Assessing for Impact on Quality of Life in Patients with Psoriatic Arthritis

April 16, 2014
Elise Oberliesen

Psoriatic arthritis is often associated with sleep disturbances, depression, and other comorbidities that can adversely affect a patient's ability to perform activities of daily living.

Some studies suggest there may be a link between psoriatic arthritis (PsA) and comorbidities such as Crohn’s disease and cancer. However, cardiovascular disease, stroke, and diabetes show more established “connections” to PsA, according to a study published in 2010 in Current Rheumatology Reports.

It turns out some patients with PsA experience depression too, says Cleveland Clinic rheumatologist Elaine Husni, MD, MPH, who is also on the National Psoriasis Foundation Medical Board. She says that mental health issues can significantly impact a patient’s quality of life (QoL), depending on the severity of their PsA. The same is true with sleep disturbances, which also frequently occur in patients with psoriatic arthritis.

Physicians and other clinicians who treat patients with PsA should consider how the disease can interrupt a person’s overall QoL (eg, can they shower independently or go to the grocery store when the coffee creamer runs low?) when devising a treatment plan.

It’s a topic that Husni says is growing in popularity. “We’re increasingly aware of QoL measures that were not previously considered when asking patients about their symptoms.”

She says the federal government is currently funding several QoL studies to better understand its impact on the disease process. The Patient Centered Outcomes Research Institute (PCORI) is a major force behind that movement.

PCORI funds comparative clinical effectiveness research (CER), which “helps patients and their healthcare providers make better informed decisions by comparing different health care options to determine what works best for patients given their needs and circumstances,” says Bryan R. Luce, PhD, Chief Science Officer at PCORI.

This research assesses how different treatments, tests, and diagnostic strategies can help or hinder a patient’s ability to get dressed, drive, and perform other activities of daily living, which Luce says are “the outcomes that really matter to patients.” Plus, it tracks symptom reduction, mood, and pain levels to determine treatment efficacy.

Although there is not much scientific literature about the connection between PsA and depression, Husni says there are more studies and research linking depression with psoriasis. And while it’s unclear exactly how the two are related, Husni says “With psoriasis there’s definitely more depression,” so she thinks it’s a good idea for physicians to screen for it.

When interviewing her patients with psoriasis or psoriatic arthritis, Husni asks them to talk about how things are going at work, in their personal lives, and with family. She says she is also on the lookout for sleep issues and mood changes.

“I tell my trainees they don’t need to address everything in one visit. This is something you keep in the back of your mind; when the patient’s more acute or dominant symptoms are controlled you can screen in subsequent visits,” says Husni.

Some patients hide their depression better than others. Some patients make radical behavior changes. So it takes a little detective work on the part of physicians to understand what’s really going on.

“Maybe a patient isn’t taking his or her medications or isn’t coming to appointments. Maybe that patient is depressed,” says Husni. She suggests that treating physicians go beyond the standard “joint exam” or “skin exam” and “feel empowered to ask the patient how they think their quality of life is impacted by the disease.”

Assess body language, like eye contact. It might be one of your best tools to spot whether something unusual is going on with a patient, says Husni.

Without adequate research funding it’s nearly impossible to uncover the biologic, genetic, and other mysteries often tangled up in the disease process. Thanks to funding from NIH and the American College of Rheumatology, University of Colorado researchers recently reported that “lung inflammation is one of the earliest signs of rheumatoid arthritis in some individuals.”

The report goes on to say, discoveries like these play a significant role in developing preventive measures for joint diseases like rheumatoid arthritis and psoriatic arthritis, and in improving mortality rates—all of which could help improve QoL.

While rheumatoid arthritis and psoriatic arthritis are different diseases, prevention still remains a top priority for both, says Kevin D. Deane, MD, associate professor of medicine in the division of rheumatology at the University of Colorado School of Medicine.

Deane says, as researchers learn more about the autoimmune system and disease-specific triggers within the body, it could advance diagnostic and treatment criteria that ultimately leads to better patient outcomes and quality of life.

While researchers can’t exactly link findings from rheumatoid arthritis to psoriatic arthritis, they can look for similarities.

“One possibility is that understanding how rheumatic diseases such as rheumatoid arthritis and psoriatic arthritis develop can help ultimately in preventing disease,” says Deane.