Dermatitis

Elevated CRP Associated With Poorer Outcomes, Mortality Among Patients With Hidradenitis Suppurativa

Jessica Nye, PhD
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No single treatment for HS is effective in eradicating disease or preventing progression, but early recognition and treatment are critical to preventing further progression to severe disease that can have an impact on quality of life.8 Therapeutic goals for stage 1 HS in young patients are to reduce pain and inflammation and prevent scarring and disease progression through multimodal management. Topical disinfectants are generally considered ineffective.4 Topical antibiotics are the therapy of choice for mild-to-moderate disease, with the introduction of oral antibiotics where topical formulations are inadequate.4 Once the disease has progressed, biologic disease modifying antirheumatic therapies, laser therapy, and surgery may have some benefit.8 Evidence supporting the use of intravenous infliximab in Hurley stage 2 and 3 HS has not been adequate enough to recommend it.9 Treatment of HS requires an aggressive multidisciplinary effort that involves antibiotic treatment, multimodal anti-inflammatory therapy and hormonal therapies, dietary and lifestyle modifications, and avoidance of physical trauma to the affected regions, which can lead to rupture of abscesses, along with early surgical unroofing and debridement. Additionally, because of the stigma and psychological distress, counseling for possible depression and to support coping skills is also recommended.3

The following article is a part of conference coverage from the 2022 American Academy of Dermatology Annual Meeting , held live from March 25 through March 29 in Boston, Massachusetts. The team at Dermatology Advisor will be reporting on the latest news and research conducted by leading experts in dermatology. Check back for more from the 2022 AAD Annual Meeting .

 

Patients with hidradenitis suppurativa (HS) who had elevated circulating blood inflammatory markers were associated with poorer clinical outcomes, according to study results presented at the 2022 Annual Meeting of the American Academy of Dermatology (AAD), held from March 25 to 29, 2022.

The chronic inflammatory condition HS is characterized by recurrent tunnels, nodules, and scarring and is associated with pain, itching, and reduced quality of life. Although HS is associated with increases from systemic inflammation, it remains unclear whether some inflammatory markers are associated with clinical outcomes.

For this retrospective cohort study, investigators at the Johns Hopkins Department of Dermatology sourced data from the TriNetX database which is comprised of 73 million health records. Patients with at least 2 incidences of HS between 2015 and 2021 (n=37,702) and matched controls (n=37,702) were evaluated for inflammatory biomarkers and clinical outcomes. The study population was a mean of 37±14.1 years old and 77.0% of the included patients were female sex.

Compared with the control group, HS was associated with increased risk for rheumatoid arthritis (relative risk [RR], 2.74; 95% CI, 2.18-3.44), inflammatory bowel disease (RR, 2.66; 95% CI, 2.11-3.37), mortality (RR, 2.46; 95% CI, 2.14-2.83), myocardial infarction (RR, 2.25; 95% CI, 1.86-2.72), malignancy (RR, 1.97; 95% CI, 1.47-2.64), cerebral infarction (RR, 1.89; 95% CI, 1.57-2.28), and venous thromboembolism (RR, 1.77; 95% CI, 1.47-2.64).

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The patients with HS were observed to have increased C reactive protein levels (CRP; mean, 25.1 mg/mL vs 15.2 mg/mL; P <.0001), erythrocyte sedimentation rates (mean, 32.9 mm/hr vs 19.2 mm/hr; P <.0001), leukocyte counts (mean, 9.67 ´109/L vs 7.57 ´109/L; P <.0001), platelet counts (mean, 288 ´109/L vs 252 ´109/L; P <.0001), and lower hemoglobin levels (mean,12.8 g/dl vs 13.6 g/dl ; P <.0001) compared with patients in the control group.

Among the HS cohort, a cutoff of >10 mg/L of CRP was found to predict increased risk for mortality (hazard ratio [HR], 2.23; 95% CI, 1.73-2.88). Elevated CRP was also associated with increased risk for venous thromboembolism (RR, 1.85; 95% CI, 1.40-2.46), malignancy (RR, 1.71; 95% CI, 1.04-2.82), and myocardial infarction (RR, 1.65; 95% CI, 1.21-2.25) among the patients with HS.

This study may have been limited by missing or incorrectly coded information in the TriNetX database. However, these data indicated that patients with HS who had elevated CRP were at increased risk for poorer cardiovascular, inflammatory, and survival outcomes. Clinicians should be aware of this relationship and examine markers of systemic inflammation among patients with HS.

Disclosure: An author declared affiliations with the pharmaceutical industry. Please refer to the original article for a full list of disclosures.

Reference

Parthasarathy V, Deng J, Bordeaux Z, et al. C-reactive protein levels and circulating blood inflammatory markers are associated with poor outcomes in Hidradenitis Suppurativa patients: a multi-center cohort study. Presented at: 2022 Annual Meeting of the American Academy of Dermatology; March 25-29, 2022. Abstract 35228

Visit Dermatology Advisor’s conference section for more coverage from AAD 2022.
 

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