Quality of Life and Treatment Satisfaction among Patients with Psoriasis and Psoriatic Arthritis and Patients with Psoriasis Only
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Introduction: Five to forty percent of patients with cutaneous psoriasis develop an inflammatory, oligoarticular spondyloarthropathy known as psoriatic arthritis.
Objective: To compare health-related quality of life (QOL) between cutaneous psoriatic patients with and without psoriatic arthritis.
Method: Secondary cross-sectional analysis of data obtained from the 2005 Spring US National Psoriasis Foundation Quality of Life Telephone/Internet Survey. 426 patients with psoriasis and/or psoriatic arthritis were included in the 2005 survey. Among these respondents, the self-reported disease histories of 140 patients with cutaneous psoriasis and psoriatic arthritis were compared with those of 278 patients with cutaneous psoriasis only. Both groups were compared with respect to demographics, skin disease severity, treatment history and satisfaction, and QOL using previously validated assessment scales.
Results: Compared with those with skin psoriasis only, respondents with cutaneous psoriasis and psoriatic arthritis were slightly older, more likely to be female and members of the National Psoriasis Foundation, and more likely to report a younger age of disease onset. They were also more likely to be unemployed, to report their job was affected by their condition, and to report a higher mean estimate of lost annual wages. On both univariate and multivariate analysis, however, no significant differences between groups were detected in skin disease severity, overall QOL, and satisfaction with current treatment options. At the same time, individuals with skin psoriasis and psoriatic arthritis were more likely to be taking systemic agents. They also reported higher mean scores for pain, while those with cutaneous psoriasis reported higher mean scores for self-consciousness only.
Conclusion: In contrast to previous reports that did not control for skin disease severity, this study demonstrates that patients with cutaneous psoriasis and psoriatic arthritis do not report significantly worse health-related QOL compared with patients with cutaneous psoriasis only. Nor do they report significantly greater dissatisfaction with current treatment options. These findings may reflect the intrinsic inadequacy of the QOL instruments used in this study for capturing the additional burden of joint disease. Alternatively, these findings may reflect the existence of a threshold of joint disease in patients with skin psoriasis and psoriatic arthritis below which joint symptoms are perceived as negligible relative to cutaneous disease.
KeywordsPsoriasis Psoriatic Arthritis Dermatology Life Quality Index Joint Symptom Prescription Drug Coverage
This study was made possible in part by a clinical trials grant from Centocor, Inc., and data were acquired from the 2005 Spring US National Psoriasis Foundation Survey with permission. Neither entity was involved, however, in the study design, preparation of the manuscript, data analysis, or the decision to submit for publication. This study is an accurate representation of our secondary interpretation of the data. We thank Dr Hang Lee for assistance with our statistical analysis.
Dr David Ciocon was funded by a 1-year fellowship grant from Centocor, Inc. Dr Alexa Kimball has received research and consulting support from Centocor, Connetics, Cytochroma, Genentech, Amgen, and Abbot, and is on the Medical Board of the US National Psoriasis Foundation. Dr Elizabeth Horn is a former Research Director of the US National Psoriasis Foundation.
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