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Rheumatologists should be cognizant of nonplaque psoriasis symptoms
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BOSTON — Rheumatologists need to be more aware of the nonplaque aspects and symptoms of psoriasis, in order to better screen and diagnose their patients, according to a presentation at the 2018 Interdisciplinary Autoimmune Summit.
“I just want to remind folks, particularly the non-rheumatologists, about the non-plaque disease aspect of psoriasis,” Joseph F. Merola, MD, MMSc, of Harvard University and Brigham and Women’s Hospital said. “I used to joke that at this point my mother could make a diagnosis of psoriasis based on thick, scaly plaques on someone’s elbow.”
He added that an awareness of the other subsets of psoriasis could be helpful for rheumatologists, for example, when faced with a seronegative rheumatoid arthritis, in order to “have some ideas about what else might be psoriasis.”
According to Merola, other disease phenotypes can include nail, scalp and inverse — or intertriginous — psoriasis, all of which are associated with an increased risk for psoriatic arthritis.
Merola described cases he had seen in which the patient had undiagnosed inverse psoriasis – an often hidden, and painful, form of the disease found in skin folds and the genitals – and PsA, which led to a delay in necessary treatment. In another case, a physician who was unfamiliar with the phenotype had prescribed antifungals for inverse psoriasis, believing it to be candida or another fungal infection, Merola said.
Some of the key findings for screening for other psoriasis phenotypes include gluteal cleft involvement, as well as certain nail symptoms, Merola noted; in addition, psoriasis may also manifest in often overlooked places, such as the patient’s scalp and genitals.
Particularly regarding genital psoriasis, he stressed the importance of overcoming the initial discomfort of discussing the condition with patients. Merola added that, beyond the cosmetic aspects of the disease, genital psoriasis can also include fissures, cracks, bleeding and other secondary changes that may not occur in other areas of the body.
“Genital psoriasis is also another variant that we do not really talk to our patients about – it makes us uncomfortable, and makes the patients uncomfortable,” Merola said. “However, if you look at the prevalence – up to 60% of patients of at least one study – of patients ever reporting genital psoriasis, it really is important because I don’t think we ask about, look or talk about this enough, despite several studies that suggest that it is highly impactful in patients’ lives.” – by Jason Laday
Reference:
Merola JF. Clinical Assessment of PSO/PsA: Patient Demonstration. Presented at: IAS 2018; April 27-29, 2018; Boston.
Disclosure: Merola reports advisory board membership with AbbVie, Amgen, Biogen IDEC, Janssen, Kiniksa, Mallinckrodt, Momenta, Novartis, Pfizer and UCB; as well as consulting fees from AbbVie, Amgen, Biogen IDEC, Celegene, Eli Lilly,GSK, Janssen, Kiniksa, Mallinckrodt, Momenta, Novartis, Pfizer, Sanofi, Science 37, Sumumed and UCB; speaking fees from AbbVie; and being an investigator with Biogen IDEC.