FAQ’s: Psoriasis, Idiopathic PAH, Contraceptives & Pulmonary Hypertension

PAH couple

Is Psoriasis associated with pulmonary arterial hypertension?

Psoriasis is an autoimmune skin disorder characterized by white patches with scaling especially over the elbows and knees.  A small study was undertaken that suggested a slightly increased risk of pulmonary hypertension in patients with psoriasis.  However, the study only looked at echo-estimated pulmonary pressures.  In my experience I have not seen any more psoriasis amongst patients with PAH nor have I seen a common association between psoriasis and the development of PAH.  In contrast to Psoriasis, there are other autoimmune diseases that are strongly associated with pulmonary hypertension such as scleroderma, lupus and mixed connective tissue disease to name a few.

What does the “Idiopathic” mean in Idiopathic Pulmonary Arterial Hypertension?

Idiopathic means simply that the medical community has yet to explain why something happens.  Today about half of patients with PAH have idiopathic disease.  Perhaps in 20 years as we learn more about the genetics and molecular biology of PAH we will have reduced that to 25%.  Don’t be frustrated because we label something as idiopathic.  As we advance our understanding of why PAH develops, we will undoubtedly reclassify many patient with IPAH into different categories.

Which Contraceptives are safe for patients with PAH?

This is a very important question.  Pregnancy carries great risk to both mother and fetus for patients with pulmonary hypertension.  I have previously written a couple of posts that describe the physiologic changes and the risks of pregnancy for PAH patients.  I will be writing a dedicated article to address contraception in detail.  The short answer is that barrier methods are extremely safe and quite effective when used correctly but require ongoing and careful attention to proper usage.  Intrauterine Devices (IUDs) are very safe and extremely effective and may be placed during an office visit with your gynecologist.  Hormonal therapy is a more complicated discussion.  Progesterone based birth control like Depo Provera and the progesterone only pills are very safe and effective.  There are now long-acting progesterone implants that last up to three years (Nexplanon and Implanon).  These are very safe and effective.

The “Pill” which is a combination of estrogen and progesterone is very effective but many PAH experts are concerned about the estrogen content raising the risk of blood clots in the lungs.  In my practice I generally avoid estrogen containing birth control unless the patient is also taking warfarin/Coumadin.

An ongoing and open dialogue about the importance of birth control is a vital part of caring for all women of childbearing potential with PAH.