What do heart disease, gastrointestinal problems and psoriasis have in common?
This isn’t the start of a bad joke. Researchers have long known that inflammation plays a key role in all those conditions – and many more – and are working on several fronts to find ways to tamp it down.
When it comes to the skin condition, Dr. Robert Kalb has been a key medical foot soldier.
Kalb, a Williamsville dermatologist and clinical professor with the University at Buffalo School of Medicine, is in the midst of studies on how to better control psoriasis, a chronic condition that can disfigure large patches of skin – as well as wreak havoc below the surface.
“People with extensive psoriasis can have significant arthritis, and psoriasis has been identified as an independent risk factor for heart disease,” he said.
Kalb, 58, grew up in Rochester and graduated magna cum laude from UB with a biochemistry degree before moving to New York City for his medical training. He and his wife, Marlisa, a Kenmore native, moved to Amherst in 1986 and raised two children, Ryan and Elisa, now in their 20s.
His Buffalo Medical Group-related practice is on Essjay Road, where he helps train UB medical students and residents and works on as many as a half-dozen psoriasis research studies at any given time. Research treatment is free and in many cases involves compensation. Call 630-1457 for more information.
“The Holy Grail is the cure, something that would prevent it completely,” he said, “but since I’ve come here in ’86, we’ve come a long way. The vast majority of patients you can control very well. The quality of life has improved tremendously. You get this comment all the time: ‘I haven’t worn shorts in two decades. I wore shorts this summer.’ ”
Q. Talk about your research.
A. It’s done in the office. There’s a study coordinator and there’s three staff members strictly for that. The latest grant is through the University of Pennsylvania School of Medicine – I’m an adjunct professor of dermatology at Penn – and the grant comes through them. Essentially, we get reimbursed to see the patients.
Q. What causes psoriasis?
A. The root cause is unknown, but it’s felt that it’s a stimulation of the immune system and it’s an overexpression of some of the immune system mediators. The chemicals that the immune system produces are overexpressed in psoriasis. There’s something called an antigen. If you’re presented with an antigen, your body responds to it. In psoriasis, the antigen is unknown, but there is an overexpression of the immune system. Think of it as a cell produces a chemical that revs up the system. It’s kind of like gasoline. If you can stop that, or block it, then you can improve the condition …
Some of the older treatments kind of suppressed every (immune system response), where some of these newer treatments block one specific chemical. If you don’t block everything else, just that one chemical, it may be a safer treatment. That’s what’s exciting about this.
The same chemicals – the scientific term is cytokine –are expressed in colitis and in Crohn’s disease, and in rheumatoid arthritis, and that’s why many of these drugs work on all these conditions.
Q. Inflammation seems to be at the heart of so many chronic diseases. What causes all this inflammation?
A. That’s the $64,000 question: What is the antigen, the stimulus? It’s being looked at and we don’t have the definitive answer. It’s probably not just one answer.
Q. Are some researchers looking at genetics?
A. There’s no question there’s a genetic connection with psoriasis, and it may be that if you have certain genes and if you have a certain stimulus that you’re going to develop psoriasis. So what’s being looked at specifically, and in general in medicine, is what medicines will work for you based on your genetic background. (This is called personalized medicine.)
On the Web: Read more about psoriasis research, and find out why you haven’t seen dermatologists in Western New York hospitals for some time, at blogs.buffalonews.com/refresh