Psoriasis and comorbid diseases Takeshita, Junko, MD, PhD, MSCE; Grewal, Sungat, BS; Langan, Sinéad M., MB, BCh, BAO, MRCP, MSc, PhD ...
Journal of the American Academy of Dermatology,
March 2017, Letnik:
76, Številka:
3
Journal Article
Recenzirano
Odprti dostop
Psoriasis is a common chronic inflammatory disease of the skin that is increasingly being recognized as a systemic inflammatory disorder. Psoriatic arthritis is a well-known comorbidity of psoriasis. ...A rapidly expanding body of literature in various populations and settings supports additional associations between psoriasis and cardiometabolic diseases, gastrointestinal diseases, kidney disease, malignancy, infection, and mood disorders. The pathogenesis of comorbid disease in patients with psoriasis remains unknown; however, shared inflammatory pathways, cellular mediators, genetic susceptibility, and common risk factors are hypothesized to be contributing elements. As additional psoriasis comorbidities continue to emerge, education of health care providers is essential to ensuring comprehensive medical care for patients with psoriasis.
Psoriasis and comorbid diseases Takeshita, Junko, MD, PhD, MSCE; Grewal, Sungat, BS; Langan, Sinéad M., MB, BCh, BAO, MRCP, MSc, PhD ...
Journal of the American Academy of Dermatology,
March 2017, Letnik:
76, Številka:
3
Journal Article
Recenzirano
Odprti dostop
As summarized in the first article in this continuing medical education series, the currently available epidemiologic data suggest that psoriasis may be a risk factor for cardiometabolic disease. ...Emerging data also suggest associations between psoriasis and other comorbidities beyond psoriatic arthritis, including chronic kidney disease, inflammatory bowel disease, hepatic disease, certain malignancies, infections, and mood disorders. Recognizing the comorbid disease burden of psoriasis is essential for ensuring comprehensive care of patients with psoriasis. The clinical implications of the comorbid diseases that are associated with psoriasis and recommendations for clinical management are reviewed in this article.
Abstract Background Recent studies suggest that psoriasis, particularly if severe, may be a risk factor for major adverse cardiac events, such as myocardial infarction, stroke, and mortality from ...cardiovascular disease. We compared the risk of major adverse cardiac events between patients with psoriasis and the general population and estimated the attributable risk of severe psoriasis. Methods We performed a cohort study in the General Practice Research Database. Severe psoriasis was defined as receiving a psoriasis diagnosis and systemic therapy (N = 3603). Up to 4 patients without psoriasis were selected from the same practices and start dates for each patient with psoriasis (N = 14,330). Results Severe psoriasis was a risk factor for major adverse cardiac events (hazard ratio 1.53; 95% confidence interval, 1.26-1.85) after adjusting for age, gender, diabetes, hypertension, tobacco use, and hyperlipidemia. After fully adjusted analysis, severe psoriasis conferred an additional 6.2% absolute risk of 10-year major adverse cardiac events. Conclusion Severe psoriasis confers an additional 6.2% absolute risk of a 10-year rate of major adverse cardiac events compared with the general population. This potentially has important therapeutic implications for cardiovascular risk stratification and prevention in patients with severe psoriasis. Future prospective studies are needed to validate these findings.
Background Complementary and alternative medicine (CAM) is commonly used for a variety of diseases in the United States. Limited population-based data exist on CAM use among patients with ...dermatologic conditions Objective We sought to determine the extent and the nature of CAM use in the United States among people with skin problems. Methods We conducted a cross-sectional survey using the 2002 National Health Interview Survey and the Alternative Health Supplement. Results Among those reporting skin problems in the past year, 49.4% (95% confidence interval 47.2-51.6) had used CAM. Only 6.0% of this group (95% confidence interval 4.2-7.7) used CAM specifically for skin disease. Those reporting skin problems were more likely to use CAM than those who did not report skin problems (odds ratio 1.7, P ≤ .001, 95% confidence interval 1.6-1.8). The most commonly used CAM modality was nonvitamin, nonmineral, natural products (ie, herbals). Limitations Because of the nature of a cross-sectional study, it is not possible to know whether the skin problem or the CAM use came first (except in situations where they used CAM specifically for skin problems). Because this is not a dermatology-focused database, the definition of skin disease is vague. Conclusion CAM use among adults with skin problems in the Unites States is common. Dermatologists should have candid discussions with their patients regarding CAM use.
The impact of psoriasis on 10-year Framingham risk Mehta, Nehal N., MD, MSCE; Krishnamoorthy, Parasuram, MBBS; Yu, YiDing, MD ...
Journal of the American Academy of Dermatology,
10/2012, Letnik:
67, Številka:
4
Journal Article
Background Psoriasis is a predictor of morbidity. It is important to determine the extent to which psoriasis remains undiagnosed. Objective To determine the prevalence of psoriasis. Methods We ...conducted a cross-sectional study using the National Health and Nutrition Examination Survey 2003-2004. Results The prevalence of diagnosed psoriasis was 3.15% (95% confidence interval CI, 2.18-4.53), corresponding to 5 million adults. Approximately 17% of these patients have moderate to severe psoriasis based on body surface area report and 25% rate psoriasis a large problem in everyday life. The prevalence of undiagnosed active psoriasis by conservative estimate was 0.4% (95% CI, 0.19-0.82), corresponding to approximately 600,000 US adults, and 2.28% (95% CI, 1.47-3.50) by a broader definition, corresponding to 3.6 million US adults. Undiagnosed patients had a trend toward being more likely to be male, nonwhite, less educated, and unmarried compared with patients who had received a diagnosis. Limitations The method for determining the presence of psoriasis had limited ability to detect mild disease and only fair interrater agreement. Conclusion More than 5 million adults have been diagnosed with psoriasis. A large number have undiagnosed psoriasis and there are important disparities which may be associated with not receiving medical attention.
Psoriasis is a common, chronic, inflammatory, multisystem disease with predominantly skin and joint manifestations affecting approximately 2% of the population. In the first 5 parts of the ...AmericanAcademy of Dermatology Psoriasis Guidelines of Care, we have presented evidence supporting the use of topical treatments, phototherapy, traditional systemic agents, and biological therapies for patients with psoriasis and psoriatic arthritis. In this sixth and final section of the Psoriasis Guidelines of Care, we will present cases to illustrate how to practically use these guidelines in specific clinical scenarios. We will describe the approach to treating patients with psoriasis across the entire spectrum of this fascinating disease from mild to moderate to severe, with and without psoriatic arthritis, based on the 5 prior published guidelines. Although specific therapeutic recommendations are given for each of the cases presented, it is important that treatment be tailored to meet individual patients’ needs. In addition, we will update the prior 5 guidelines and address gaps in research and care that currently exist, while making suggestions for further studies that could be performed to help address these limitations in our knowledge base.
Background Studies indicate adherence to biologics among patients with psoriasis is low, yet little is known about their use in the Medicare population. Objective We sought to investigate real-world ...utilization patterns in a national sample of Medicare beneficiaries with psoriasis initiating infliximab, etanercept, adalimumab, or ustekinumab. Methods We conducted a retrospective claims analysis using 2009 through 2012 100% Medicare Chronic Condition Data Warehouse Part A, B, and D files, with 12-month follow-up after index prescription. Descriptive and multivariate analyses were used to examine rates of and factors associated with biologic adherence, discontinuation, switching, and restarting. Results We examined 2707 patients initiating adalimumab (40.0%), etanercept (37.9%), infliximab (11.7%), and ustekinumab (10.3%); during 12-month follow-up, 38% were adherent and 46% discontinued treatment, with 8% switching to another biologic and 9% later restarting biologic treatment. Being female and being ineligible for low-income subsidies were associated with increased odds of decreased adherence. Outcomes varied by index biologic. Limitations Patient-reported reasons for nonadherence or gaps in treatment are unavailable in claims data. Conclusion Medicare patients initiating biologics for psoriasis had low adherence and high discontinuation rates. Further investigation into reasons for inconsistent utilization, including exploration of patient and provider decision-making and barriers to more consistent treatment, is needed.
Background There is a need to better understand the safety of tumor necrosis factor (TNF) inhibitors in patients with psoriatic disease in whom TNF inhibitors are frequently used as monotherapy. ...Objective We sought to examine the risks of infection and malignancy with the use of TNF antagonists in adult patients with psoriatic disease. Methods We conducted a systematic search for trials of TNF antagonists for adults with plaque psoriasis and psoriatic arthritis. We included randomized, placebo-controlled trials of etanercept, infliximab, adalimumab, golimumab, and certolizumab for the treatment of plaque psoriasis and psoriatic arthritis. Twenty of 820 identified studies with a total of 6810 patients were included. Results were calculated using fixed effects models and reported as pooled odds ratios. Results Odds ratios for overall infection and serious infection over a mean of 17.8 weeks were 1.18 (95% confidence interval CI 1.05-1.33) and 0.70 (95% CI 0.40-1.21), respectively. When adjusting for patient-years, the incidence rate ratio for overall infection was 1.01 (95% CI 0.92-1.11). The odds ratio for malignancy was 1.48 (95% CI 0.71-3.09) and 1.26 (95% CI 0.39-4.15) when nonmelanoma skin cancer was excluded. Limitations Short duration of follow-up and rarity of malignancies and serious infections are limitations. Conclusions There is a small increased risk of overall infection with the short-term use of TNF antagonists for psoriasis that may be attributable to differences in follow-up time between treatment and placebo groups. There was no evidence of an increased risk of serious infection and a statistically significant increased risk in cancer was not observed with short-term use of TNF inhibitors.
There have been several articles and reports in recent months about comorbidities and risks that affect psoriasis patients in addition to their underlying disease. This piece reviews the current ...literature and begins to address what should be done with this new information by updating the clinician about what health screening tests, preventative exams, and referrals should be considered in this population.
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