COMORBIDITIES AND QUALITY OF LIFE IN PATIENTS WITH MODERATE TO SEVERE PSORIASIS
Main Article Content
Keywords
arthritis, cardiovascular diseases, comorbidities, psoriasis, quality of life
Abstract
Psoriasis is a common, chronic inflammatory immunologically mediated disease of the skin, showing a high prevalence of associated comorbidities, and strongly affecting patients’ quality of life (QOL), with profound impact on the psychological aspect. We aimed to establish the correlation between QOL and the associated comorbidities in patients with moderate to severe psoriasis. A cross-sectional, observational, epidemiological study was conducted. Adult patients diagnosed with moderate to severe psoriasis at least 6 months prior to the study visit and receiving or not receiving treatment for psoriasis were eligible for inclusion. A total of 146 patients were included. The study population showed mean 36-item short-form (SF-36) physical and mental health scores and Dermatological Life Quality Index (DLQI) of 49.7, 46.2 and 5.3, respectively. The multiple linear regression models showed that patients with moderate to severe psoriasis and a diagnosis of psoriatic arthritis (PsA), hypertension, diabetes mellitus, sleep disturbances or obesity were found to have lower SF-36 health physical scores. Female patients with depression or anxiety disorders had lower SF-36 health mental scores. Patients diagnosed with moderate to severe psoriatic disease and associated anxiety disorder had greater DLQI scores. Moderate to severe psoriasis has a significant burden on the QOL of patients. Regardless of sex, patients with several comorbidities such as PsA, hypertension or obesity were found to have worse scores in the physical component of the QOL questionnaire, whilst women were more affected in the mental health component than men.
References
2. National Psoriasis Foundation. Statistics. Available from http://www. psoriasis.org/learn_statistics. Accessed on January 24, 2013.
3. Menter A, Gottlieb A, Feldman SR et al. Guidelines of care for the management of psoriasis and psoriatic arthritis: section 1. Overview of psoriasis and guidelines of care for the treatment of psoriasis with biologics. J Am Acad Dermatol 2008; 58(5): 826– 850.
4. Onumah N, Kircik LH. Psoriasis and its comorbidities. J Drugs Dermatol 2012; 11(5 Suppl): s5–s10.
5. Wohlrab J, Fiedler G, Gerdes S et al. Recommendations for detection of individual risk for comorbidities in patients with psoriasis. Arch Dermatol Res 2013; 305(2): 91–98.
6. Puig-Sanz L. Psoriasis, a systemic disease? Actas Dermosifiliogr 2007; 98(6): 396–402.
7. Sommer DM, Jenisch S, Suchan M et al. Increased prevalence of the metabolic syndrome in patients with moderate to severe psoriasis. Arch Dermatol Res 2006; 298(7): 321–328.
8. Gottlieb AB, Dann F. Comorbidities in patients with psoriasis. Am J Med 2009; 122(12): 1150–1159.
9. Lotti T, Hercogova J, Prignano F. The concept of psoriatic disease: can cutaneous psoriasis any longer be separated by the systemic comorbidities? Dermatol Ther 2010; 23(2): 119–122.
10. Myers WA, Gottlieb AB, Mease P. Psoriasis and psoriatic arthritis: clinical features and disease mechanisms. Clin Dermatol 2006; 24 (5): 438–447.
11. Dauden E, Castaneda S, Suarez C et al. Clinical practice guideline for an integrated approach to comorbidity in patients with psoriasis. J Eur Acad Dermatol Venereol 2013; 27: 1387–1404.
12. Kimball AB, Guerin A, Tsaneva M et al. Economic burden of comorbidities in patients with psoriasis is substantial. J Eur Acad Dermatol Venereol 2011; 25(2): 157–163.
13. Gelfand JM, Feldman SR, Stern RS et al. Determinants of quality of life in patients with psoriasis: a study from the US population. J Am Acad Dermatol 2004; 51(5): 704–708.
14. Rapp SR, Feldman SR, Exum ML et al. Psoriasis causes as much disability as other major medical diseases. J Am Acad Dermatol 1999; 41(3 Pt 1): 401–407.
15. Ware JE Jr, Sherbourne CD. The MOS 36-item short-form health survey (SF-36). I. Conceptual framework and item selection. Med Care 1992; 30(6): 473–483.
16. Bronsard V, Paul C, Prey S et al. What are the best outcome measures for assessing quality of life in plaque type psoriasis? A systematic review of the literature. J Eur Acad Dermatol Venereol 2010; 24(Suppl 2): 17–22.
17. Finlay AY, Khan GK. Dermatology Life Quality Index (DLQI) a simple practical measure for routine clinical use. Clin Exp Dermatol 1994; 19(3): 210–216.
18. Kumar S, Han J, Li T et al. Obesity, waist circumference, weight change and the risk of psoriasis in US women. J Eur Acad Dermatol Venereol 2013; 27: 1293–1298.
19. Setty AR, Curhan G, Choi HK. Obesity, waist circumference, weight change, and the risk of psoriasis in women: Nurses’ Health Study II. Arch Intern Med 2007; 167(15): 1670–1675.
20. Li W, Han J, Qureshi AA. Obesity and risk of incident psoriatic arthritis in US women. Ann Rheum Dis 2012; 71(8): 1267–1272.
21. Johnston A, Arnadottir S, Gudjonsson JE et al. Obesity in psoriasis: leptin and resistin as mediators of cutaneous inflammation. Br J Dermatol 2008; 159(2): 342–350.
22. National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel III). Third Report of the National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel III) final report. Circulation 2002; 106(25): 3143– 3421.
23. Mente A, Yusuf S, Islam S et al. Metabolic syndrome and risk of acute myocardial infarction a case-control study of 26,903 subjects from 52 countries. J Am Coll Cardiol 2010; 55(21): 2390–2398.
24. Azfar RS, Gelfand JM. Psoriasis and metabolic disease: epidemiology and pathophysiology. Curr Opin Rheumatol 2008; 20(4): 416– 422.
25. Love TJ, Qureshi AA, Karlson EW et al. Prevalence of the metabolic syndrome in psoriasis: results from the National Health and Nutrition Examination Survey, 2003-2006. Arch Dermatol 2011; 147(4): 419– 424.
26. Gelfand JM, Neimann AL, Shin DB et al. Risk of myocardial infarction in patients with psoriasis. JAMA 2006; 296(14): 1735–1741.
27. Sanchez-Moya AI, Dauden E. Incidence of tuberculosis infection in psoriatic patients on anti-TNF therapy: report of a case series with 144 patients. J Eur Acad Dermatol Venereol 2011; 25(6): 730–733.
28. Sanchez-Moya AI, Garcia-Doval I, Carretero G et al. Latent tuberculosis infection and active tuberculosis in patients with psoriasis: a study on the incidence of tuberculosis and the prevalence of latent tuberculosis disease in patients with moderate-severe psoriasis in Spain. BIOBADADERM registry. J Eur Acad Dermatol Venereol 2013; 27: 1366–1374.
29. Bordignon V, Bultrini S, Prignano G et al. High prevalence of latent tuberculosis infection in autoimmune disorders such as psoriasis and in chronic respiratory diseases, including lung cancer. J Biol Regul Homeost Agents 2011; 25(2): 213–220.
30. Ramagopalan SV, Goldacre R, Skingsley A et al. Associations between selected immune-mediated diseases and tuberculosis: record-linkage studies. BMC Med 2013; 11: 97.
31. Sanchez Carazo JL, Lopez-Estebaranz JL, Guisado C et al. Clinical characteristics of patients with moderate to severe psoriasis in Spain. Poster presented at the 40th National Congress of Dermatology and Venereology (AEDV); June 6-9: Oviedo, Spain 2012.
32. Grozdev I, Kast D, Cao L et al. 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 2012; 132(4): 1111–1116.
33. Mattei PL, Corey KC, Kimball AB. Psoriasis Area Severity Index (PASI) and the Dermatology Life Quality Index (DLQI): the correlation between disease severity and psychological burden in patients treated with biological therapies. J Eur Acad Dermatol Venereol 2014; 28(3): 333–337.
34. Dauden E, Pujol RM, S anchez-Carazo JL et al.; on behalf of the VACAP Study Investigators. Demographic characteristics and healthrelated quality of life of patients with moderate-to-severe psoriasis: the VACAP study. Actas Dermosifiliogr. 2013; 104(9):807–814.
35. Koo J. Population-based epidemiologic study of psoriasis with emphasis on quality of life assessment. Dermatol Clin 1996; 14(3): 485–496.
Article Sidebar
Article Details
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
All articles published in JPTCP are licensed under Copyright Creative Commons Attribution-NonCommercial 4.0 International License.
Shilpa Soni
Assistant Professor, Department of Dermatology, Venerology and Leprosy, NIMS, Jaipur (Rajasthan)