Department of Medicine Dermatology and Venereology Unit Karolinska Institutet, Stockholm, Sweden

PSORIASIS Studies of phenotype at onset and of associated cardiovascular morbidity

Lotus Mallbris

Stockholm 2005

Supervisors: Mona Ståhle, Professor Chair of Department of Medicine Dermatology and Venereology Unit Karolinska Institutet, Stockholm, Sweden Fredrik Granath, Associate Professor Department of Medicine Clinical Epidemiology Unit Karolinska Institutet, Stockholm, Sweden Olof Akre, Associate Professor Department of Medicine Clinical Epidemiology Unit Karolinska Institutet, Stockholm, Sweden Opponent: Jonathan N. Barker, Professor London’s University, King's College London St John’s Institute of Dermatology, Skin Inflammation Unit London, United Kingdom of England

Thesis Committee: Niklas Hammar, Associate Professor Department of Environmental Medicine (IMM) Epidemiology Unit Karolinska Institutet, Stockholm, Sweden Kenneth Pehrsson, Associate Professor Department of Medicine Cardiology Unit Karolinska Institutet, Stockholm, Sweden Carin Vahlquist, Associate Professor Department of Medical Science Uppsala University, Uppsala, Sweden All previously papers were reproduced with permission from the publisher. Published and printed by Karolinska Universitetsservice US-AB, Stockholm, Sweden PSORIASIS- studies at phenotype at onset and of associated cardiovascular morbidity Cover: by Jila Khodayar and Ali Nersi, “Victory of the spirit over the imperious self” © Lotus Mallbris, 2005

ISBN 91-7140-414-7

The Lotus flower grows in muddy water without adhering to it; a reminder of our inner divine potential to reach total concrete consciousness towards our spiritual perfection though our material life.

ABSTRACT Psoriasis is a complex inflammatory skin disorder, affecting 2-3% of the population in the western world. The etiology of psoriasis is not yet known. However it is likely that its pathogenesis involves interplay between multiple genetic and environmental triggers. The aim of this thesis was to study psoriasis phenotypes at disease onset, to explore putative precipitating factors and to investigate cardiovascular morbidity in psoriasis. Firstly, we established the Stockholm Psoriasis Cohort (SPC), comprising 400 adults (