This is a prospective natural history cohort study to understand the long term effect of inflammation on vascular and metabolic health in patients with psoriasis. Furthermore, this study will enable the collection of clinical data, tissue and blood in an organized fashion to probe novel inflammatory pathways involved in cardiometabolic disease. Subjects are defined as patients whose diagnosis of psoriasis is clinically confirmed by a referring dermatologist or rheumatologist. Self-referred patients will be seen first by NIH dermatology to confirm the diagnosis of psoriasis prior to enrollment in the longitudinal study. Within the clinical context, this is standard of care whereby a patient is diagnosed with psoriasis when noted to have typical skin findings and associated findings of systemic disease of joints, nails and hair. Most commonly, these diagnoses are made by skin and joint specialists, the main referral sources for the protocol. Severity will be defined as mild, moderate, or severe based on estimated psoriasis body surface area categories. The start of observation time will be the first visit to the NIH Clinical Center in which the subject agrees to longitudinal, regular participation in PACI and gives written informed consent. This screening visit would be the baseline visit. In the event that a subject is not willing to participate in all of the study procedures during the initial screening visit, they will be evaluated at this initial visit, permitted to participate in studies they consent to, but then will not be followed longitudinally in this protocol beyond visit 1. The end of observation time will be four years from entrance into the study (or death). Patients will remain in contact after the initial 4 year observation for occurrence of cardiovascular outcomes. Also, during the course of the study, patients will be instructed to return to the NIH CC if their psoriasis becomes severe (flare). The primary outcome will be vascular inflammation measured by FDG PET CT, that is, FDG uptake within the aorta as measured by standardized uptake value (SUV). Coronary vessel wall area, mean aortic wall thickness and cardiometabolic biomarkers will be secondary outcomes. Exploratory efforts involve assessment of myocardial perfusion to understand whether coronary plaque modifies coronary flow by CCTA, MRI and PET.
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