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Gnanaraj P, Dayalan H, Elango T, Malligarjunan H, Raghavan V, Rao R. Downregulation of involucrin in psoriatic lesions following therapy with propylthiouracil, an anti-thyroid thioureylene: immunohistochemistry and gene expression analysis. Int J Dermatol 2014; 54:302-6. [DOI: 10.1111/ijd.12565] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Pushpa Gnanaraj
- Department of Dermatology; Sri Ramaswamy Memorial (SRM) Medical College Hospital and Research Center; Kattankulathur Kancheepuram India
| | - Haripriya Dayalan
- Department of Medical Research; Sri Ramaswamy Memorial (SRM) Medical College Hospital and Research Center; Kattankulathur Kancheepuram India
| | - Tamilselvi Elango
- Department of Medical Research; Sri Ramaswamy Memorial (SRM) Medical College Hospital and Research Center; Kattankulathur Kancheepuram India
| | - Hemamalini Malligarjunan
- Department of Medical Research; Sri Ramaswamy Memorial (SRM) Medical College Hospital and Research Center; Kattankulathur Kancheepuram India
| | - Vijayashree Raghavan
- Department of Pathology; Chettinad Hospital and Research Institute; Kelambakkam Chennai India
| | - Ramesh Rao
- Department of Pathology; Chettinad Hospital and Research Institute; Kelambakkam Chennai India
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152
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Chen Y, Xin T, Cheng ASK. Evaluating the effectiveness of psychological and/or educational interventions in psoriasis: a narrative review. J Dermatol 2014; 41:775-8. [PMID: 25109476 DOI: 10.1111/1346-8138.12583] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2014] [Accepted: 06/25/2014] [Indexed: 11/30/2022]
Abstract
The aim of the present study was to review the effectiveness of psychological and/or educational interventions for reducing psoriasis severity and improving psychological and quality of life (QOL) outcomes in psoriasis. Sixteen papers met the inclusion criteria. Overall, the effectiveness of the existing interventions from this narrative synthesis is positive, especially in psychological and QOL outcomes. Of the 16 included studies, only five were randomized controlled trials (RCTs). The strength of the evidence to support the effectiveness of the existing interventions was limited due to methodological weakness in the included studies. The review concludes that further research is needed to examine the effectiveness of psychological and/or educational interventions for individuals with psoriasis, including a greater number of RCTs in order to increase the methodological validity of intervention studies. Also, future research needs to be conducted to establish which interventions are most effective for specific sub-populations who may best profit from psycho-educational interventions.
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Affiliation(s)
- Yongfeng Chen
- Guangdong Provincial Dermatology Hospital, Guangzhou, China
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153
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Chung J, Callis Duffin K, Takeshita J, Shin DB, Krueger GG, Robertson AD, Troxel AB, Van Voorhees AS, Edson-Heredia E, Gelfand JM. Palmoplantar psoriasis is associated with greater impairment of health-related quality of life compared with moderate to severe plaque psoriasis. J Am Acad Dermatol 2014; 71:623-32. [PMID: 24894455 DOI: 10.1016/j.jaad.2014.04.063] [Citation(s) in RCA: 66] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2014] [Revised: 04/24/2014] [Accepted: 04/27/2014] [Indexed: 11/16/2022]
Abstract
BACKGROUND The impact of palmoplantar psoriasis on health-related quality of life (QoL) is largely unknown. OBJECTIVE We sought to compare clinical characteristics and patient-reported outcomes between patients with palmoplantar psoriasis and moderate to severe plaque psoriasis. METHODS We conducted a cross-sectional study of patients with plaque psoriasis (N=1153) and palmoplantar psoriasis (N=66) currently receiving systemic or light treatment for psoriasis. RESULTS Patients with palmoplantar psoriasis were more likely to report Dermatology Life Quality Index scores that correspond to at least a moderate impact on QoL (odds ratio [OR] 2.08; 95% confidence interval [CI] 1.20-3.61); problems with mobility (OR 1.98; 95% CI 1.10-3.58), self-care (OR 3.12; 95% CI 1.24-7.86), and usual activities (OR 2.47; 95% CI 1.44-4.22) on the European Quality of Life-5 Dimensions questionnaire; and heavy topical prescription use of at least twice daily in the preceding week (OR 2.81; 95% CI 1.63-4.85) than those with plaque psoriasis. LIMITATIONS Our assessment tools may not account for all dimensions of health-related QoL affected by palmoplantar disease, and these results may not be generalizable to patients with milder forms of psoriasis. CONCLUSION Patients with palmoplantar psoriasis experience greater health-related QoL impairment and are more likely to report heavy use of topical prescriptions than those with moderate to severe plaque psoriasis.
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Affiliation(s)
- Jina Chung
- Department of Dermatology, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania
| | | | - Junko Takeshita
- Department of Dermatology, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania; Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania
| | - Daniel B Shin
- Department of Dermatology, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania; Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania
| | - Gerald G Krueger
- Department of Dermatology, University of Utah School of Medicine, Salt Lake City, Utah
| | | | - Andrea B Troxel
- Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania
| | - Abby S Van Voorhees
- Department of Dermatology, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania
| | | | - Joel M Gelfand
- Department of Dermatology, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania; Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania.
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154
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Milčić D, Janković S, Vesić S, Milinković M, Janković J. Assessment of quality of life in patients with psoriasis: a study from Serbia. Int J Dermatol 2014; 54:523-8. [PMID: 24738764 DOI: 10.1111/ijd.12391] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND Psoriasis has a substantial impact on patients' quality of life. OBJECTIVES The aims of this study were to assess the impact of the clinical severity of psoriasis on patients' quality of life and to determine the effects of psoriasis-related stress on patients' everyday life. METHODS The cross-sectional study was conducted at the Institute of Dermatovenereology, Clinical Center of Serbia, Belgrade. The study included 201 patients (124 men and 77 women), aged 18-70 with a diagnosis of psoriasis, hospitalized or treated as outpatients during 2009. For the assessment of patients' quality of life, the psoriasis disability index (PDI) was used. The stress related to psoriasis was measured with the psoriasis life stress inventory (PLSI) and disease severity with the psoriasis area and severity index (PASI). RESULTS We found moderate correlation between PLSI and all PDI subscales and overall score (correlation coefficients ranged from 0.334 to 0.521). The correlation between PASI and PDI subscales was weak, while we failed to find any significant correlation between PASI and the PLSI. The results of multiple regression analysis indicated that stress, more severe disease, and lower educational level are significant determining factors of a poorer quality of life in patients with psoriasis. CONCLUSION Our results support the importance of assessing the quality of life in psoriasis and effects of stress in patients' adjustment to their condition and may have important implications for a psychological stress management approach in the clinical management of psoriasis.
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Affiliation(s)
- Danijela Milčić
- Institute of Dermatovenereology, Clinical Center of Serbia and Faculty of Medicine, University of Belgrade, Belgrade, Serbia
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155
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Kragballe K, van de Kerkhof P. Pooled safety analysis of calcipotriol plus betamethasone dipropionate gel for the treatment of psoriasis on the body and scalp. J Eur Acad Dermatol Venereol 2014; 28 Suppl 2:10-21. [DOI: 10.1111/jdv.12444] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2014] [Accepted: 02/06/2014] [Indexed: 11/30/2022]
Affiliation(s)
- K. Kragballe
- Department of Dermatology; Århus University Hospital; Århus Denmark
| | - P. van de Kerkhof
- Department of Dermatology; Radboud University Medical Centre; Nijmegen The Netherlands
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156
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Daudén E, Bewley A, Lambert J, Girolomoni G, Cambazard F, Reich K. Expert recommendations: the use of the fixed combination calcipotriol and betamethasone dipropionate gel for the topical treatment of psoriasis. J Eur Acad Dermatol Venereol 2014; 28 Suppl 2:22-32. [DOI: 10.1111/jdv.12443] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2014] [Accepted: 02/06/2014] [Indexed: 01/14/2023]
Affiliation(s)
- E. Daudén
- Department of Dermatology; Hospital Universitario de la Princesa; Madrid Spain
| | - A. Bewley
- Department of Dermatology; Barts Health NHS Trust; London UK
| | - J. Lambert
- Department of Dermatology; Ghent University Hospital; Ghent Belgium
| | - G. Girolomoni
- Department of Dermatology; University of Verona; Verona Italy
| | | | - K. Reich
- Dermatologikum Hamburg; Hamburg Germany
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Reich K, Daudén E. Treatment adherence: a hurdle for real-life effectiveness in psoriasis? J Eur Acad Dermatol Venereol 2014; 28 Suppl 2:1-3. [DOI: 10.1111/jdv.12442] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Affiliation(s)
- K. Reich
- Dermatologikum Hamburg; Hamburg Germany
| | - E. Daudén
- Department of Dermatology; Hospital Universitario de la Princesa; Madrid Spain
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Baker CS, Foley PA, Braue A. Psoriasis uncovered--measuring burden of disease impact in a survey of Australians with psoriasis. Australas J Dermatol 2013; 54 Suppl 1:1-6. [PMID: 23379483 DOI: 10.1111/ajd.12010] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2012] [Accepted: 11/22/2012] [Indexed: 11/29/2022]
Abstract
BACKGROUND/OBJECTIVES Internationally, the understanding of psoriasis has advanced in recent years to the point now where it is no longer considered a benign or cosmetic skin condition but a systemic, immune-mediated disease associated with significant comorbidities and considerable detriment to quality of life. The aim of this study was to gain a better understanding of the physical, psychosocial and medical burden of psoriasis on Australian adults and the impact on health status. METHODS Two large-scale multi-centre cross-sectional studies of Australian adults with psoriasis were conducted during 2010 and 2011, with the participation of a national patient representative group (Psoriasis Australia). The studies were based on detailed questionnaires that were self-completed by individuals with psoriasis. RESULTS A total of 362 and 330 completed surveys were received in 2010 and 2011, respectively. A significant physical, psychosocial and medical burden was reported by the respondents. It was noteworthy that patients reported actively concealing their disease from the general public (83%), work colleagues (65%), friends (58%), employers (49%), family (40%), close friends (39%) and spouse/partner (20%). The mean five-dimension European quality of life (EQ-5D) score for the 2011 cohort was 0.73, representing a significant impact on their HRQoL. The presence of comorbidities, found in three-quarters of the cohort, was associated with an even greater detriment to their HRQoL (mean score 0.64). CONCLUSIONS Psoriasis imposes a significant psychosocial burden on the lives of patients, including a profound impact upon their personal and professional relationships, social interactions and quality of life, to a degree comparable to other serious chronic conditions. This study highlights the importance of collaboration between primary and specialist health-care providers in developing patient management strategies that address the spectrum of physical and psychological manifestations associated with psoriasis.
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Affiliation(s)
- Chris S Baker
- Department of Dermatology, St Vincent's Hospital, Melbourne, Victoria, Australia.
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160
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Impact of Active and Stable Psoriasis on Health-Related Quality of Life: The PSO-LIFE Study. ACTA ACUST UNITED AC 2013; 104:685-93. [DOI: 10.1016/j.adengl.2013.02.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2012] [Accepted: 02/21/2013] [Indexed: 11/21/2022]
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161
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Daudén E, Herrera E, Puig L, Sánchez-Carazo J, Toribio J, Perulero N. Impacto en la calidad de vida relacionada con la salud de pacientes con psoriasis activa y estable. Estudio PSO-LIFE. ACTAS DERMO-SIFILIOGRAFICAS 2013. [DOI: 10.1016/j.ad.2013.02.018] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
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Langeland E, Robinson HS, Moum T, Larsen MH, Wahl AK. Mental health among people with psoriasis undergoing patient education in climate therapy. Scand J Psychol 2013; 54:508-14. [PMID: 24111658 DOI: 10.1111/sjop.12073] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2013] [Accepted: 06/17/2013] [Indexed: 11/26/2022]
Abstract
This study investigated the mental health of people with psoriasis undergoing patient education in climate therapy. A prospective design included a baseline assessment and two follow-ups after a 3-week patient education program. Participants were 254 adults. Positive mental health was measured by the mental health continuum short form (0-70), and negative mental health by the emotional distress subscale (1-4) of the health education impact questionnaire. Paired-samples t-tests were used to evaluate changes in mental health from baseline to follow-up. Multiple linear regression was used to analyse the ability of socio-demographic and clinical variables and emotional distress to predict changes in positive mental health. To predict change in negative mental health we repeated the same analysis but with a change in negative mental health as a dependent variable and positive mental health as an independent variable. The results show that positive mental health and health-related emotional distress improved significantly from before to after the intervention by 7.1 points, p < 0.001 and 0.21 points, p < 0.001) respectively. At the second follow-up, health-related emotional distress remained significantly improved compared with baseline levels by 0.11 points, p = 0.004. The longer participants had lived with psoriasis ( β = 146, p = 0.027), and the presence of co-morbid health problems (β = 111, p = 0.051) the greater the improvement in the positive mental health immediately after the intervention. No predictors were identified for negative mental health. This study indicates that the promotion of positive mental health needs to be integrated into the climate therapy program, and sustained in their home context.
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Affiliation(s)
- E Langeland
- Faculty of Health and Social Sciences, Bergen University College, Norway
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163
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Ahmad Fadzil MH, Prakasa E, Asirvadam VS, Nugroho H, Affandi AM, Hussein SH. 3D surface roughness measurement for scaliness scoring of psoriasis lesions. Comput Biol Med 2013; 43:1987-2000. [PMID: 24054912 DOI: 10.1016/j.compbiomed.2013.08.009] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2012] [Revised: 08/04/2013] [Accepted: 08/15/2013] [Indexed: 01/14/2023]
Abstract
Psoriasis is an incurable skin disorder affecting 2-3% of the world population. The scaliness of psoriasis is a key assessment parameter of the Psoriasis Area and Severity Index (PASI). Dermatologists typically use visual and tactile senses in PASI scaliness assessment. However, the assessment can be subjective resulting in inter- and intra-rater variability in the scores. This paper proposes an assessment method that incorporates 3D surface roughness with standard clustering techniques to objectively determine the PASI scaliness score for psoriasis lesions. A surface roughness algorithm using structured light projection has been applied to 1999 3D psoriasis lesion surfaces. The algorithm has been validated with an accuracy of 94.12%. Clustering algorithms were used to classify the surface roughness measured using the proposed assessment method for PASI scaliness scoring. The reliability of the developed PASI scaliness algorithm was high with kappa coefficients>0.84 (almost perfect agreement).
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Affiliation(s)
- M Hani Ahmad Fadzil
- Centre for Intelligent Signal and Imaging Research, Department of Electrical & Electronic Engineering, Universiti Teknologi PETRONAS, Perak, Malaysia.
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164
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Levy AR, Davie AM, Brazier NC, Jivraj F, Albrecht LE, Gratton D, Lynde CW. Economic burden of moderate to severe plaque psoriasis in Canada. Int J Dermatol 2013; 51:1432-40. [PMID: 23171010 DOI: 10.1111/j.1365-4632.2011.05359.x] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND Psoriasis is a chronic debilitating disease affecting approximately one million Canadians. The objective of this study is to estimate the economic burden in $CDN (2008) of moderate to severe plaque psoriasis among Canadian adults. METHODS Using a cross-sectional design, direct resource use, costs, lost productivity, and quality of life were obtained for 90 subjects diagnosed with psoriasis in three dermatology clinics in British Columbia, Ontario, and Québec. An Excel-based economic model was developed to project the annual cost of psoriasis, from the societal perspective. RESULTS The estimated mean annual cost of psoriasis was $7999/subject (95% CI: $3563-$12,434) with direct costs accounting for 57%. Mean lost productivity costs, which accounted for 43% of the mean annual costs of psoriasis, were $3442/subject (95% CI: $1293-$5590). CONCLUSION Projecting the mean costs per patient to the afflicted population yields an estimated total annual cost of $1.7 billion (95% CI: $0.8-$2.6 billion) attributable to moderate to severe psoriasis in Canada. Understanding the interplay between direct costs, lost productivity, and quality of life is critical for accurately identifying and evaluating effective treatments for this disease.
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Affiliation(s)
- Adrian R Levy
- Department of Community Health and Epidemiology, Dalhousie University, Halifax, NS, Canada.
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165
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Frez MLF, Asawanonda P, Gunasekara C, Koh C, Loo S, Oon HH, Thai VH, Tsai TF, Youn SW. Recommendations for a patient-centered approach to the assessment and treatment of scalp psoriasis: a consensus statement from the Asia Scalp Psoriasis Study Group. J DERMATOL TREAT 2013; 25:38-45. [PMID: 23083439 DOI: 10.3109/09546634.2012.742176] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND International consensus statements on the management of scalp psoriasis are available, but no such recommendations exist for Asia. METHODS The Asia Scalp Psoriasis Study Group (ASPSG) met in May 2011 to review the epidemiologic pattern of scalp psoriasis in Southeast Asia and to develop Asia-specific recommendations for its management. RESULTS The overall prevalence of psoriasis in Asia is <0.3%, but 75-90% have scalp involvement, whether isolated or with lesions elsewhere, which can negatively impact quality of life (QoL). Treatment decisions should be based primarily on objective disease severity, but should also take account of patient QoL. Psychosocial support and more aggressive treatment should be offered to all patients with moderate to severe QoL impairment. Topical therapy is indicated first-line in all patients, with combination therapy (corticosteroid + calcipotriol), more occlusive formulations, keratolytics, and very potent corticosteroids for patients needing greater or faster efficacy. Systemic therapies, light or laser treatments should be reserved for patients with severe and recalcitrant disease. CONCLUSIONS The ASPSG recommends a patient-centered approach to scalp psoriasis management, consistent with the international consensus statements. Asian physicians should also consider patient QoL, prior treatment response, formulation preferences, likely adherence, cost, time available for self-management, and potential adverse events.
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Affiliation(s)
- Maria Lorna F Frez
- Department of Dermatology, University of the Philippines , Manila , Philippines
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166
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Boutin M. Among Other Flaws, Hypothetical Migraine Study Lacks Independent Evaluation And Patient Engagement. Health Aff (Millwood) 2012; 31:2231-5. [DOI: 10.1377/hlthaff.2012.0764] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
- Marc Boutin
- Marc Boutin ( ) is executive vice president and chief operating officer of the National Health Council, in Washington, D.C
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167
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Greenberger S, Harats D, Salameh F, Lubish T, Harari A, Trau H, Shaish A. 9-cis–Rich β-Carotene Powder of the AlgaDunaliellaReduces the Severity of Chronic Plaque Psoriasis: A Randomized, Double-Blind, Placebo-Controlled Clinical Trial. J Am Coll Nutr 2012; 31:320-6. [DOI: 10.1080/07315724.2012.10720430] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
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168
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Dauden E, Herrera E, Puig L, Sánchez-Carazo JL, Toribio J, Caloto MT, Nocea G, Roset M, Lara N. Validation of a new tool to assess health-related quality of life in psoriasis: the PSO-LIFE questionnaire. Health Qual Life Outcomes 2012; 10:56. [PMID: 22624984 PMCID: PMC3458920 DOI: 10.1186/1477-7525-10-56] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2011] [Accepted: 05/03/2012] [Indexed: 11/12/2022] Open
Abstract
Background Several questionnaires have been used to measure health related quality of life (HRQoL) in patients with psoriasis, few have been adapted for use in Spain; none of them was developed specifically for the Spanish population. The purpose of the study was to validate and assess the sensitivity to change of a new questionnaire to measure HRQOL in patients with psoriasis (PSO-LIFE). Methods Observational, prospective, multicenter study performed in centers around Spain. Patients with active or inactive psoriasis completed the PSO-LIFE together with other Dermatology Quality of Life Index (DLQI) and Psoriasis Disability Index (PDI). A control group of patients with urticaria or atopic dermatitis was also included. Internal consistency and test-retest reliability of the PSO-LIFE were assessed by calculating Cronbach’s alpha and Intraclass Correlation Coefficient (ICC). Validity was assessed by examining factorial structure, the capacity to discriminate between groups, and correlations with other measures. Sensitivity to change was measured using effect sizes. Results The final sample included for analysis consisted of 304 patients and 56 controls. Mean (SD) age of psoriasis patients was 45.3 (14.5) years compared to 38.8 (14) years for controls (p < 0.01). Cronbach’s alpha for the PSO-LIFE was 0.95 and test-retest reliability using the ICC was 0.98. Factor analysis showed the questionnaire to be unidimensional. Mean (SD) PSO-LIFE scores differed between patients with psoriasis and controls (64.9 [22.5] vs 69.4 [17.3]; p < 0.05), between those with active and inactive disease (57.4 [20.4] vs 76.4 [20.6]; p < 0.01), and between those with visible and non-visible lesions (63.0 [21.9] vs. 74.8 [23.9]; p < 0.01). The correlation between PSO-LIFE and PASI scores was moderate (r = −0.43) while correlations with DLQI and PDI dimensions ranged from moderate to high (between 0.4 and 0.8). Effect size on the PSO-LIFE in patients reporting ‘much improved’ health status at study completion was 1.01 (large effect size). Conclusions The present results provide substantial support for the reliability, validity, and responsiveness of the PSO-LIFE questionnaire in the population for which it was designed.
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169
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Love TJ, Zhu Y, Zhang Y, Wall-Burns L, Ogdie A, Gelfand JM, Choi HK. Obesity and the risk of psoriatic arthritis: a population-based study. Ann Rheum Dis 2012; 71:1273-7. [PMID: 22586165 DOI: 10.1136/annrheumdis-2012-201299] [Citation(s) in RCA: 198] [Impact Index Per Article: 16.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
BACKGROUND Obesity is associated with an increased risk of psoriasis; however, its potential impact on the risk of psoriatic arthritis (PsA) remains unclear. OBJECTIVES To evaluate the association between body mass index (BMI) and the risk of PsA among patients with psoriasis from the general population. METHODS The authors conducted a cohort study using data from The Health Improvement Network, an electronic medical records database representative of the UK general population, collected between 1995 and 2010. The exposure of interest was the first BMI measured after psoriasis diagnosis and endpoints were incident cases of physician-diagnosed PsA. The authors estimated the RR of PsA after adjusting for age, sex, and histories of trauma, smoking and alcohol consumption. RESULTS Among 75,395 individuals with psoriasis (43% male, mean follow-up of 5 years, and mean age of 52 years), 976 developed PsA (incidence rate, 26.5 per 10,000 person-years). The PsA incidence rates increased with increasing BMI. Compared with psoriasis patients with BMI <25 kg/m(2), the RRs for developing PsA were 1.09 (0.93-1.28) for BMIs from 25.0 to 29.9, 1.22 (1.02-1.47) for BMIs from 30.0 to 34.9 and 1.48 (1.20-1.81) for BMIs ≥35.0. In our secondary analysis among all individuals, regardless of psoriasis (~2 million), the corresponding multivariate RRs tended to be stronger (1.0, 1.17, 1.57, 1.96; p for trend <0.001). CONCLUSIONS This general population study suggests that obesity is associated with an increased risk of incident PsA and supports the importance of weight reduction among psoriasis patients who often suffer from the metabolic syndrome and obesity.
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Affiliation(s)
- Thorvardur Jon Love
- Department of Science, Education, and Innovation, Landspitali University Hospital, Fossvogur, Reykjavik, Iceland
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170
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Barker J, Hoffmann M, Wozel G, Ortonne JP, Zheng H, van Hoogstraten H, Reich K. Efficacy and safety of infliximab vs. methotrexate in patients with moderate-to-severe plaque psoriasis: results of an open-label, active-controlled, randomized trial (RESTORE1). Br J Dermatol 2012; 165:1109-17. [PMID: 21910713 DOI: 10.1111/j.1365-2133.2011.10615.x] [Citation(s) in RCA: 144] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND Infliximab is indicated for treatment of moderate-to-severe plaque psoriasis in adults whose disease cannot be controlled with other systemic therapies, including methotrexate (MTX). To date, no studies have directly compared the efficacy and safety of infliximab and MTX. OBJECTIVES To compare the efficacy and safety of infliximab vs. MTX in adults with moderate-to-severe plaque psoriasis. METHODS MTX-naïve patients (n = 868) were randomized 3:1 to receive infliximab 5 mg kg⁻¹ at weeks 0, 2, 6, 14 and 22 or MTX 15 mg weekly with a dose increase to 20 mg weekly at week 6 if the Psoriasis Area and Severity Index (PASI) response was < 25%. At week 16, patients with < PASI 50 response could switch treatment groups. The primary efficacy endpoint was PASI 75 response at week 16. Major secondary efficacy endpoints were PASI 75 response at week 26, and the proportion of patients achieving a Physician's Global Assessment (PGA) score of cleared (0) or minimal (1) at weeks 16 and 26. Others included Dermatology Life Quality Index, 36-Item Short Form Health Survey, and PGA, PASI 50, PASI 75 and PASI 90 responses over time. RESULTS The primary endpoint was achieved by a significantly greater proportion of infliximab-treated patients (508/653, 78%) than MTX-treated patients (90/215, 42%; P < 0·001). Key secondary endpoints also were achieved by a greater proportion of infliximab-treated patients. Similar responses were observed at week 26 in patients who switched from MTX to infliximab at week 16. Overall adverse event (AE) incidence was comparable between groups, but incidence of serious and severe AEs was slightly higher in the infliximab group. CONCLUSIONS Infliximab was well tolerated and more efficacious than MTX in patients with moderate-to-severe plaque psoriasis. Infliximab also was efficacious in patients who failed MTX and switched to infliximab.
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Affiliation(s)
- J Barker
- St John's Institute of Dermatology, King's College London, London, UK
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171
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Physical and mental impact of psoriasis severity as measured by the compact Short Form-12 Health Survey (SF-12) quality of life tool. J Invest Dermatol 2011; 132:1111-6. [PMID: 22205305 DOI: 10.1038/jid.2011.427] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
The Short Form-12 Health Survey (SF-12) is used to assess the patient's quality of life (QoL) using the physical component score (PCS) and the mental component score (MCS). The purpose of this study was to determine whether the SF-12 PCS and MCS are associated with psoriasis severity and to compare QoL between Murdough Family Center for Psoriasis (MFCP) patients and patients with other major chronic diseases included in the National Survey of Functional Health Status data. We used data from 429 adult patients enrolled in MFCP. Psoriasis Area Severity Index (PASI) was used to assess psoriasis severity at the time of completion of the SF-12 questionnaire. Other variables included age, sex, body mass index, psoriatic arthritis, psychiatric disorders, and comorbidities. Linear regression models were used to estimate effect sizes ± 95% confidence intervals. For every 10-point increase in PASI, there was a 1.1 ± 1.3 unit decrease in MCS (P=0.100) and a 2.4 ± 1.3 unit decrease in PCS (P<0.001). Psoriasis severity was associated with PCS and MCS after adjusting for variables, although the strength of the relationship was attenuated in some models. Psoriasis severity is associated with decreased QoL. SF-12 may be a useful tool for assessing QoL among psoriasis patients.
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172
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Badıllı U, Şen T, Tarımcı N. Microparticulate based topical delivery system of clobetasol propionate. AAPS PharmSciTech 2011; 12:949-57. [PMID: 21748539 DOI: 10.1208/s12249-011-9661-7] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2011] [Accepted: 06/30/2011] [Indexed: 12/20/2022] Open
Abstract
Psoriasis is a chronic, autoimmune skin disease affecting approximately 2% of the world's population. Clobetasol propionate which is a superpotent topical corticosteroid is widely used for topical treatment of psoriasis. Conventional dosage forms like creams and ointments are commonly prefered for the therapy. The purpose of this study was to develop a new topical delivery system in order to provide the prolonged release of clobetasol propionate and to reduce systemic absorption and side effects of the drug. Clobetasol propionate loaded-poly(D,L-lactic-co-glycolic acid) (PLGA) microspheres were prepared by oil-in-water emulsion-solvent evaporation technique. Particle size analysis, morphological characterization, DSC and XRD analyses and in vitro drug release studies were performed on the microparticle formulations. Emulgel formulations were prepared as an alternative for topical delivery of clobetasol propionate. In vitro drug release studies were carried out from the emulgel formulations containing pure drug and drug-loaded microspheres. In addition, the same studies were performed to determine the drug release from the commercial cream product of clobetasol propionate. The release of clobetasol propionate from the emulgel formulations was significantly higher than the commercial product. In addition, the encapsulation of clobetasol propionate in the PLGA microspheres significantly delayed the drug release from the emulgel formulation. As a result, the decrease in the side effects of clobetasol propionate by the formulation containing PLGA microspheres is expected.
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173
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Hauber AB, Gonzalez JM, Schenkel B, Lofland JH, Martin S. The value to patients of reducing lesion severity in plaque psoriasis. J DERMATOL TREAT 2011; 22:266-75. [DOI: 10.3109/09546634.2011.588193] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
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174
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Staidle JP, Dabade TS, Feldman SR. A pharmacoeconomic analysis of severe psoriasis therapy: a review of treatment choices and cost efficiency. Expert Opin Pharmacother 2011; 12:2041-54. [PMID: 21736530 DOI: 10.1517/14656566.2011.590475] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
INTRODUCTION Psoriasis is a chronic, inflammatory disease afflicting 2% of the US population; it results in significant morbidity. The annual healthcare costs related to psoriasis are an estimated $11.3 billion and, with an expanding biologic market, an updated costs analysis is needed. AREAS COVERED Current treatments, including systemic agents (acitretin, cyclosporine, methotrexate), phototherapies and all available biologics (adalimumab, etanercept, infliximab, alefacept, ustekinumab) appropriate for severe psoriasis are described mechanistically and with regard to their efficacy, quality-of-life improvements and side effects. A cost-efficacy model considering US health-system-based annual costs, clinical and quality-of-life improvements was created. Reported Psoriasis Area and Severity Index improvement of 75% from baseline (PASI-75) scores, Dermatology Life Quality Index (DLQI) improvements and estimated costs of medications are described. Annual costs ranged from $1330 for methotrexate to $48,731 for high-dose etanercept. The lowest cost per achieving DLQI minimally important difference was from phototherapy; the highest was from alefacept. The lowest costs per patient achieving PASI-75 was from methotrexate and the highest was from alefacept. EXPERT OPINION Phototherapies and methotrexate offer high efficacy for their costs. Therapeutic approaches must be individualized for each patient given all considerations described.
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Affiliation(s)
- Jonathan P Staidle
- Wake Forest University School of Medicine, Medical Center Boulevard, Department of Dermatology, Winston-Salem, NC 27157-1071, USA
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175
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Mahajan R, Kanwar AJ, Kaur I. Assessing quality of life in patients with psoriasis and its improvement with treatment. J Eur Acad Dermatol Venereol 2011; 26:661-2. [PMID: 21672036 DOI: 10.1111/j.1468-3083.2011.04127.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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176
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Langley R, Reich K. In touch with psoriasis: a patient-centred approach to therapy. J Eur Acad Dermatol Venereol 2011; 25 Suppl 4:1-2. [DOI: 10.1111/j.1468-3083.2011.04058.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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177
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Bewley A, Page B. Maximizing patient adherence for optimal outcomes in psoriasis. J Eur Acad Dermatol Venereol 2011; 25 Suppl 4:9-14. [DOI: 10.1111/j.1468-3083.2011.04060.x] [Citation(s) in RCA: 91] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
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178
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Ljosaa T, Mork C, Stubhaug A, Moum T, Wahl A. Skin pain and skin discomfort is associated with quality of life in patients with psoriasis. J Eur Acad Dermatol Venereol 2011; 26:29-35. [DOI: 10.1111/j.1468-3083.2011.04000.x] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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179
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Lin HC, Lucas PT, Feldman SR, Balkrishnan R. Medication use and associated health care outcomes and costs for patients with psoriasis in the United States. J DERMATOL TREAT 2011; 23:196-202. [DOI: 10.3109/09546634.2010.544708] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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180
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Love TJ, Qureshi AA, Karlson EW, Gelfand JM, Choi HK. Prevalence of the metabolic syndrome in psoriasis: results from the National Health and Nutrition Examination Survey, 2003-2006. ACTA ACUST UNITED AC 2010; 147:419-24. [PMID: 21173301 DOI: 10.1001/archdermatol.2010.370] [Citation(s) in RCA: 225] [Impact Index Per Article: 16.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
OBJECTIVES To estimate the prevalence of the metabolic syndrome among individuals with psoriasis and to examine the association between these 2 conditions in the general US population. DESIGN Cross-sectional health survey of a nationally representative random sample of the noninstitutionalized civilian US population. SETTING The National Health and Nutrition Examination Survey, 2003-2006. PARTICIPANTS The study included 6549 participants aged 20 to 59 years. MAIN OUTCOME MEASURES Prevalence of the metabolic syndrome defined by the revised National Cholesterol Education Program Adult Treatment Panel III definition and odds ratios for associations after adjustment for age, sex, race/ethnicity, smoking status, and C-reactive protein levels. RESULTS The prevalence of the metabolic syndrome was 40% among psoriasis cases and 23% among controls. According to 2008 US census data, the projected number of patients with psoriasis aged 20 to 59 years with the metabolic syndrome was 2.7 million. The univariate and multivariate odds ratios for patients with psoriasis and the metabolic syndrome were 2.16 (95% confidence interval, 1.16 to 4.03) and 1.96 (1.01 to 3.77), respectively. The most common feature of the metabolic syndrome among patients with psoriasis was abdominal obesity, followed by hypertriglyceridemia and low levels of high-density lipoprotein cholesterol. CONCLUSIONS The prevalence of the metabolic syndrome is high among individuals with psoriasis. Given the serious complications associated with the metabolic syndrome, this frequent comorbidity should be recognized and taken into account in the long-term treatment of individuals with psoriasis.
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Affiliation(s)
- Thorvardur Jon Love
- Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts, USA.
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Realidad terapéutica de la psoriasis moderada-grave en España. Encuesta de opinión. ACTAS DERMO-SIFILIOGRAFICAS 2010. [DOI: 10.1016/j.ad.2010.06.011] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
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Lee YW, Park EJ, Kwon IH, Kim KH, Kim KJ. Impact of Psoriasis on Quality of Life: Relationship between Clinical Response to Therapy and Change in Health-related Quality of Life. Ann Dermatol 2010; 22:389-96. [PMID: 21165207 DOI: 10.5021/ad.2010.22.4.389] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2010] [Revised: 06/03/2010] [Accepted: 06/03/2010] [Indexed: 11/08/2022] Open
Abstract
BACKGROUND Psoriasis exerts significant, negative, impact on patients' quality of life (QOL). Recently, the relationship between QOL and skin lesion improvement has been emphasized in the treatment of psoriasis patients. OBJECTIVE The purpose of study was to compare the QOL in psoriasis and other skin diseases, and to evaluate the generic QOL, skin specific QOL, stress, depression and anxiety before and after treatment in patients. METHODS A total of 138 patients with psoriasis were recruited in this study and 83 patients complete the questionnaire at week 16. Questionnaires were comprised of generic WHO QOL scale, dermatology specific questionnaires (Skindex-29), psoriasis life stress inventory (PLSI), Beck depression inventory (BDI), and Beck anxiety inventory (BAI). Clinical response was assessed by the PASI. RESULTS After treatment, health-related QOL was improved and PASI improvement showed smaller correlation with Skindex-29, compared with the correlations between self-reported severity score (SRSS) improvement and Skindex-29. Regression analysis revealed that duration, SRSS, stress, and depression were factors affecting baseline HRQOL in patients, and age, duration, and SRSS were predictors associated with HTQOL score changes. CONCLUSION Treatment improved HRQOL, BAI, BDI, and PLSI scores. Psoriasis may become more burdensome in groups of patients who suffer long disease duration, high SRSS, depression, and stressful environments.
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Affiliation(s)
- Young Wook Lee
- Department of Dermatology, Hallym University College of Medicine, Anyang, Korea
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183
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Arcese A, Aste N, Bettacchi A, Camplone G, Cantoresi F, Caproni M, DʼAmico D, Fabbri P, Filosa G, Galluccio A, Hansel K, Lisi P, Micali G, Musumeci ML, Nicolini M, Parodi A, Patania M, Pezza M, Potenza C, Richetta A, Simonacci M, Trevisan P, Valenti G, Calvieri S. Treating Psoriasis with Etanercept in Italian Clinical Practice. Clin Drug Investig 2010; 30:507-16. [DOI: 10.2165/11537470-000000000-00000] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
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184
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Kimball AB, Guérin A, Tsaneva M, Yu AP, Wu EQ, Gupta SR, Bao Y, Mulani PM. Economic burden of comorbidities in patients with psoriasis is substantial. J Eur Acad Dermatol Venereol 2010; 25:157-63. [DOI: 10.1111/j.1468-3083.2010.03730.x] [Citation(s) in RCA: 87] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
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Treatment of Moderate-to-Severe Psoriasis in Clinical Practice: A Survey of Spanish Dermatologists. ACTAS DERMO-SIFILIOGRAFICAS 2010. [DOI: 10.1016/s1578-2190(10)70733-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
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186
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Wasel N, Poulin Y, Andrew R, Chan D, Fraquelli E, Papp K. A Canadian Self-Administered Online Survey to Evaluate the Impact of Moderate-to-Severe Psoriasis among Patients. J Cutan Med Surg 2009; 13:294-302. [DOI: 10.2310/7750.2009.08066] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Background: Few population studies of individuals living with psoriasis have been performed in Canada. Objective: The objective of this survey was to understand the severity and impact of psoriasis on the lives of Canadian patients. Methods: An online survey was conducted using a consumer panel. Eligible subjects reported a diagnosis of psoriasis and provided a self-reported level of severity. In addition, subjects had to either (a) have psoriasis covering at least 3% of their body surface area; (b) have psoriasis on a sensitive area of the body; or (c) be currently undergoing treatment for their psoriasis with systemic medication and/or phototherapy. Results: A total of 514 panelists met the inclusion criteria and completed the survey. Current moderate, severe, or very severe psoriasis was reported by 65% of respondents. Nearly all subjects (96%) had psoriasis affecting a sensitive area of the body. At the time of the survey, 18% were taking systemic medication and/or phototherapy. Comorbidities, such as obesity and high blood pressure, were highly prevalent, with 75% of respondents reporting at least one other diagnosis. Data from the SF-8 and Dermatology Life Quality Index instruments indicated that psoriasis negatively impacted quality of life. Conclusion: Moderate-to-severe psoriasis places a burden on Canadian patients, some of whom may be receiving suboptimal treatment or treatment not appropriate for the severity of their condition.
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Affiliation(s)
- Norman Wasel
- From Stratica Medical, Edmonton, AB; Université Laval, Hôpital Hotel-Dieu de Québec, and Centre Dermatologique du Québec Métropolitain, Québec, QC; Medical Affairs, Janssen-Ortho Inc., Toronto, ON; Business Information, Janssen-Ortho Inc., Toronto, ON; K. Papp Clinical Research, Waterloo, ON
| | - Yves Poulin
- From Stratica Medical, Edmonton, AB; Université Laval, Hôpital Hotel-Dieu de Québec, and Centre Dermatologique du Québec Métropolitain, Québec, QC; Medical Affairs, Janssen-Ortho Inc., Toronto, ON; Business Information, Janssen-Ortho Inc., Toronto, ON; K. Papp Clinical Research, Waterloo, ON
| | - Robin Andrew
- From Stratica Medical, Edmonton, AB; Université Laval, Hôpital Hotel-Dieu de Québec, and Centre Dermatologique du Québec Métropolitain, Québec, QC; Medical Affairs, Janssen-Ortho Inc., Toronto, ON; Business Information, Janssen-Ortho Inc., Toronto, ON; K. Papp Clinical Research, Waterloo, ON
| | - Daphne Chan
- From Stratica Medical, Edmonton, AB; Université Laval, Hôpital Hotel-Dieu de Québec, and Centre Dermatologique du Québec Métropolitain, Québec, QC; Medical Affairs, Janssen-Ortho Inc., Toronto, ON; Business Information, Janssen-Ortho Inc., Toronto, ON; K. Papp Clinical Research, Waterloo, ON
| | - Elisa Fraquelli
- From Stratica Medical, Edmonton, AB; Université Laval, Hôpital Hotel-Dieu de Québec, and Centre Dermatologique du Québec Métropolitain, Québec, QC; Medical Affairs, Janssen-Ortho Inc., Toronto, ON; Business Information, Janssen-Ortho Inc., Toronto, ON; K. Papp Clinical Research, Waterloo, ON
| | - Kim Papp
- From Stratica Medical, Edmonton, AB; Université Laval, Hôpital Hotel-Dieu de Québec, and Centre Dermatologique du Québec Métropolitain, Québec, QC; Medical Affairs, Janssen-Ortho Inc., Toronto, ON; Business Information, Janssen-Ortho Inc., Toronto, ON; K. Papp Clinical Research, Waterloo, ON
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187
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Lynde CW, Poulin Y, Guenther L, Jackson C. The Burden of Psoriasis in Canada: Insights from the pSoriasis Knowledge IN Canada (SKIN) Survey. J Cutan Med Surg 2009; 13:235-52. [DOI: 10.2310/7750.2009.08071] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Background: Although some data addressing the burden of illness associated with psoriasis and psoriatic arthritis (PsA) have been reported for American and European patient populations, similar data have been lacking for Canadians with these diseases. Objective: We sought to characterize the natural history of disease in a sample of Canadians with a history of moderate to severe psoriasis, with or without diagnosed PsA or other recognized comorbid conditions, and to identify factors that influenced their perception of psoriasis as a problem in their daily lives. Methods: A nationwide telephone survey, pSoriasis Knowledge IN Canada (SKIN), was conducted between April 30 and June 2, 2007, on 500 people who indicated that they had been diagnosed with psoriasis and that their skin lesions had at some time affected an area at least as large as three palms of their hand (3% of body surface area [BSA]). Results: The mean age at diagnosis for psoriasis among SKIN survey respondents was 28 years, with 31% (155 of 500) indicating that they developed the disease prior to age 18 years. At the time of the survey, 54% (269 of 500) of respondents were experiencing lesions affecting a BSA equivalent to at least three palms (3%). In response to questions on the burden of illness, 35% (176 of 500) of respondents indicated that they considered psoriasis to be a substantial problem in their daily life. Both affected BSA at the time of the survey and self-reported extent of skin involvement at the height of the condition (BSAmax) correlated with the perception of psoriasis as a substantial problem. Other subpopulations in which psoriasis was commonly identified as a substantial problem included women and individuals with diagnosed PsA. Whereas 18% (88 of 500) of respondents were diagnosed with PsA, the number who reported joint pain or stiffness was substantially higher (51%; 256 of 500), suggesting that some respondents may have had incipient or undiagnosed PsA. Conclusions: This survey reveals that psoriasis, PsA, and their associated comorbidities impose a severe burden on the daily lives of Canadians with a history of moderate to severe psoriasis.
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Affiliation(s)
- Charles W. Lynde
- From the Lynde Centre for Dermatology, Markham, ON; Department of Medicine, Université Laval, Quebec City, QC; The Guenther Dermatology Research Centre, London, ON; and Canadian Skin Patient Alliance, Ottawa, ON
| | - Yves Poulin
- From the Lynde Centre for Dermatology, Markham, ON; Department of Medicine, Université Laval, Quebec City, QC; The Guenther Dermatology Research Centre, London, ON; and Canadian Skin Patient Alliance, Ottawa, ON
| | - Lyn Guenther
- From the Lynde Centre for Dermatology, Markham, ON; Department of Medicine, Université Laval, Quebec City, QC; The Guenther Dermatology Research Centre, London, ON; and Canadian Skin Patient Alliance, Ottawa, ON
| | - Christine Jackson
- From the Lynde Centre for Dermatology, Markham, ON; Department of Medicine, Université Laval, Quebec City, QC; The Guenther Dermatology Research Centre, London, ON; and Canadian Skin Patient Alliance, Ottawa, ON
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Shikiar R, Heffernan M, Langley RG, Willian MK, Okun MM, Revicki DA. Adalimumab treatment is associated with improvement in health‐related quality of life in psoriasis: Patient‐reported outcomes from a Phase II randomized controlled trial. J DERMATOL TREAT 2009; 18:25-31. [PMID: 17365264 DOI: 10.1080/09546630601121060] [Citation(s) in RCA: 65] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
BACKGROUND Psoriasis substantially impairs the health-related quality of life (HRQOL) of patients, and a comprehensive evaluation of treatment includes HRQOL measures. OBJECTIVE To assess the impact of adalimumab on patient-reported outcomes (PROs) of patients with moderate to severe psoriasis. METHODS In a Phase II, randomized, controlled trial, the efficacy and safety of two dosages of adalimumab (40 mg weekly or every other week) versus placebo were assessed for 12 weeks in the treatment of moderate to severe plaque psoriasis. Patients completed the Dermatology Life Quality Index (DLQI), Short-Form 36 (SF-36) Health Survey, and EuroQOL-5D (EQ-5D) at baseline and 12 weeks. The primary endpoint was the percentage of patients achieving a > or =75% reduction in the Psoriasis Area and Severity Index score (PASI 75). Investigators assessed PASI and Physician's Global Assessment (PGA) scores. RESULTS Adalimumab patients (either dosage) displayed significantly greater improvements versus placebo patients in DLQI, EQ-5D, and SF-36 Mental Component Summary scores, as well as in Bodily Pain, Vitality, Social Functioning, Role-Emotional, and Mental Health domains. The adalimumab 40-mg weekly group also reported significantly greater improvements in SF-36 Physical Component Summary scores versus the placebo group. CONCLUSION Both adalimumab dosages were efficacious in improving dermatology-specific and general PROs in patients with moderate to severe psoriasis.
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Salaffi F, Carotti M, Gasparini S, Intorcia M, Grassi W. The health-related quality of life in rheumatoid arthritis, ankylosing spondylitis, and psoriatic arthritis: a comparison with a selected sample of healthy people. Health Qual Life Outcomes 2009; 7:25. [PMID: 19296831 PMCID: PMC2674445 DOI: 10.1186/1477-7525-7-25] [Citation(s) in RCA: 227] [Impact Index Per Article: 15.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2008] [Accepted: 03/18/2009] [Indexed: 01/22/2023] Open
Abstract
Background The health-related quality of life (HRQL) is an important indicator of the burden of musculoskeletal disease. The Medical Outcome Study Short-Term 36 (SF-36) is the most used tool that evaluates HRQL as a subjective perception about psychological and physical limitations due to an underlying illness. The purpose of this study was to compare the HRQL scores among patients with rheumatoid arthritis (RA), psoriatic arthritis (PsA) and ankylosing spondylitis (AS) and a selected sample of health people and determine their relationship with measures of clinical condition. Methods 799 patients (469 with RA, 164 with AS, 65 with axial PsA and 101 with peripheral PsA) accepted the invitation to participate. 1579 healthy controls were used for the comparison. We calculated scores for the eight SF-36 subscales, the Physical Component Summary (PCS) score, and the Mental Component Summary (MCS) score, according to published algorithms. Disease-related characteristics included disease duration, comorbidity, a measure for disease activity and for radiographic damage. The presence of comorbidity was ascertained through patient's self-reports by the Self-Administered Comorbidity Questionnaire (SCQ). Comparison were performed with respect to sex and age, and s-scores were calculated for comparison with the norm. Multivariate analyses were used to assess the relationship between HRQL and radiographic damage, disease activity, and socio-demographic data. Results The four inflammatory rheumatic diseases (IRD), compared to controls, significantly impaired all eight health concepts of the SF-36 (p < 0.0001) in both component PCS and MCS scores (p < 0.0001). Overall, the dimensions typically affected were physical functioning, limitations due to physical function, and bodily pain. The disease with the worst HRQL for those dimensions was RA. The multivariate analyses revealed that the physical component was influenced by a high disease activity and comorbidity. The severity of psoriatic lesions was associated with poor mental functioning in patients with PsA. Conclusion Chronic IRD have a clearly detrimental effect on the HRQL in both sex and in age groups, and physical domain is more impaired than mental and social ones.
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Affiliation(s)
- Fausto Salaffi
- Dipartimento di Patologia Molecolare e Terapie Innovative, Clinica Reumatologica - Università Politecnica delle Marche, Ancona, Italy.
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Olivieri I, de Portu S, Salvarani C, Cauli A, Lubrano E, Spadaro A, Cantini F, Cutro MS, Mathieu A, Matucci-Cerinic M, Pappone N, Punzi L, Scarpa R, Mantovani LG. The psoriatic arthritis cost evaluation study: a cost-of-illness study on tumour necrosis factor inhibitors in psoriatic arthritis patients with inadequate response to conventional therapy. Rheumatology (Oxford) 2008; 47:1664-70. [PMID: 18725374 PMCID: PMC2569134 DOI: 10.1093/rheumatology/ken320] [Citation(s) in RCA: 64] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
Abstract
OBJECTIVE To evaluate costs, benefits and cost-effectiveness of anti-TNF agents in PsA patients with inadequate response to conventional treatment. METHODS A total of 107 patients, from nine Italian rheumatology centres, with different forms of PsA were given anti-TNF treatment, mainly etanercept (87%). Information on resource use, health-related quality of life, disease activity, function and laboratory values were collected at baseline and through out the 12 months of therapy. Cost (expressed in euro 2007) and utility (measured by EuroQol) before and after anti-TNF therapy initiation were compared in order to estimate the incremental cost per quality-adjusted life year (QALY) gained, and cost-effectiveness acceptability curve was calculated. RESULTS At the end of 12 months, there was a significant increase in direct cost due to an increase of drug cost caused by TNF inhibitors that was only partially offset by the decrease in indirect cost. In the last 6 months of therapy, the direct cost increased by euro5052, the cost for the National Health System (NHS) by euro5044 and the social cost by euro4638. However, a gain of 0.12 QALY resulted in a cost per QALY gained of euro40 876 for the NHS and of euro37 591 for the society. The acceptability curve showed that there would be a 97% likelihood that anti-TNF therapy would be considered cost-effective at willingness-to-pay threshold of euro60 000 per QALY gained. CONCLUSION Cost-effectiveness ratios are within the commonly accepted willingness-to-pay threshold. These results need to be confirmed in larger samples of patients.
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Affiliation(s)
- I Olivieri
- Rheumatology Department, Ospedale San Carlo, Contrada Macchia Romana, 85100 Potenza, Italy.
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Delfino M, Holt EW, Taylor CR, Wittenberg E, Qureshi AA. Willingness-to-pay stated preferences for 8 health-related quality-of-life domains in psoriasis: a pilot study. J Am Acad Dermatol 2008; 59:439-47. [PMID: 18639364 DOI: 10.1016/j.jaad.2008.05.032] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2008] [Revised: 04/25/2008] [Accepted: 05/27/2008] [Indexed: 12/17/2022]
Abstract
BACKGROUND Psoriasis is a chronic skin condition that has a major impact on health-related quality of life (QOL). We evaluated health-related QOL via willingness to pay and a ranking task for 8 domains of health relevant to psoriasis: intimacy, physical comfort, self-care, ability to work or volunteer, ability to concentrate, emotional health, social comfort, and ability to sleep. OBJECTIVE The goals of the study were to pilot test a new method to measure QOL impact in psoriasis and identify the areas of life most affected by psoriasis. METHODS Forty participants with a history of psoriasis were interviewed in a face-to-face format. First, participants were asked to rank the 8 domains of health we were investigating. Second, patients were asked how much money they would be willing to pay for a hypothetical cure for each domain of health. Responses in US dollars were interpreted as strength of preference rather than absolute monetary values. RESULTS About half of the patients in the sample (48%) were female, 60% had a college degree or further education, and 38% had an income level over $45,000/y. Physical comfort, social comfort, and emotional health were highly ranked by more than 75% of respondents. Ability to concentrate was least likely to be affected by psoriasis with just a quarter (25.7%) of respondents ranking this domain as important. The median amount patients were willing to pay for a hypothetical cure of psoriasis specific to a particular domain was highest for physical comfort ($2000, 25th quartile = $500, 75th quartile = $5500) and emotional health ($2000, 25th quartile = $250, 75th quartile = $5000), and lowest for ability to sleep ($625, 25th quartile = $50, 75th quartile = $5000). LIMITATIONS The sample size is modest for this pilot study. Willingness to pay as a method of eliciting stated preferences for qualitative aspects of health may be influenced by individual perception of money. CONCLUSIONS This study successfully pilot tested a willingness-to-pay method and a ranking task to measure the relative severity of 8 domains of health-related QOL and found that physical comfort, social comfort, and emotional health were the domains of health most affected by psoriasis.
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Affiliation(s)
- Matthew Delfino
- Department of Dermatology, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts 02115, USA
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192
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Abstract
Psoriasis is a chronic and debilitating inflammatory disease associated with serious comorbidities. Psoriasis can have a significant impact on a patient's quality of life and is associated with loss of productivity, depression, and an increased prevalence of malignancy. Emerging comorbidities of psoriasis include cardiovascular disease and metabolic syndrome. Psoriasis patients have an increased prevalence of the core components of metabolic syndrome, including obesity, dyslipidemia, and insulin resistance. The relationship between psoriasis and comorbidities such as metabolic syndrome and cardiovascular disease is likely linked to the underlying chronic inflammatory nature of psoriasis. The molecular mechanisms involved in psoriasis-associated dysregulation of metabolic function are believed to be due, in large part, to the action of increased levels of proinflammatory factors, such as tumor necrosis factor-alpha, that are central to the pathogenesis of psoriasis. Recent studies investigating the effects of tumor necrosis factor antagonists on the treatment of cardiovascular disease and metabolic syndrome support this concept.
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193
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Carruthers A, Carruthers J. Patient-reported outcomes with botulinum neurotoxin type A. J COSMET LASER THER 2008; 9 Suppl 1:32-7. [PMID: 17885884 DOI: 10.1080/17429590701523752] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Clinical trials establishing the efficacy of botulinum neurotoxin type A historically have included as outcomes investigator assessments and general patient global assessments of treatment. However, these outcomes are of limited value in determining the specific benefits desired by patients who seek facial rejuvenation. To address this issue, several patient-reported outcomes measures have been developed and utilized in clinical trials of botulinum neurotoxin type A (specifically, the BOTOX Cosmetic brand). The outcomes include the Self-Perception of Age (SPA) measure and the Facial Line Outcomes (FLO) questionnaire. On the FLO questionnaire, patients rate the degree to which their facial lines bother them; make them look older than they would like; prevent them from having a smooth facial appearance; and make them look tired, stressed, or angry when that is not how they feel. Several clinical trials have demonstrated significant improvements in these outcomes from baseline and versus placebo for the treatment of multiple upper facial lines as well as for treating the glabella as a single region. These outcomes data help in understanding patient objectives and motivations, establishing a treatment plan, and ensuring patient satisfaction. Clinicians can use the SPA measure for all patients to help show the value of treatment.
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Affiliation(s)
- Alastair Carruthers
- Department of Dermatology and Skin Science, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada.
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Sticherling M, Minden K, Küster RM, Krause A, Borte M. [Psoriasis und Psoriasis arthritis in childhood and adolescence. Overview and consensus statement of the 9th Wörlitz Expert Round Table Discussion 2006 for the Society for Child and Adolescent Rheumatology]. Z Rheumatol 2007; 66:349-54. [PMID: 17623119 DOI: 10.1007/s00393-007-0145-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
There are about 1.2-1.6 million psoriasis sufferers in Germany. In about a third of these, the disease manifests before the age of 20. A classic complication of psoriasis is psoriasis arthritis (PsA), which, from the latest figures, effects about 20% of all psoriasis patients. PsA also starts in childhood and is included under the term juvenile idiopathic arthritis (JIA). The expert round table discussion which took place in 2006 in Wörlitz elaborated the recommendations for the classification, comprehensive diagnostics and therapy of effected children and adolescents. As controlled studies are lacking, the treatment of PsA has been empirically based and carried out in analogy with the treatment of other forms of JIA. The use of methotrexate (MTX) shows a good success rate. In 2004, about a third of the patients found in the core documentation, including over 80% of children and adolescents undergoing a primary therapy, were treated with MTX, a quarter in combination with other medication. A total of 7% of all and 16% of those undergoing primary therapy were treated with etanercept, most (>80%) in combination with basis medication, usually MTX. Consensus opinion indicated that an early, and intensive local skin therapy should be applied in order to reduce inflammatory activity. If PsA is present, the early use of non-steroid anti-inflammatories as well as local therapy of the joints with the intra-articular application of glucocorticosteroids is recommended. The primary medication should preferentially be MTX, if necessary combined with other therapies. In cases of a severe, episodic progression as well as high inflammatory activity, systemic glucocorticosteroids should be considered. Further studies addressing both the clinical course of jPsA compared to the adult manifestation as well as optimal therapeutic procedures should be initiated in the near future.
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Affiliation(s)
- M Sticherling
- Hautklinik, Universitätsklinikum Erlangen, Hartmannstrasse 14, 91052 Erlangen.
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195
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Setty AR, Curhan G, Choi HK. Smoking and the risk of psoriasis in women: Nurses' Health Study II. Am J Med 2007; 120:953-9. [PMID: 17976422 PMCID: PMC2696351 DOI: 10.1016/j.amjmed.2007.06.020] [Citation(s) in RCA: 126] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2007] [Revised: 06/06/2007] [Accepted: 06/08/2007] [Indexed: 02/06/2023]
Abstract
BACKGROUND Psoriasis is a common, chronic, inflammatory skin disorder. Smoking may increase the risk of psoriasis, but no prospective data are available on this relation. METHODS We prospectively examined over a 14-year time period (1991-2005) the relation between smoking status, duration, intensity, cessation, and exposure to secondhand smoke, and incident psoriasis in 78,532 women from the Nurses Health Study II. The primary outcome was incident, self-reported, physician-diagnosed psoriasis. RESULTS We documented 887 incident cases of psoriasis. Compared with those who had never smoked, the multivariate relative risk (RR) of psoriasis was 1.78 (95% confidence interval [CI], 1.46 to 2.16) for current smokers and 1.37 (95% CI, 1.17 to 1.59) for past smokers. Compared with nonsmokers, the multivariate RR of psoriasis was 1.60 (95% CI, 1.31 to 1.97) for those who had smoked 11-20 pack-years and 2.05 (95% CI, 1.66 to 2.53) for those who had smoked > or =21 pack-years. Compared with never smokers, the multivariate RR of psoriasis was 1.61 (95% CI, 1.30 to 2.00) for those who quit smoking <10 years ago, 1.31 (95% CI, 1.05 to 1.64) for 10-19 years ago, and 1.15 (95% CI, 0.88 to 1.51) for > or =20 years ago. Prenatal and childhood exposure to passive smoke was associated with an increased risk of psoriasis. CONCLUSIONS In this prospective analysis, current and past smoking, and cumulative measures of smoking were associated with the incidence of psoriasis. The risk of incident psoriasis among former smokers decreases nearly to that of never smokers 20 years after cessation.
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Affiliation(s)
- Arathi R Setty
- Department of Rheumatology, Allergy and Immunology, Massachusetts General Hospital, Harvard Medical School, Boston, Mass, USA
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Abstract
BACKGROUND The successful treatment of patients with chronic plaque psoriasis depends not only on the method of therapy but also on psychosocial factors. METHODS AND RESULTS A pilot study was performed on 22 patients with chronic plaque psoriasis. The psychosocial stress, psychiatric features and their changes were assessed over a 3-week inpatient rehabilitation stay in a specialty clinic. The severity of the psoriasis, the subjective degree of suffering and the psychometric variables related to psychosomatic symptoms were assessed before and at the end of the treatment. After the hospitalization, the severity of disease and anger were both significantly decreased, along with an increased interest in social interactions. CONCLUSION In psoriasis patients, one can distinguish between different psychosocial factors, some of which are more likely to change. Stable attributes such as personality style can impact on compliance as well as on coping behaviors, thereby influencing treatment success. Our study shows that even within a rather short inpatient treatment period of 3 weeks not only the disease severity but also negative psychosocial stressors can be improved.
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Affiliation(s)
- J A Bahmer
- Zentrum für Klinische Psychologie und Rehabilitation der Universität Bremen, Grazer Strasse 6, 28359 Bremen
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