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Delphi-based recommendations for the management of cardiovascular comorbidities in patients with psoriatic arthritis and moderate-to-severe psoriasis

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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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The authors confirm that all data supporting the findings of this study are available within the article and its supplementary materials.

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Acknowledgements

The participation of the following researchers is appreciated: PS Del Río, A Urruticoechea, J Gratacós, M Carrascos, L Mateo, E Beltrán, AJ García, F Javier García-Latasa, MS Bustabad, FJ Maceiras, AF Monteagudo, ML García, S Pérez, JF García, O Martínez, MC García, I Belinchon, MA Martínez, BE Joven, E Dauden, R García, P de la Cueva, MT Navío, A Hernández, C Schoendor, F Ortega.

Funding

This work was supported by Pfizer Inc. The sponsor was not involved in the study design; collection, analysis, and interpretation of the data; or the writing of the manuscript.

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Authors and Affiliations

  1. Rheumatology Unit, Hospital Universitario Fundación de Alcorcón, C/Budapest 1, 28922, Alcorcón, Madrid, Spain

    Pedro Zarco Montejo & Raquel Almodóvar González

  2. Respiratory Medicine Unit, Hospital Universitario Fundación de Alcorcón, Madrid, Spain

    Eva De Higes-Martínez

  3. Endocrinology and Nutrition Unit, Hospital Universitario Fundación de Alcorcón, Madrid, Spain

    Juan José Gorgojo-Martínez

  4. Internal Medicine Unit, Hospital Universitario Fundación de Alcorcón, Madrid, Spain

    Carlos Guijarro Herraiz

  5. Rey Juan Carlos University, Madrid, Spain

    Carlos Guijarro Herraiz

  6. Rehabilitation Unit, Hospital Universitario Fundación de Alcorcón, Madrid, Spain

    María Jesús López Navas

  7. Primary Care, National Coordinator for Dermatology at SEMERGEN, Madrid, Spain

    David Palacios

  8. Psychiatric Unit, Hospital Universitario Fundación de Alcorcón, Madrid, Spain

    Jose Carlos Peláez Álvarez

  9. Dermatology Unit, Hospital Universitario Fundación de Alcorcón, Madrid, Spain

    Diana Ruíz Genao & Jose Luis López Estebaranz

  10. Medical Statistics Consulting S.L., Valencia, Spain

    Blanca Piedrafita

  11. Pfizer España, Madrid, Spain

    Susana Gómez, Erica Falkenbach & Francisco Jose Rebollo Laserna

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  1. Pedro Zarco Montejo
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Contributions

All authors had contributed to the study conception and design as well as to material preparation and data collection, which was critically revised for important intellectual content. All authors read and approved the final manuscript. All authors agree to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work have been appropriately investigated and resolved.

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Correspondence to Raquel Almodóvar González.

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Conflicts of interest

The following authors have received consulting and/or speaker fees: PZM from Abbvie, Elli Lilly, MSD, Novartis, Pfizer and UCB Pharma; JLLE from Almirall, Galderma, Leo Pharma, Novartis, Abbvie, Pfizer, Elli Lilly, Janssen, Celgene and Isdin; DRG from Pfizer, LeoPharma, Novartis, Elli Lilly, Janssen, Celgene and Abbvie; RAG from Abbvie, Celgene, Gebro, Janssen, Eli Lilly, MSD, Novartis, Pfizer and UCB; JJGM from Astra-Zeneca, Janssen, Eli Lilly, MSD, Mundipharma, Novo-Nordisk, Pfizer; Abbott, AbbVie, Boehringer Ingelheim Pharmaceuticals, Esteve, Roche and Sanofi-Aventis; CGH from Amgen, Ferrer, MSD, Pfizer and Sanofi-Aventis; EDHM from Pfizer, AstraZeneca, GSK, Novartis, Esteve, Chiesi, Ferrer, Rovi, Mundipharma and Eli Lilly; JCPA from Pfizer, Shire Pharmaceuticals Iberica, MSD and Laboratorios Rovi. MJLN, DP and BP declare no conflict of interest. FJRL, EF and SG are employees of Pfizer Inc.

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Zarco Montejo, P., Almodóvar González, R., De Higes-Martínez, E. et al. Delphi-based recommendations for the management of cardiovascular comorbidities in patients with psoriatic arthritis and moderate-to-severe psoriasis. Rheumatol Int 40, 969–981 (2020). https://doi.org/10.1007/s00296-020-04573-w

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