Lifting the psoriasis burden | Dermatology Times

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Psoriasis affects more than 8 million Americans and has been associated with a number of comorbidities. Aside from the quality-of-life impact, the disease has an economic impact, as well. Experts say there is a need to capture the true direct and indirect costs to improve outcomes for patients with psoriasis and psoriatic arthritis.

Of the 2%-3% of patients with psoriasis, 10%-30% develop psoriatic arthritis. And, while almost one in four psoriasis patients have moderate-to-severe disease, women and younger patients experience the greatest negative impact on their quality of life.1

Nearly 60% of people with psoriasis2 and 40% of people with psoriatic arthritis report their disease has a large effect on their everyday lives.

Psoriasis is also associated with numerous comorbidities, including metabolic syndrome, diabetes, hypertension, obesity, hypercholesterolaemia, joint disease (psoriatic arthritis), depression and anxiety, liver and kidney disease, and malignancy, especially cutaneous T-cell lymphoma.

“It really is in the true sense of the word a systemic disease,” says Abby Van Voorhees, M.D., professor and chair of dermatology at Eastern Virginia Medical School, Norfolk, Va.

Patients with psoriasis also have an increased risk of early death,4 particularly from the consequences of cardiovascular disease, such as myocardial infarction.5 Cardiovascular disease appears to occur earlier in patients with psoriasis — and the increased risk is similar to that related to diabetes, she adds.

A real-world study looking at U.S. patients with psoriasis found the most prevalent comorbidities to be hyperlipidemia (48.6%), hypertension (44.7%), depression (18.7%), type 2 diabetes mellitus (18.3%), and obesity (15.0%).6

“A substantial proportion of patients with psoriasis have comorbid conditions that should be considered when formulating a treatment and management plan,” says Steven Feldman, M.D., of the department of dermatology, Wake Forest University School of Medicine, Winston-Salem, N.C., who was a researcher on this study.

“These conditions can complicate treatment of patients with psoriasis. The choice of treatment may have intended or unintended effects on some of the common comorbidities,” he adds.

References: 

1. Gelfand JM, Feldman SR, Stern RS, Thomas J, Rolstad T, Margolis DJ. Determinants of quality of life in patients with psoriasis: a study from the U.S. population. J Am Acad Dermatol. 2004 Nov;51(5):704-8.

2. Stern RS, Nijsten T, Feldman SR, Margolis DJ, Rolstad T. Psoriasis is common, carries a substantial burden even when not extensive, and is associated with widespread treatment dissatisfaction. J Investig Dermatol Symp Proc. 2004 Mar;9(2):136-9.

3. Gelfand JM, Gladman DD, Mease PJ, Smith N, Margolis DJ, Nijsten T, Stern RS, Feldman SR, Rolstad T. Epidemiology of psoriatic arthritis in the population of the United States. J Am Acad Dermatol. 2005 Oct;53(4):573.

4. Springate DA, Parisi R, Kontopantelis E, Reeves D, Griffiths CE, Ashcroft DM. Incidence, prevalence and mortality of patients with psoriasis: a U.K. population-based cohort study. Br J Dermatol. 2017 Mar;176(3):650-8.

5. Wu JJ1, Choi YM, Bebchuk JD. Risk of myocardial infarction in psoriasis patients: a retrospective cohort study. J Dermatolog Treat. 2015;26(3):230-4.

6. Shah K, Mellars L, Changolkar A, Feldman SR. Real-world burden of comorbidities in US patients with psoriasis. J Am Acad Dermatol. 2017;77:287-92.

7. Brezinski EA, Dhillon JS, Armstrong AW. Economic Burden of Psoriasis in the United States: A Systematic Review. JAMA Dermatol. 2015;151(6):651-8.

8. Armstrong AW, Robertson AD, Wu J, Schupp C, Lebwohl MG. Undertreatment, treatment trends, and treatment dissatisfaction among patients with psoriasis and psoriatic arthritis in the United States: findings from the National Psoriasis Foundation surveys, 2003-2011. JAMA Dermatol. 2013;149(10):1180-5.

9. Korman NJ, Zhao Y, Pike J, Roberts J, Sullivan E. Patient satisfaction with current psoriasis treatment: a real-world study in the USA. Dermatol Online J. 2016;22(2).

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