Circulating inflammatory cytokines and psoriasis risk: A systematic review and meta-analysis

Abstract

Background: Psoriasis is a systemic immune-mediated chronic inflammatory skin disease; its systemic manifestations and periodic recurrence negatively affect a patient's quality of life. Inflammatory cytokines are known to have an important role in the onset and progression of psoriasis, however, data on the association between circulating inflammatory cytokines and psoriasis risk is inconclusive. Here, we explore the relevance of circulating proinflammatory factors to the pathogenesis of psoriasis using a meta-analysis.

Objective: To explore the association between circulating levels of inflammatory factors and psoriasis to elucidate the mechanisms underlying psoriasis and improve clinical diagnosis and treatment.

Methods: We systematically retrieved articles published in PubMed, EMBASE, the Cochrane Library and the Web of Science from the establishment of each database to January 2023. The standard mean difference (SMD) in cytokine levels of individuals with psoriasis and healthy controls was used to check for correlations between circulating inflammatory factor levels and psoriasis.

Results: Fifty-seven studies, with data from 2838 patients, were retrieved and included in the meta-analysis. Eleven inflammatory factors were studied (circulating interleukin-2 (IL-2), IL-4, IL-12, IL-17, IL-18, IL-22, IL-23, IL-35, IL-36, transforming growth factor-beta (TGF-β) and gamma-interferon (IFN-γ)). Of these, IL-2 [SMD = 1.29 (95% CI: 0.61-1.97; P <0.001)], IL-17 [SMD = 0.71 (95% CI: 0.12-1.30; P = 0.018)], IL-18 [SMD = 1.27 (95% CI: 0.64-1.90; P <0.001)], and IFN-γ [SMD = 1.90 (95% CI: 1.27-2.52; P <0.001)] levels had significant correlations with psoriasis.

Conclusion: Increased serum concentrations of the circulating inflammatory cytokines IL-2, IL-17, IL-18 and IFN-γ were significantly correlated with psoriasis.

Fig 1. Preferred Report Items in Systematic Reviews and Meta-Analyses (PRISMA).

Fig 2. Sensitivity analysis of the association between circulating inflammatory factors and psoriasis risk.

Sensitivity analysis of the correlation between IL-2 and the risk of psoriasis(a). Sensitivity analysis of the correlation between IL-17 and the risk of psoriasis(b). Sensitivity analysis of the correlation between IL-18 and the risk of psoriasis(c). Sensitivity analysis of the correlation between IFN-γ and the risk of psoriasis(d).

Fig 3. Forest plot of publication bias test for the correlation between IL-2, IL-17, IL-18, IFN-γ and the risk of psoriasis after removing studies that may cause heterogeneity.