Unmasking Pulmonary Parenchymal Changes in Psoriasis Patients: A Radiological Perspective

TL;DR

This study found that psoriasis patients may have lung changes visible on CT scans, even without symptoms, and smoking increases the risk.

Contribution

The study reveals pulmonary parenchymal changes in asymptomatic psoriasis patients and links them to smoking rather than disease severity or treatment.

Findings

Radiologists found parenchymal lesions in 43% of psoriasis patients' HRCT scans.

Smoking status significantly increased the likelihood of imaging findings compared to never smokers.

PASI scores and treatment options did not affect pulmonary parenchymal alterations.

Abstract

Background and Objectives: The relationship between psoriasis and pulmonary comorbidities remains to be explained. Our main objective was to investigate pulmonary parenchymal alterations in psoriasis outpatients with chest CT scans who did not exhibit pulmonary symptoms, regardless of their course of treatment or disease severity. Materials and Methods: We examined pulmonary function tests, laboratory data, and SF-36 questionnaires from 270 consecutive psoriasis patients who underwent high-resolution computed tomography scans. Psoriasis duration, treatment details, and smoking status were analyzed to identify the associations affecting lung involvement. Results: The median age was 48 years, and the median duration of psoriasis was 15 years. A total of 72.6% were on biologics with a median PASI score of 1.5. In total, 43.2% were current smokers. Radiologists reported parenchymal lesions in 118 (43%) of the 270 patients’ HRCT images. Reticular changes (41%) were the most common radiological finding, followed by nodules (38%), and emphysematous changes (21%). Only age, mental health, and smoking status were found to influence the possibility of the occurrence of HRCT findings in multivariate analysis (p < 0.001). PASI scores and treatment options did not impact pulmonary parenchymal alterations (p > 0.05). Conclusions: The striking part was that when compared to never smokers, the imaging findings were 1.9 times more common in current smokers (p < 0.05). Using international consensus criteria, two (0.01%) patients were radiologically diagnosed as UIP, and two (0.01%) were identified as NSIP. Psoriasis patients may exert pulmonary disease without clinical manifestation. Pulmonary function tests and radiological evaluation with CT are highly recommended in detecting pulmonary parenchymal changes when indications such as age and current smoking history are present.