Sclerosis Is Linked to Psoriasis and May Impact on Patients’ Survival: A Large Cohort Study. J. Clin. Med. 2019, 8, 521.

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