Patient Education, Shared Decision-Making Gaps Found in Psoriatic Disease

Patients with moderate-to-severe plaque psoriasis with or without concomitant psoriatic arthritis are unaware of the systemic nature and increased comorbidity risk associated with psoriatic disease, according to interim results from a survey published in Dermatology and Therapy.¹

“This interim analysis highlights the need for patient education, productive dialogue, and shared decision-making between patients and healthcare practitioners for optimal management of psoriatic disease,” wrote April Armstrong, MD, MPH, professor of dermatology at University of Southern California in Los Angeles, and colleagues.

In psoriatic disease, patients’ understanding of their disease and their dialogue with healthcare professionals on treatment options is becoming more important. In this study, investigators aimed to determine patients’ understanding of the systemic nature of psoriasis and psoriatic arthritis and the associated burden of living with these conditions. The relationship between patient and healthcare professionals was also assessed.

A cross-sectional, quantitative online survey, called Psoriasis and Beyond: The Global Psoriatic Disease Survey, was conducted in patients with moderate-to-severe plaque psoriasis, with or without psoriatic arthritis. The analysis included responses from 1,678 patients from 11 countries.

Overall, 31% of patients with psoriasis reported concomitant psoriatic arthritis, of whom 80% considered the severity of their psoriatic arthritis as moderately or highly active. While 63% of patients had heard the term “psoriatic disease,” few patients were aware of psoriasis manifestations, with 29% aware of psoriatic arthritis and 18% aware of axial symptoms. Similarly, few patients were aware of comorbidities, with 21% and 18% aware of obesity and cardiovascular disease, respectively.

Among patients with psoriasis andconcurrent psoriatic arthritis, 70% reported swollen and tender joints, especially of the fingers and/or toes. Additionally, 84% experienced stigma and discrimination and reported that their disease had a negative impact on work, relationships and emotions.

On average, the confirmed diagnosis of psoriasis and psoriatic arthritis after first symptom was delayed by 2–3 years and 2 years, respectively.

Overall, 42% of patients had never discussed treatment goals with their healthcare provider.

“Active involvement of the patient in setting treatment goals is required as both the patient and healthcare professionals need to communicate openly about their objectives,” the authors wrote. “Patient education with a focus on monitoring joints for early detection of psoriatic arthritis may enable early access to treatments.”

Of the 15% of patients with psoriasis and 14% of patients with psoriatic arthritis who were dissatisfied with their current treatment, 57% reported incomplete relief of skin symptoms and 45% reported incomplete relief of joint symptoms as primary reasons for dissatisfaction.

Less than half of patients with psoriatic arthritis were treated by a rheumatologist. “This may lead to disease mismanagement, with patients treated by non-specialists,” the authors concluded.

Reference:

Armstrong, A., Bohannan, B., Mburu, S. et al. Impact of Psoriatic Disease on Quality of Life: Interim Results of a Global Survey. Dermatol Ther (Heidelb) (2022). https://doi.org/10.1007/s13555-022-00695-0