Burden of Disease: Psoriasis and Psoriatic Arthritis
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Psoriatic arthritis (PsA) increases the disease burden associated with psoriasis by further diminishing quality of life, increasing health care costs and cardiovascular risk, and potentially causing progressive joint damage. The presence of PsA influences psoriasis treatment by increasing overall disease complexity and, within the framework of current guidelines and recommendations, requiring the use of conventional disease-modifying anti-rheumatic drugs or tumor necrosis factor-α inhibitors in order to prevent progressive joint damage. Despite its important impact, PsA is still under-diagnosed in dermatology practice. Dermatologists are well positioned to recognize and treat PsA, given that it characteristically presents, on average, 10 years subsequent to the appearance of skin symptoms. Regular screening of psoriasis patients for early evident joint symptoms should be incorporated into daily dermatologic practice. Although drugs effective in PsA are available, not all patients may respond to treatment, and others may lose their initial response over time. New investigational therapies, such as inhibitors of interleukin-17A, interleukin-12/23, Janus kinase 3, or phosphodiesterase-4, may address unmet needs in psoriatic disease, with further research needed to determine the role of these agents in reducing joint damage and other comorbidities.
KeywordsPsoriasis Psoriatic Arthritis Psoriasis Patient Ustekinumab Dermatology Life Quality Index
Novartis supported this manuscript with an unrestricted writing grant.
Dr Boehncke reports having received honoraria as an advisor or speaker for Abbott, Amgen, Biogen Idec, Janssen, Lilly, MSD, Novartis, and Pfizer and research grants from Janssen and Pfizer. Dr Menter reports having received honoraria as an advisor, investigator, or speaker for Abbott, Allergan, Amgen, Celgene, Galderma, Janssen, LEO Pharma, Lilly, Novartis, Novo Nordisk, Pfizer, Stiefel Laboratories, Syntrix Biosystems, and Wyeth; and research grants from Abbott, Allergan, Amgen, Celgene, Janssen, Lilly, Novartis, Novo Nordisk, Pfizer, Stiefel Laboratories, and Syntrix Biosystems.
Drs Boehncke and Menter had full access to all papers cited in this article and take responsibility for the accuracy of the data analysis. Both authors were responsible for the analysis and interpretation of data reported in this article and in revising the manuscript for important intellectual content. Both approved the final submitted version.
The authors are indebted to Kathryn Miles and Andrew Horgan of BioScience Communications, New York, NY, for help in literature searches and in preparing the draft of this manuscript, activities that were supported by Novartis.
- 6.Haroon M, Kirby B, Fitzgerald O. High prevalence of psoriatic arthritis in patients with severe psoriasis with suboptimal performance of screening questionnaires. Ann Rheum Dis. 2013;72(5):736-40Google Scholar
- 12.Mease PJ. Measures of psoriatic arthritis: Tender and Swollen Joint Assessment, Psoriasis Area and Severity Index (PASI), Nail Psoriasis Severity Index (NAPSI), Modified Nail Psoriasis Severity Index (mNAPSI), Mander/Newcastle Enthesitis Index (MEI), Leeds Enthesitis Index (LEI), Spondyloarthritis Research Consortium of Canada (SPARCC), Maastricht Ankylosing Spondylitis Enthesis Score (MASES), Leeds Dactylitis Index (LDI), Patient Global for Psoriatic Arthritis, Dermatology Life Quality Index (DLQI), Psoriatic Arthritis Quality of Life (PsAQOL), Functional Assessment of Chronic Illness Therapy-Fatigue (FACIT-F), Psoriatic Arthritis Response Criteria (PsARC), Psoriatic Arthritis Joint Activity Index (PsAJAI), Disease Activity in Psoriatic Arthritis (DAPSA), and Composite Psoriatic Disease Activity Index (CPDAI). Arthritis Care Res. 2011;63(Suppl. 11):S64–85.CrossRefGoogle Scholar
- 19.Lee S, Mendelsohn A, Sarnes E. The burden of psoriatic arthritis: a literature review from a global health systems perspective. Pharm Ther. 2010;35:680–9.Google Scholar
- 25.Eder L, Jayakar J, Shanmugarajah S, et al. The burden of carotid artery plaques is higher in patients with psoriatic arthritis compared with those with psoriasis alone. Ann Rheum Dis. 2012 (Epub ahead of print).Google Scholar
- 34.Boehncke WH, Salgo R, Garbaraviciene J, et al. Effective continuous systemic therapy of severe plaque-type psoriasis is accompanied by amelioration of biomarkers of cardiovascular risk: results of a prospective longitudinal observational study. J Eur Acad Dermatol Venereol. 2011;25:1187–93.PubMedCrossRefGoogle Scholar
- 36.Di Minno MN, Iervolino S, Peluso R, on behalf of the CaRRDs study group, et al. Carotid intima-media thickness in psoriatic arthritis. Differences between tumor necrosis factor-α blockers and traditional disease-modifying antirheumatic drugs. Arterioscler Thromb Vasc Biol. 2011;31:705–12.PubMedCrossRefGoogle Scholar
- 53.Association of American Medical Colleges. 2008 physician specialty data. Center for Workforce Studies [online]. https://www.aamc.org/download/47352/data/specialtydata.pdf. (Accessed 24 Sep 2012).
- 70.van Baarsen LG, Lebre MC, van der Coelen D, et al. Expression levels of IL-17A, IL-17F and their receptors in synovium of patients with rheumatoid arthritis, psoriatic arthritis and osteoarthritis: a target validation study [abstract]. Ann Rheum Dis. 2011;70(Suppl. 3):536.Google Scholar
- 76.Mease PJ, Gladman DD, Ritchlin CT, Adalimumab Effectiveness in Psoriatic Arthritis Trial Study Group, et al. Adalimumab for the treatment of patients with moderately to severely active psoriatic arthritis: results of a double-blind, randomized, placebo-controlled trial. Arthritis Rheum. 2005;52:3279–89.PubMedCrossRefGoogle Scholar
- 78.McInnes IB, Kavanaugh A, Gottlieb AB, et al. Ustekinumab in patients with active psoriatic arthritis: results of the phase 3, multicenter, double-blind, placebo-controlled PSUMMIT I study [abstract]. Ann Rheum Dis. 2012;71 Suppl. 3:107 (Abstract OP0158).Google Scholar
- 82.McInnes I, Sieper J, Braun J, et al. Anti-interleukin 17A monoclonal antibody secukinumab reduces signs and symptoms of psoriatic arthritis in a 24-week multicenter, double-blind, randomized, placebo-controlled trial [abstract]. Arthritis Rheum. 2011;63(10 Suppl.):S306.Google Scholar
- 86.Tzellos T, Kyrgidis A, Zouboulis CC. Re-evaluation of the risk for major adverse cardiovascular events in patients treated with anti-IL-12/23 biological agents for chronic plaque psoriasis: a meta-analysis of randomized controlled trials. J Eur Acad Dermatol Venereol. 2013;27:622–7.PubMedCrossRefGoogle Scholar