الفهرس 
Table of contentsOnly 14 pages are availabe for public view
 |  | from | 181 |  |  |
| | | from | 181 | | |
Abstract
Introduction : Psoriasis is a chronic skin disease that affects about 2% of general population. Comorbidities classically associated with psoriasis are psoriatic arthritis (PsA), Crohn’s disease, psychological/psychiatric disorders (DPP) and uveitis. It was demonstrated that, the metabolic syndrome as a whole and its individual components have been associated with psoriasis (Naldi, 2010; Lamb et al., 2017).Celiac disease defined as disease of small intestine characterized by mucosal inflammation, villous atrophy and crypt hyperplasia upon exposure to dietary gluten (Robert et al., 2018).It was demonstrated that, there was an increase in gluten sensitivity prevalence in patients with psoriasis (Bhatia et al., 2014). Gluten-sensitive enteropathy commonly manifests with minimal or no gastrointestinal symptoms. These symptoms are gastric pain, diarrhea, gas, heart burn, nausea, tiredness, lactose intolerance and weight loss (Singh et al., 2010).Gluten mainly composed of two groups of proteins called glutenin and gliadin. Because of gluten impact on dietary, life-style, and chronic ill-health and the potential to affect the course of psoriasis, a possible association of gluten-related pathology with psoriasis has been hypothesized. Gluten-free diet improves severity of psoriasis in patients who are positive for anti-tissue transglutaminase IgA (anti tTG IgA), anti gliadian IgA and/or IgG even though no celiac disease (CD) clinically exist (Huo et al., 2018; Kolchak et al., 2018). Tissue transglutaminase IgA antibodies are sensitive and specific marker of CD, and according European Society for Pediatric Gastroenterology, Hepatology, and Nutrition guidelines, TGA-IgA should be used as the first serological test when CD is suspected in symptomatic patients with normal IgA levels (Szymańska et al., 2015). The Aim of this study: This study aims to compare the level of antitissue transglutaminase IgA in psoriatic patients versus non-psoriatic control group and to find its relation with psoriasis severity in order to get benefit from gluten free diet. Materials and methods: This was a case-control study conducted on 45 patients complaining of psoriasis who were attending the outpatient clinic, inpatient of Dermatology, Andrology & STDs Department, and Mansoura University Hospitals and 45 age and sex matched completely healthy people (as controls). Results : • Demographic characteristics and anthropometric measurements demonstrated insignificant differences among both groups. • Psoriatic cases demonstrated significant increase in WBCs count and significant decrease in RBCs count compared to non-psoriatic control group. • Psoriatic cases demonstrated significant increase in TTG-IgA compared to non-psoriatic control group. • GIT manifestations were prevalent among psoriatic cases and correlated positively with the degree of psoriasis activity (PASI score). • TTG-IgA concentration showed excellent value in differentiating psoriatic cases from control group with the best detected cut off point was 0.196 for OD and 79.5 for concentration yielding accuracy of 94.4% & 95.6% respectively. • TTG-IgA concentration showed excellent value in differentiating psoriatic cases from control group with the best detected cut off point was 0.3235 for OD and 146.5 for concentration yielding accuracy of 89.5% each in differentiating severe psoriatic cases from mild cases. • TTG-IgA concentration showed good value in differentiating moderate psoriatic cases from mild cases with the best detected cut off point was 0.3265 for OD and 149.5 for concentration yielding accuracy of 76.5%. • TTG-IgA demonstrated as a significant positive correlation with PASI score among psoriatic cases. • TTG-IgA concentration could be used as a significant predictor for psoriasis as well as its severity. Conclusion : The anti-tissue transglutaminase IgA level demonstrated significant elevation among psoriatic cases and correlated positively with the disease activity (as revealed by PASI score). In addition, it could be used as a predictor for psoriasis diagnosis and severity. This also, raises the awareness about the potential association between psoriasis and celiac disease (as revealed by GIT manifestations).