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Zarco Montejo P, Almodóvar González R, De Higes-Martínez E, Gorgojo-Martínez JJ, Guijarro Herraiz C, López Navas MJ, Palacios D, Peláez Álvarez JC, Ruíz Genao D, Piedrafita B, Gómez S, Falkenbach E, Rebollo Laserna FJ, López Estebaranz JL. Delphi-based recommendations for the management of cardiovascular comorbidities in patients with psoriatic arthritis and moderate-to-severe psoriasis. Rheumatol Int 2020; 40:969-981. [PMID: 32274527 DOI: 10.1007/s00296-020-04573-w] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2020] [Accepted: 03/26/2020] [Indexed: 02/07/2023]
Abstract
The aim of this study was to generate practical recommendations to assist rheumatologists and dermatologists in the management of cardiovascular (CV) comorbidities in patients with moderate-to-severe psoriasis (MS-PSO) and psoriatic arthritis (PsA). A two-round Delphi study was conducted. A panel of experts rated their agreement with a set of statements (n = 52) on a nine-point Likert scale (1 = totally disagree; 9 = totally agree). Statements were classified as inappropriate (median 1-3), irrelevant (median 4-6) or appropriate (median 7-9). Consensus was established when at least two-thirds of the panel responded with a score within any one range. A total of 25 experts, 60% rheumatologists and 40% dermatologists, participated in two consultation rounds. There was overall unanimity on the appropriateness of an initial assessment for CV risk factors in all patients with MS-PSO and PsA. Most panelists (88.0%) also supported the evaluation of patients' psychological and physical status. Additionally, most panelists (72.2%) agreed on a novel sequential approach for the management of CV comorbidities. This sequence starts with the assessment of hypertension, diabetes and dyslipidemia along with the identification of depression and anxiety disorders. Once these factors are under control, smoking cessation programs might be initiated. Finally, if patients have not met weight loss goals with lifestyle modifications, they should receive specialized treatment for obesity. This study has drawn up a set of practical recommendations that will facilitate the management of CV comorbidities in patients with MS-PSO and PsA.
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Affiliation(s)
- Pedro Zarco Montejo
- Rheumatology Unit, Hospital Universitario Fundación de Alcorcón, C/Budapest 1, 28922, Alcorcón, Madrid, Spain
| | - Raquel Almodóvar González
- Rheumatology Unit, Hospital Universitario Fundación de Alcorcón, C/Budapest 1, 28922, Alcorcón, Madrid, Spain.
| | - Eva De Higes-Martínez
- Respiratory Medicine Unit, Hospital Universitario Fundación de Alcorcón, Madrid, Spain
| | | | - Carlos Guijarro Herraiz
- Internal Medicine Unit, Hospital Universitario Fundación de Alcorcón, Madrid, Spain
- Rey Juan Carlos University, Madrid, Spain
| | | | - David Palacios
- Primary Care, National Coordinator for Dermatology at SEMERGEN, Madrid, Spain
| | | | - Diana Ruíz Genao
- Dermatology Unit, Hospital Universitario Fundación de Alcorcón, Madrid, Spain
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