Determinants of quality of life in psoriasis patients: a cluster analysis of 50 patients

Clinical Characteristics of Psoriasis for Initiation of Biologic Therapy: A Cluster Analysis

BACKGROUND

Psoriasis is a complex and heterogeneous disease that widely affects a patient's life. Biological therapy is usually prescribed in patients with severe psoriasis that do not respond to conventional treatment. However, data on the specific patient characteristics receiving biologics are still unavailable.

OBJECTIVE

To classify patients with psoriasis into subgroups with distinct phenotypes through cluster analysis, and to evaluate the differences between the clusters to predict disease prognosis by examining the response to biological therapy.

METHODS

The clinical characteristics of the patients with psoriasis were investigated and categorized using hierarchical cluster analysis. After clustering, the clinical characteristics of the patients were compared and the initiation of treatment with biologics according to the clusters were evaluated.

RESULTS

A total of 361 patients with psoriasis were classified into two clusters using 16 distinct clinical phenotypes. Group 1 (n=202) consisted of male smokers and alcohol users with higher psoriasis area and severity index (PASI), older age of onset, higher body mass index, and comorbidities including psoriatic arthritis, hypertension, and diabetes when compared to group 2 (n=159). Group 1 had a significantly higher probability of biological treatment initiation than group 2 (p=0.039). The measured risk factors for the initiation of biologics compared were PASI (p<0.001) and nail involvement (p=0.022).

CONCLUSION

Cluster analysis classified patients with psoriasis into two subgroups according to their clinical characteristics. Predicting the disease prognosis using a combination of specific clinical parameters may aid in the management of the disease.

Correlation of Psoriasis Disability Index and Psoriasis Area and Severity Index: A Study from Afghanistan

Background

Psoriasis is a common skin disease that affects physical, psychological, and social well-being of patients. Several studies have assessed health-related quality of life of patients with psoriasis in different populations with large variations.

Objective

To investigate, for the first time, the impact of psoriasis on quality of life of Afghan patients with psoriasis.

Methods

This is a prospective observational study conducted at the dermatology department of Maiwand Teaching hospital in Kabul City during April 2018 to May 2019. Patients with plaque psoriasis with age ≥16 years were included in the study. Psoriasis Disability Index was used for the assessment of health-related quality of life. Psoriasis Area and Severity Index was used to define the severity of disease. Appropriate tests were performed using Statistical Package for Social Science.

Results

A total of 174 patients with psoriasis were included in the study, 89 of them were male (51.1%) and 85 of them were female (48.9%). The mean age of the patients was 27.7 years with 13.2 years SD, and the average duration of the disease was 3.2 years with 4.7 years SD. The mean of PASI score was 13.3 with 7.8 SD, while the mean of total PDI was 9.6 with 3.7 SD; there was a strong correlation between total PDI and PASI score (r=0.751, p<0.001). The mean of total PDI was higher among moderate-to-severe psoriasis, female patients, younger age, and those who were single.

Conclusion

Our study highlighted that psoriasis disability index was highly correlated with psoriasis area and severity index. Furthermore, the quality of life was more affected among female patients, patients younger than 40 years, and those patients who were single.

Pain Management in Painful Psoriasis and Psoriatic Arthropathy: Challenging and Intricately Intertwined Issues Involving Several Systems

PURPOSE OF REVIEW

Psoriasis and psoriatic arthropathy are inflammatory autoimmune conditions that can lead to profound emotional distress, social stigmatization, isolation, disfigurement, pain, disability, unemployment, and decreased quality of life. Thus, this disease has immense psychological, social, and economic implications as the pain experienced is closely associated with the primary disease burden. This review focuses on discussing the primary disease burden of psoriasis and psoriatic arthropathy, as well as management of different types of pain in these patients.

RECENT FINDINGS

Pain affects over 40% of patients with psoriasis, ranging from neuropathic to nociceptive. Treatment of pain largely focuses on treating the underlying disease with mild topical steroids and non-steroidal medications including vitamin D analogs followed by systemic immunomodulatory agents for more severe disease. Interventional options such as corticosteroid injections are available for select cases (conditional recommendation). Psoriasis and psoriatic arthropathy have been associated with underreporting and resultant undertreatment of pain. Pain control in these conditions is complex and requires a multidisciplinary approach. More research and guidelines are needed in the areas of reporting of psoriatic disease, associated pain, psoriatic nociception, and optimal clinical management.

General measures and quality of life issues in psoriasis

Psoriasis generally does not affect survival but has significant detrimental effect on quality of life (QOL), which may be comparable to that of ischemic heart disease, diabetes, depression, and cancer. The foremost important thing in the management of psoriasis is counseling of the patient. The clinician needs to be empathetic and spend adequate time with the patient and educating the patient about psoriasis. Clinicians should make it clear to the patient that the primary goal of treatment is control of the disease rather than cure. Eating a balanced and low glycemic diet could be an important adjuvant factor in the prevention and treatment of moderate nonpustular psoriasis. Obese people are more likely to have severe psoriasis and psoriatic arthritis than people with an average body mass index. Dietary supplementation with oily fish, rich in n-3 fatty acids, in psoriasis had shown mixed results in trials. Promising results have been documented for parenteral application of n-3 fatty acid, but not with oral supplementation. Increased smoking or alcohol abuse increases the risk of developing psoriasis and may influence disease severity, and hence must be avoided. Soaking in warm water with bath oil can be done in extensive psoriasis for hydration and emollient effect, and bland soaps or soap substitutes should be used; antiseptics should be avoided as they may irritate the skin. Relatively small, localized patches of psoriasis may improve with occlusion, i.e., waterproof adhesive dressings. The use of emollients is an internationally accepted standard adjunctive to the treatment of psoriasis. Dermatology Life Quality Index is a psychometrically sound and responsive measure of psoriasis-specific outcomes and most comprehensively captures the impact of clinical signs and symptoms on patient's well-being.

Disease Severity, Quality of Life, and Psychiatric Morbidity in Patients With Psoriasis With Reference to Sociodemographic, Lifestyle, and Clinical Variables: A Prospective, Cross-Sectional Study From Lahore, Pakistan

BACKGROUND

Psoriasis is an immune-mediated, chronic disease with a genetic background that involves skin, nails, and joints. The incidence of psoriasis varies from 2.0% to 4.0% depending on the geographical location, ethnic background, and environmental conditions. Recent research has proved that psoriasis is a systemic inflammatory disease with extensive systemic implications. Objectives of the study were to explore the severity of psoriasis, dermatology-related quality of life, and psychiatric health of the patients with reference to sociodemographic, lifestyle, and clinical characteristics.

METHOD

Consecutive patients with psoriasis (ICD-10 criteria) from skin outpatient clinics of 3 tertiary care hospitals in Lahore, Pakistan, between November 1, 2012, and December 31, 2012, were assessed in this prospective cross-sectional study. The final sample includes 87 patients who were evaluated for severity of psoriasis (Psoriasis Area Severity Index [PASI]), dermatology-related quality of life (Dermatology Life Quality Index [DLQI]), and psychiatric morbidity (12-item General Health Questionnaire [GHQ-12]) and were assessed on 23 sociodemographic, lifestyle, and clinical variables.

RESULTS

Of the 23 variables, the PASI was significantly associated with education and habit of drinking alcohol (P < .05), the DLQI was significantly associated with disturbed eating (P < .05), and the GHQ-12 score was significantly associated with hair disease (P < .05), current income (P < .05), and disturbed eating and sleeping (P < .01). The PASI, DLQI, and GHQ-12 were not usually affected by sociodemographic, lifestyle, and clinical factors, except for some variables such as education of the patient, alcohol intake, eating and sleeping disturbance, and income status. A statistically significant correlation (P < .01) was found between all 3 scores (ie, PASI, DLQI, and GHQ-12). The correlation coefficients of the PASI with the DLQI and GHQ-12 are 0.345 and 0.460, respectively, and that of the DLQI with the GHQ-12 is 0.635. A moderating effect of the DLQI score was found on the relationship between the PASI and GHQ-12 scores.

CONCLUSIONS

Psoriasis has an immense impact on the life of patients and common comorbidities in psoriasis including coronary heart disease, depression, cerebrovascular disease, and metabolic syndrome. Screening for these comorbidities in psoriasis patients is essential. Impaired quality of life negatively affects the psyche of patients and initiates coping mechanisms, which may lead to depression and anxiety, social dysfunction, and loss of confidence, and the psychosocial burden of the disease may become more than the physical burden. The dermatologist usually manages physical disease and fails to address the social, emotional, and psychological aspects. Quality of life improves if these psychological aspects are also properly dealt with.