Patients with moderate to severe psoriasis are at increased risk of developing psoriatic arthritis (PsA) and several comorbidities and risk factors, including obesity, metabolic syndrome, cardiovascular disease, autoimmune disease, psychiatric illness, liver disease, COPD, sleep apnoea, smoking and alcohol abuse.
Such comorbidities will increase patients' likelihood of needing urgent care or hospitalisation and reduce their quality of life. However, they are often underdiagnosed in patients who have psoriasis.
This study aimed to develop recommendations to improve the diagnosis and management of PsA, psychological factors and cardiovascular disease in patients diagnosed with moderate to severe psoriasis.
A systematic literature review was carried out to establish the incidence and impact of each comorbidity. A steering group composed statements to address data gaps and 12 experts then undertook a Delphi survey to obtain consensus on the detection and management of each comorbidity.
The experts agreed that patients with psoriasis should be assessed annually for signs and symptoms of PsA and that PsA screening questionnaires should be used routinely in dermatological practice.
They agreed dermatologists should examine the patients' hands and feet and question them about any pain and stiffness in their joints, including peripheral and axial pain.
They agreed patients with psoriasis should be assessed regularly for anxiety, depression and addictive behaviour, and should be referred to a psychiatrist if psychological factors were found to affect the management of their psoriasis, or if the dermatologist suspected depression.
The experts also agreed patients with psoriasis should be assessed annually for a number of cardiovascular disease risk factors (BP, BMI, waist circumference, lipids, fasting glucose, HbA1c, smoking status), that cardiovascular disease risks should be managed aggressively in these patients and that dermatologists should provide them with weight loss and lifestyle advice during routine management.
Strohal R, Kirby B, Puig L. J Eur Acad Dermatol Venereol 2014; 28: 1661-9