This article is more than 5 years old. Information may no longer be current.
Speaker: Patient Perspective is Important to Fully Assess Disease Severity
Click Here to Manage Email Alerts
CLEVELAND — Rheumatologic health care providers need to look all aspects of psoriasis, including the patient perspective, to determine whether patients warrant systemic or biologic therapies, according to a presenter here at the Rheumatology Nurses Annual Conference.
“We often share patients with rheumatology who have joint disease and it is unclear whether they have psoriatic arthritis. They may, but it is simply unclear and it is thought it would be useful to give the patients a trial of systemic medication. Making that jump would be a lot easier if we thought the psoriasis on the skin a warranted systemic treatment,” Anthony P. Fernandez, MD, PhD, director of medical dermatology, Departments of Dermatology and Pathology at the Cleveland Clinic, said.
Anthony P. Fernandez
He said when considering if a patient warrants treatment with a systemic agent, the easiest way to assess disease severity is to look at the patient’s body surface area. The National Psoriasis Foundation has recommended a classification of mild for patients with less than three palms worth of psoriasis, three palms to 10 palms as moderate, and more than 10 palms as severe disease, with the surface of the palm being 1% of the patient’s body surface area. However, health care providers need to take into account other aspects of a patient’s disease to fully assess disease severity, he said.
“We need to look at the physical symptoms, and psoriasis is associated with significant physical symptoms in most patients,” he said.
Results have indicated that up to 83% of patients with psoriasis experience skin pain associated with their lesions, and have difficulty with activities of daily living, work and recreation. Almost 93% of patients experience pruritus, with 54% reporting sleeping problems due to itching at night.
Fernandez also said providers need to take into account the psychological aspects of the disease, especially because psoriasis affects the particularly sensitive areas of the body. Large studies have found 31% of patients not as sexually active as they would like to be, 87% experience embarrassment or helplessness, and 42% report adverse social and family interactions. In addition, up to 60% of patients meet criteria for clinical depression, he said.
Fernandez said results of a large multinational study showed 27% of patients reported their psoriasis as being severe, which included 22% of patients who (based on body surface area alone) would be assessed as having mild disease and almost 40% who would be assessed as having moderate disease.
“So clearly, patients are thinking about other aspects of the disease besides simply body surface in assessing severity,” he said.
Fernandez said surveys have shown the physical and mental impact of psoriasis is greater than other diseases, such as osteoarthritis, cancer and congestive heart failure.
“We need to look all these aspects of how a patient is affected to determine if they warrant a systemic or biologic therapy,” he said. – by Kristine Houck, MA, ELS
Reference:
Fernandez AP. Psoriasis, lupus and common drug reactions. Presented at: Rheumatology Nurses Society Annual Conference; Aug. 3-6, 2016; Cleveland.
Disclosure: Fernandez reports he is on the speakers bureau from AbbVie and Celegene, is a consultant for AbbVie and Novartis, and receives research support from AbbVie.