C-reactive protein and alpha2-macroglobulin plasma activity in medium-severe and severe psoriasis.

Background: An acute phase of psoriasis can be induced by cytokines involved in psoriatic pathogenic phenomena. Activation of the acute phase reaction by proinflammatory cytokines (including interleukins 1 and 6, tumour necrosis factor alpha) may account for systemic symptoms in severe psoriasis, especially in pustular and arthropathic forms of this disease.

Objective: To study the activity of selected acute phase proteins in psoriatics before and after effective treatment.

Method: Plasma concentrations of C-reactive protein (CRP) and alpha2-macroglobulin (alpha2-MG) were examined in 175 males with medium-severe and severe psoriasis in the active stage, before treatment and in remission achieved with various treatments (local, acitretin, psoralen + ultraviolet A, retinoid + psoralen + UVA [Re-PUVA] methotrexate, cyclosporin A). Clinical activity of psoriasis was evaluated using the Psoriasis Area and Severity Index score, ranging from 18 to 70.8 (mean 29.2). Measurements were done using the immunoenzymatic method. The control group consisted of 30 healthy male volunteers.

Results: In the active stage of disease highly increased plasma levels of both CRP and alpha2-MG were found (P < 0.001). It appeared that efficacious treatment was correlated with a considerable decrease of the proteins examined towards the control values. Mean levels of alpha2-MG after treatment did not differ significantly from those of controls (P > 0.15). However, despite their strong decrease following all methods of treatment, mean plasma levels of CRP remained significantly elevated during remission compared with those of the healthy controls (P < 0.001).

Conclusions: The results of this study indicate that in medium-severe and severe psoriasis the acute phase response can be initiated and is not completely extinguished in phases of clinical remission.