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Pavlova N, Kioskli K, Smith C, Picariello F, Rayner L, Moss‐Morris R. Psychosocial aspects of obesity in adults with psoriasis: A systematic review. SKIN HEALTH AND DISEASE 2021; 1:e33. [PMID: 35664982 PMCID: PMC9060108 DOI: 10.1002/ski2.33] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/28/2021] [Revised: 03/08/2021] [Accepted: 03/28/2021] [Indexed: 02/04/2023]
Abstract
Background Excess weight is a common (30%–40%) multifactorial concern that remains understudied in adults with psoriasis. Objectives This systematic review aimed to synthesise the evidence on the psychosocial factors associated with body weight in psoriasis and to use these findings to inform clinical practice. The review was registered with PROSPERO (registration number: CRD42020201138). Methods Electronic databases, related reviews and associated reference lists were searched. Observational and experimental studies reporting on the relationship of psychosocial factors to weight‐related outcomes in adults with body mass index (BMI) of ≥30 kg/m2 and psoriasis were eligible. The methodological quality of the included studies was assessed using the Critical Appraisal Skills Programme (CASP). Results Eighteen studies were included in the review, the majority of which (n = 16) examined cross‐sectional associations between psychosocial factors and weight outcomes. Although the strengths of the associations were heterogeneous, most studies confirmed the positive association between high BMI and increased reports of depression and anxiety, impaired quality of life, deteriorated sleep quality, sexual dysfunction, and daily functioning issues. Only four studies were rated as high quality. Conclusions The current evidence of the association between psychosocial factors and weight‐related outcomes is largely cross‐sectional with unclear directionality of causality. Longitudinal studies are needed to examine the replicability and generalisability of the examined obesity‐related psychosocial factors in psoriasis. Theoretical exploration of subgroup differences and similarities may pave the way towards intervention personalisation, and ultimately, improved patient outcomes.
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Affiliation(s)
- N.T. Pavlova
- Health Psychology Section, Psychology Department King's College London Institute of Psychiatry Psychology and Neuroscience London UK
| | - K. Kioskli
- Department of Computer Science, Centre for Adaptive Computing Systems University of London London UK
- Gruppo Maggioli, Research and Development Lab Athens Greece
| | - C. Smith
- Health Psychology Section, Psychology Department King's College London Institute of Psychiatry Psychology and Neuroscience London UK
- St John's Institute of Dermatology Guy's and St Thomas' NHS Foundation Trust London UK
| | - F. Picariello
- Health Psychology Section, Psychology Department King's College London Institute of Psychiatry Psychology and Neuroscience London UK
| | - L. Rayner
- Department of Psychological Medicine King's College London Institute of Psychiatry Psychology and Neuroscience London UK
| | - R. Moss‐Morris
- Health Psychology Section, Psychology Department King's College London Institute of Psychiatry Psychology and Neuroscience London UK
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Krajewska-Włodarczyk M, Owczarczyk-Saczonek A, Placek W, Wojtkiewicz M, Wiktorowicz A, Wojtkiewicz J. Distal interphalangeal joint extensor tendon enthesopathy in patients with nail psoriasis. Sci Rep 2019; 9:3628. [PMID: 30842536 PMCID: PMC6403314 DOI: 10.1038/s41598-019-39985-7] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2018] [Accepted: 02/07/2019] [Indexed: 12/20/2022] Open
Abstract
The aim of the study was an ultrasound assessment of distal interphalangeal (DIP) joint enthesopathy in patients with nail psoriasis. Altogether, 72 patients with nail psoriasis (41 with psoriasis and 31 with psoriatic arthritis) and 30 people in the control group participated in the study. In total, 1014 nails were examined. The thickness of DIP digital extensor tendons in the groups of patients with psoriasis (Ps) and psoriatic arthritis (PsA) was correlated with the nail bed thickness (r = 0.316, p = 0.027 vs. r = 0.402, p = 0.031, respectively) and with the thickness of the nail matrix in patients with psoriasis (r = 0.421, p = 0.012). The linear regression model showed the tendon thickness in Ps patients to be affected by the nail bed thickness, duration of psoriasis and the thickness of the nail matrix, whereas in PsA patients it was found to be significantly affected by duration of psoriasis and of arthritis, the nail bed thickness, CRP concentration and the swollen joint count. Our findings may indicate the role of the nail-tendon apparatus changes in the PsA development and they emphasise the justifiability of US examinations in patients with psoriasis direct assessment of morphological changes in nails as potential predictors of PsA development.
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Affiliation(s)
- Magdalena Krajewska-Włodarczyk
- Department of Rheumatology, Municipal Hospital in Olsztyn, 10-900, Olsztyn, Poland. .,Department of Internal Medicine, School of Medicine, Collegium Medicum, University of Warmia and Mazury, 10-900, Olsztyn, Poland. .,Department of Pathophysiology, School of Medicine, Collegium Medicum, University of Warmia and Mazury, 10-900, Olsztyn, Poland.
| | - Agnieszka Owczarczyk-Saczonek
- Department of Dermatology, Sexually Transmitted Diseases and Clinical Immunology, School of Medicine, Collegium Medicum, University of Warmia and Mazury, 10-900, Olsztyn, Poland
| | - Waldemar Placek
- Department of Dermatology, Sexually Transmitted Diseases and Clinical Immunology, School of Medicine, Collegium Medicum, University of Warmia and Mazury, 10-900, Olsztyn, Poland
| | - Maja Wojtkiewicz
- Faculty of Earth Sciences, Department of Geomatics and Cartography Nicolaus Copernicus University, Torun, Poland.,DRAMIŃSKI S.A. Ultrasound Scanners, Olsztyn, Poland
| | | | - Joanna Wojtkiewicz
- Department of Pathophysiology, School of Medicine, Collegium Medicum, University of Warmia and Mazury, 10-900, Olsztyn, Poland.,Laboratory for Regenerative Medicine, School of Medicine, Collegium Medicum, University of Warmia and Mazury, 10-900, Olsztyn, Poland
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3
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Effect of Methotrexate in the Treatment of Distal Interphalangeal Joint Extensor Tendon Enthesopathy in Patients with Nail Psoriasis. J Clin Med 2018; 7:jcm7120546. [PMID: 30558114 PMCID: PMC6306839 DOI: 10.3390/jcm7120546] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2018] [Revised: 12/06/2018] [Accepted: 12/12/2018] [Indexed: 12/13/2022] Open
Abstract
To assess the effect of methotrexate on the development of distal interphalangeal joint extensor tendon enthesopathy in psoriasis, thirty-two people aged 34 to 57 years with nail psoriasis and distal interphalangeal joint extensor tendon enthesopathy (19 patients with Ps (psoriasis) and 13 with PsA (psoriatic arthritis) were started on methotrexate at 15 to 25 mg/week and the treatment was continued for 6 months). A total of 319 nails were examined. After six months of treatment, the thicknesses of the nail plate, nail bed and nail matrix were found to decrease in both groups of patients. Methotrexate treatment resulted in a decrease in the joint extensor tendon thickness only in patients with Ps (0.94 ± 0.05 vs. 0.96 ± 0.04, p < 0.001), where the tendon thickness after treatment correlated with the matrix thickness (r = 0.337, p = 0.018) and with the bed thickness (r = 0.299, p = 0.039). Methotrexate treatment resulted in a decrease in the extensor tendon thickness only in patients with Ps but not in PsA. The findings of this study may suggest the effectiveness of systemic treatment of nail psoriasis in patients without arthritis and the use of US nail examinations in Ps and PsA patients in morphological change assessment and response to treatment.
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Ultrasound Assessment of Changes in Nails in Psoriasis and Psoriatic Arthritis. BIOMED RESEARCH INTERNATIONAL 2018; 2018:8251097. [PMID: 30271786 PMCID: PMC6151197 DOI: 10.1155/2018/8251097] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/20/2018] [Accepted: 08/16/2018] [Indexed: 12/14/2022]
Abstract
Aim of the Study The aim of the study was to conduct an ultrasound (US) assessment of changes in fingernails in psoriatic patients with nail involvement. Material A total of 69 patients with psoriatic changes in nails participated in the study, including 38 patients with psoriasis (Ps) and 31 with psoriatic arthritis (PsA) and 30 people in the control group. A total of 988 nails were examined. Results The thickness of the nail plate, nail bed, and matrix as shown in an ultrasound examination increased with the mNAPSI index (r=0.328, p=0.021; r=0.219, p=0.036; and r=0.422, p=0.011, respectively). The thickness of nail plate, bed, and matrix in patients with onycholysis and hyperkeratosis-type changes (concomitant or present separately) was significantly greater than when only pitting-type changes occurred (p=0.007, p=0.035, and p=0.023, respectively). An examination of nails with only pitting-type changes showed an increase in the matrix thickness compared to the control group (p=0.018). The focal hyperechoic involvement of the dorsal plate (80%) was the change most often observed in an US examination in Ps patients, whereas loosening of the borders of the ventral plate was most often observed in PsA patients. The thickness of nail bed in PsA patients increased with the duration of arthritis (r=0.399, p=0.022) and was correlated with the number of swollen digits (r=0.278, p=0.041). Conclusions The findings of this study may indicate an association of an inflammation in the nail bed with PsA development. Apart from a direct assessment of the described morphological changes of nails, a US examination could prove useful in an assessment of intensity of a local inflammation as a prognostic factor for PsA development.
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5
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Sanchez IM, Shankle L, Wan MT, Afifi L, Wu JJ, Doris F, Bridges A, Boas M, Lafoy B, Truman S, Orbai AM, Takeshita J, Gelfand JM, Armstrong AW, Siegel MP, Liao W. Building a Citizen Pscientist: Advancing Patient-Centered Psoriasis Research by Empowering Patients as Contributors and Analysts. Dermatol Ther (Heidelb) 2018; 8:405-423. [PMID: 29876724 PMCID: PMC6109031 DOI: 10.1007/s13555-018-0242-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2018] [Indexed: 01/16/2023] Open
Abstract
Introduction To design and implement a novel cloud-based digital platform that allows psoriatic patients and researchers to engage in the research process. Methods Citizen Pscientist (CP) was created by the National Psoriasis Foundation (NPF) to support and educate the global psoriatic disease community, where patients and researchers have the ability to analyze data. Psoriatic patients were invited to enroll in CP and contribute health data to a cloud database by responding to a 59-question online survey. They were then invited to perform their own analyses of the data using built-in visualization tools allowing for the creation of “discovery charts.” These charts were posted on the CP website allowing for further discussion. Results As of May 2017, 3534 patients have enrolled in CP and have collectively contributed over 200,000 data points on their health status. Patients posted 70 discovery charts, generating 209 discussion comments. Conclusion With the growing influence of the internet and technology in society, medical research can be enhanced by crowdsourcing and online patient portals. Patient discovery charts focused on the topics of psoriatic disease demographics, clinical features, environmental triggers, and quality of life. Patients noted that the CP platform adds to their well-being and allows them to express what research questions matter most to them in a direct and quantifiable way. The implementation of CP is a successful and novel method of allowing patients to engage in research. Thus, CP is an important tool to promote patient-centered psoriatic disease research.
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Affiliation(s)
- Isabelle M Sanchez
- Department of Dermatology, University of California San Francisco, San Francisco, USA
| | - Lindsey Shankle
- National Psoriasis Foundation, Portland, USA.,Citizen Pscientist Governance Council, National Psoriasis Foundation, Portland, USA
| | - Marilyn T Wan
- Department of Dermatology, University of Pennsylvania, Philadelphia, USA.,Citizen Pscientist Governance Council, National Psoriasis Foundation, Portland, USA
| | - Ladan Afifi
- Department of Dermatology, University of California San Francisco, San Francisco, USA.,Citizen Pscientist Governance Council, National Psoriasis Foundation, Portland, USA
| | - Jashin J Wu
- Department of Dermatology, Kaiser Permanente Los Angeles Medical Center, Los Angeles, USA.,Citizen Pscientist Governance Council, National Psoriasis Foundation, Portland, USA
| | - Frank Doris
- Citizen Pscientist Governance Council, National Psoriasis Foundation, Portland, USA
| | - Alisha Bridges
- Citizen Pscientist Governance Council, National Psoriasis Foundation, Portland, USA
| | - Marc Boas
- Citizen Pscientist Governance Council, National Psoriasis Foundation, Portland, USA
| | - Brian Lafoy
- Citizen Pscientist Governance Council, National Psoriasis Foundation, Portland, USA
| | - Sarah Truman
- Citizen Pscientist Governance Council, National Psoriasis Foundation, Portland, USA
| | - Ana-Maria Orbai
- Citizen Pscientist Governance Council, National Psoriasis Foundation, Portland, USA.,Division of Rheumatology, Johns Hopkins University School of Medicine, Baltimore, USA
| | - Junko Takeshita
- Department of Dermatology, University of Pennsylvania, Philadelphia, USA.,Citizen Pscientist Governance Council, National Psoriasis Foundation, Portland, USA
| | - Joel M Gelfand
- Department of Dermatology, University of Pennsylvania, Philadelphia, USA.,Citizen Pscientist Governance Council, National Psoriasis Foundation, Portland, USA
| | - April W Armstrong
- Citizen Pscientist Governance Council, National Psoriasis Foundation, Portland, USA
| | - Michael P Siegel
- National Psoriasis Foundation, Portland, USA.,Citizen Pscientist Governance Council, National Psoriasis Foundation, Portland, USA
| | - Wilson Liao
- Department of Dermatology, University of California San Francisco, San Francisco, USA. .,Citizen Pscientist Governance Council, National Psoriasis Foundation, Portland, USA.
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Acosta-Felquer ML, Ruta S, Rosa J, Marin J, Ferreyra-Garrot L, Galimberti ML, Galimberti R, Garcia-Monaco R, Soriano ER. Ultrasound entheseal abnormalities at the distal interphalangeal joints and clinical nail involvement in patients with psoriasis and psoriatic arthritis, supporting the nail-enthesitis theory. Semin Arthritis Rheum 2017. [DOI: 10.1016/j.semarthrit.2017.05.002] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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7
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Development and Validation of a Novel Questionnaire for Adherence with Topical Treatments in Psoriasis (QATOP). Am J Clin Dermatol 2017; 18:571-581. [PMID: 28321796 DOI: 10.1007/s40257-017-0272-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
BACKGROUND Self-report measures are the most used methodologies for the evaluation of adherence to psoriasis topical treatment, although currently there is no standard questionnaire for this purpose. OBJECTIVE The present study aimed at developing a novel questionnaire (Questionnaire for Adherence to TOPical treatment [QATOP]) for the assessment of adherence to topical treatment in psoriasis. METHODS A questionnaire containing nine items organized into two parts (part 1: current patient treatment; part 2: adherence to treatment, amount used, and treatment-associated variables) was developed, supported by a systematic literature review, qualitative patient focus interviews, and expert-group input. Its content validity was determined by a pilot study of six patients. Adherence to topical treatment was then assessed in 35 patients with psoriasis, after 45 days of treatment, using the QATOP and a medication log. Associations between different items of the QATOP and the log were investigated. RESULTS Adherence results were 63.5 ± 29.2% for the log and 60.9 ± 24.4% for the QATOP, and were strongly correlated (R = 0.819, p < 0.001). Distinct posologic regimens were reported by patients, which, in some cases, were not the usual doses. Patients also reported using doses of medicine on each application that were markedly lower than required. CONCLUSION The QATOP is a valid and reliable self-report measure of adherence to topical treatment in patients with psoriasis. The use of this standard questionnaire could improve the methodological quality of adherence studies. Improvement of the clarity of posologic instructions is clearly urgently needed.
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8
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van Geel M, Otero M, de Jong E, van de Kerkhof P, Seyger M. Validation of the Simplified Psoriasis Index in Dutch children and adolescents with plaque psoriasis. Br J Dermatol 2016; 176:771-776. [DOI: 10.1111/bjd.15120] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/20/2016] [Indexed: 02/02/2023]
Affiliation(s)
- M.J. van Geel
- Department of Dermatology; Radboud University Medical Center; PO Box 9101 6500 HB Nijmegen the Netherlands
| | - M.E. Otero
- Department of Dermatology; Radboud University Medical Center; PO Box 9101 6500 HB Nijmegen the Netherlands
| | - E.M.G.J. de Jong
- Department of Dermatology; Radboud University Medical Center; PO Box 9101 6500 HB Nijmegen the Netherlands
| | - P.C.M. van de Kerkhof
- Department of Dermatology; Radboud University Medical Center; PO Box 9101 6500 HB Nijmegen the Netherlands
| | - M.M.B. Seyger
- Department of Dermatology; Radboud University Medical Center; PO Box 9101 6500 HB Nijmegen the Netherlands
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9
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Correlation between Dermatology Life Quality Index (DLQI) scores and Work Limitations Questionnaire (WLQ) allows the calculation of percent work productivity loss in patients with psoriasis. Arch Dermatol Res 2015; 307:451-3. [DOI: 10.1007/s00403-015-1567-x] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2014] [Revised: 04/07/2015] [Accepted: 04/22/2015] [Indexed: 10/23/2022]
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10
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Kitchen H, Cordingley L, Young H, Griffiths CEM, Bundy C. Patient-reported outcome measures in psoriasis: the good, the bad and the missing! Br J Dermatol 2015; 172:1210-21. [PMID: 25677764 DOI: 10.1111/bjd.13691] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/25/2015] [Indexed: 01/22/2023]
Abstract
As a long-term condition, psoriasis demands significant personal and professional input for optimal self-management. Low levels of well-being and high levels of psychological distress in patients with psoriasis are associated with reduced resources for self-care. Patient-reported outcome (PRO) measures can be used to assess physical, social and psychological functioning in order to guide treatment. In this article, we systematically reviewed the development and validation of existing PRO measures. PubMed (Medline), PsycINFO and CINAHL were searched systematically using predefined search terms. The search was limited to articles in the English language relating to human subjects. Articles were selected for full review through explicit inclusion/exclusion criteria. PRO measures were critically reviewed in accordance with the published guidelines and theory on the development and validation of PROs. The search identified 967 abstracts; 71 of these articles met the criteria for full review. In these 71 articles, 45 PRO measures were found: 16 were specific to psoriasis, 21 assessed other dermatological conditions and eight were developed for generic nondermatological health conditions. The review revealed several limitations of the existing measures, including: (i) a composite structure assessing multiple, poorly-defined concepts; (ii) a lack of evidence for face and content validity; (iii) a failure to include both patient and clinician perspectives and requirements and (iv) a lack of evidence regarding the feasibility and acceptability for patients and physicians. No single PRO measure with adequate evidence of validity, reliability and sensitivity to change captures patient well-being in psoriasis. A valid, sensitive, specific and acceptable PRO that assesses the full impact of psoriasis on well-being is needed for the comprehensive clinical management of psoriasis.
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Affiliation(s)
- H Kitchen
- The Dermatology Research Centre, University of Manchester and Manchester Academic Health Science Centre, University of Manchester, Manchester, UK
| | - L Cordingley
- The Dermatology Research Centre, University of Manchester and Manchester Academic Health Science Centre, University of Manchester, Manchester, UK.,Manchester Centre for Health Psychology, University of Manchester and Manchester Academic Health Science Centre, University of Manchester, Manchester, UK
| | - H Young
- The Dermatology Research Centre, University of Manchester and Manchester Academic Health Science Centre, University of Manchester, Manchester, UK.,Salford Royal NHS Foundation Trust, University of Manchester and Manchester Academic Health Science Centre, University of Manchester, Manchester, UK
| | - C E M Griffiths
- The Dermatology Research Centre, University of Manchester and Manchester Academic Health Science Centre, University of Manchester, Manchester, UK.,Salford Royal NHS Foundation Trust, University of Manchester and Manchester Academic Health Science Centre, University of Manchester, Manchester, UK
| | - C Bundy
- The Dermatology Research Centre, University of Manchester and Manchester Academic Health Science Centre, University of Manchester, Manchester, UK.,Manchester Centre for Health Psychology, University of Manchester and Manchester Academic Health Science Centre, University of Manchester, Manchester, UK
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Herschel S, Schmitt J, Bauer A. Satisfaction with medical treatment in patients with hand dermatitis - a cross-sectional study. J Dtsch Dermatol Ges 2013; 11:1007-13. [PMID: 23931717 DOI: 10.1111/ddg.12150] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2013] [Accepted: 05/08/2013] [Indexed: 11/28/2022]
Abstract
BACKGROUND Despite the significant clinical and economic burden of hand dermatitis, data on patients' satisfaction with treatment and related determining factors are lacking. PATIENTS AND METHODS We performed a cross-sectional study using a standardized survey, including all patients with hand dermatitis treated between 12/2001 and 11/2008 at the Department of Dermatology, TU Dresden. Patients were asked about socio-demographic data, disease characteristics, occupational data, quality of life, treatment satisfaction and their treatment goals. Based on an a priori model, possible impact factors on treatment satisfaction were analyzed using regression modeling. RESULTS Of 382 contacted patients, 215 agreed to participate in the study (133 [61.3%] female). The mean age was 42 years. 155 patients (72.1%) had had severe or very severe hand dermatitis in the past. The majority of the patients were satisfied with the medical treatment. Treatment satisfaction was determined by the impression of professional competence (p < 0.001), physicians' empathy (p < 0.001), sufficient information on course, prognosis, and treatment options (p < 0.001), the patients' self-treatment competency (p < 0.001), quality of life (p = 0.007), as well as on the severity of hand dermatitis (p < 0.001). CONCLUSIONS The data point out that in the therapy of chronic hand dermatitis, along with professional competence, the physicians' empathy, provision of sufficient information about the disease, and teaching self-treatment competency play a prominent role in improving the treatment satisfaction of the patients.
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Affiliation(s)
- Solveig Herschel
- Clinic and Polyclinic for Dermatology, Carl Gustav Carus Medical School, Technical University, Dresden, Germany.
| | - Jochen Schmitt
- Center for Evidence-based Healthcare, Carl Gustav Carus University Hospital, Dresden, Germany.,Institute and Polyclinic for Occupational and Social Medicine, Carl Gustav Carus Medical School, Technical University, Dresden, Germany
| | - Andrea Bauer
- Clinic and Polyclinic for Dermatology, Carl Gustav Carus Medical School, Technical University, Dresden, Germany
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Gottlieb AB, Armstrong AW. Psoriasis Outcome Measures: A Report from the GRAPPA 2012 Annual Meeting. J Rheumatol 2013; 40:1428-33. [DOI: 10.3899/jrheum.130456] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Psoriasis is a multisystem disease. The cutaneous and musculoskeletal manifestations (psoriatic arthritis) are well recognized. However, the other manifestations of psoriatic disease including metabolic syndrome, atherosclerotic cardiovascular disease, depression, poor self-esteem, and self-destructive habits including obesity, smoking and excess alcohol consumption are underappreciated. At the 2012 annual meeting of the Group for Research and Assessment of Psoriasis and Psoriatic Arthritis (GRAPPA), members addressed the need to develop uniform, validated, standardized outcome measures for psoriatic disease, measures that are useful to all stakeholders including patients, physicians, regulators, and payers.
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13
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Paul C, Gourraud PA, Bronsard V, Prey S, Puzenat E, Aractingi S, Aubin F, Bagot M, Cribier B, Joly P, Jullien D, Le Maitre M, Richard-Lallemand MA, Ortonne JP. Evidence-based recommendations to assess psoriasis severity: systematic literature review and expert opinion of a panel of dermatologists. J Eur Acad Dermatol Venereol 2010; 24 Suppl 2:2-9. [PMID: 20443994 DOI: 10.1111/j.1468-3083.2009.03561.x] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Severity of psoriasis appears to be multidimensional and its assessment in everyday clinical practice requires a complex holistic approach. OBJECTIVES To develop evidence-based recommendations to assess severity of plaque-type psoriasis in adult patients in everyday clinical practice. METHODS A scientific committee (10 members identified on the basis of their expertise in psoriasis) using Delphi methodology selected eight questions in three domains: severity, health-related quality of life (HR-QoL) and comorbidities. Three systematic literature reviews (one per domain) of all studies published between January 1980 and June 2009 were performed based on Pub-Med, Cochrane and Embase database. Selected articles were systematically reviewed and evidence appraised according to the Oxford Levels of Evidence. On June 2009, a group of 44 French dermatologists both hospital and office based participated in a meeting including three separate rounds of discussions, plenary sessions, and modified Delphi technique votes. Recommendations for clinical practice based on systematic review and clinical experience were formulated by the group. Subsequently, agreements among the participants regarding these recommendations as well as potential impact on clinical practice were evaluated. RESULTS A total of 10 642 references were identified, of which 154 articles were analysed. Ten key recommendations on the assessment of psoriasis severity were formulated: three recommendations relating to severity assessment, three recommendations relating to HR-QoL (including the use of the Dermatology Life Quality Index [DLQI] in clinical practice) and four recommendations relating to comorbidities (including systematic screening for peripheral or axial inflammatory joint damage, regardless of psoriasis severity). CONCLUSIONS Ten recommendations to assess the severity of plaque-type psoriasis in adult patients in daily practice were developed. The recommendations are based on systematic appraisal of available evidence. They were developed and supported by a panel of dermatologists, which enhances their validity and practical relevance.
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Affiliation(s)
- C Paul
- Dermatology Department, Paul Sabatier University, Toulouse, France.
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14
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Puzenat E, Bronsard V, Prey S, Gourraud PA, Aractingi S, Bagot M, Cribier B, Joly P, Jullien D, Le Maitre M, Paul C, Richard-Lallemand MA, Ortonne JP, Aubin F. What are the best outcome measures for assessing plaque psoriasis severity? A systematic review of the literature. J Eur Acad Dermatol Venereol 2010; 24 Suppl 2:10-6. [DOI: 10.1111/j.1468-3083.2009.03562.x] [Citation(s) in RCA: 175] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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15
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Spuls PI, Lecluse LL, Poulsen MLN, Bos JD, Stern RS, Nijsten T. How Good Are Clinical Severity and Outcome Measures for Psoriasis?: Quantitative Evaluation in a Systematic Review. J Invest Dermatol 2010; 130:933-43. [DOI: 10.1038/jid.2009.391] [Citation(s) in RCA: 162] [Impact Index Per Article: 11.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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16
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Ortonne J, Chimenti S, Luger T, Puig L, Reid F, Trüeb RM. Scalp psoriasis: European consensus on grading and treatment algorithm. J Eur Acad Dermatol Venereol 2009; 23:1435-44. [PMID: 19614856 DOI: 10.1111/j.1468-3083.2009.03372.x] [Citation(s) in RCA: 55] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
The scalp is a common site of involvement of psoriasis and, for many patients, is a challenging aspect of their disease. This can be attributed not only to the scaling, itching and cosmetic embarrassment that go with scalp psoriasis, but also to the fact that the scalp skin is relatively inaccessible, making topical therapies difficult to apply. The proximity of sensitive facial skin can also limit the use of potentially irritating topical treatments. Nevertheless, the specific challenges of scalp psoriasis are often neglected by treatment guidelines. This paper summarizes the discussions that took place at an international conference of experts convened in Geneva, Switzerland, in March 2008. The objective of the meeting was to review the available treatments for scalp psoriasis in terms of efficacy, safety, convenience, and the implications for patient compliance with treatment. In addition, definitions of mild, moderate and severe scalp psoriasis were agreed. This paper presents a treatment algorithm that includes recommendations for patients in all three categories. It considers the role of potent topical corticosteroids, vitamin D3 derivatives, salicylic acid preparations, and photo- and radiotherapy, as well as systemic therapies, including newer biological agents, for patients with widespread psoriasis with scalp involvement. Data from clinical trials indicate that a potent topical corticosteroid in a short-contact formulation is the most appropriate treatment for most patients with scalp psoriasis.
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Affiliation(s)
- Jp Ortonne
- Centre Hospitalier Universitaire de Nice, Nice, France
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Schmitt J, Csötönyi F, Bauer A, Meurer M. Determinants of treatment goals and satisfaction of patients with atopic eczema. J Dtsch Dermatol Ges 2008; 6:458-65. [DOI: 10.1111/j.1610-0387.2007.06609.x] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Schmitt J, Ford DE. Understanding the relationship between objective disease severity, psoriatic symptoms, illness-related stress, health-related quality of life and depressive symptoms in patients with psoriasis - a structural equations modeling approach. Gen Hosp Psychiatry 2007; 29:134-40. [PMID: 17336662 DOI: 10.1016/j.genhosppsych.2006.12.004] [Citation(s) in RCA: 65] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2006] [Revised: 12/05/2006] [Accepted: 12/11/2006] [Indexed: 11/28/2022]
Abstract
OBJECTIVES The aim of this study was to assess associations between objective disease severity, psoriasis symptoms, illness-related stress (IRS), health-related quality of life (HRQL) and depressive symptoms in patients with psoriasis. METHOD Cross-sectional study conducted between January and May 2005. Recruitment of 265 adult patients with psoriasis through Internet advertisements. Analysis of the validity of different measurement models and the fit of hypothesized structural models using a structural equations modeling approach. RESULTS Thirty-two percent of the participants screened positive for depression. Because of poor discriminant validity (correlation: 0.919), IRS and HRQL were considered as one factor. The final measurement model had adequate validity and fit. A significant proportion of the variance of depressive symptoms was explained by HRQL (standardized direct effect: 0.916; P<.001). After adjustment for HRQL, objective severity of psoriasis was inversely related to depressive symptoms (standardized direct effect: -0.250; P=.094). CONCLUSION In psoriasis - a condition without direct brain involvement - specific disease-related problems in everyday life seem to cause depression in a significant proportion of patients. It is therefore critically important to regularly assess and work to maximize HRQL in psoriasis patients. Patients with high HRQL impairment despite objectively mild psoriasis should be screened for depression.
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Affiliation(s)
- Jochen Schmitt
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
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Schmitt JM, Ford DE. Work Limitations and Productivity Loss Are Associated with Health-Related Quality of Life but Not with Clinical Severity in Patients with Psoriasis. Dermatology 2006; 213:102-10. [PMID: 16902286 DOI: 10.1159/000093848] [Citation(s) in RCA: 109] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2006] [Accepted: 03/10/2006] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND According to current guidelines the cost of productivity loss should be considered in pharmacoeconomic analyses. The cost of health-related productivity loss in psoriasis patients is unknown. OBJECTIVE To estimate the cost of productivity loss in psoriasis and its association with health-related quality of life and clinical disease severity. METHODS Cross-sectional study, recruitment of adult participants through Internet advertisements. 201 (72.3%) out of 278 eligible participants completed the study. Health-related work productivity loss, quality of life and clinical severity of psoriasis were assessed by standardized instruments. RESULTS Indirect costs of productivity loss clearly exceed the total direct cost. In contrast to objective clinical disease severity, health-related quality of life (measured by the Dermatology Life Quality Index) is an independent predictor of work productivity. CONCLUSIONS There is good reason to believe that intervention can reduce health-related productivity loss by improving patients' quality of life. Savings from increased work productivity might offset comparatively high acquisition costs of biological agents.
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Affiliation(s)
- Jochen M Schmitt
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
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