MDNG Primary CareJanuary 2011
Volume 13
Issue 1

Medical Websites

The Natural History of Psoriasis

This Medversation resource, previously available online only, was just converted to a downloadable PDF on January 6 of this year. Within, physicians will find in-depth chapters focusing on the natural history of psoriasis, psoriasis epidemiology and pathogenesis, clinical manifestations of psoriasis, and disease severity and burden. Of particular use to the primary care physician is the section that covers clinical assessment tools (Psoriasis Area and Severity Index, Physician Global Assessment, Dermatology Life Quality Index, 36-item Short Form Health Survey), which should be helpful in determining whether a patient should be referred to a specialist for treatment.

Online CME

Psoriasis HQ

The CME well at Psoriasis HQ seems to be running dry. Only one activity (listed below) is still active and that was the only posted in all of 2010. The resources page, on the other hand, remains of use, featuring downloadable assessment tools and diagnostic reference cards.

Psoriasis Quality-of-Life Issues and Comorbid Medical Conditions: Treating the Whole Patient

Credits: 0.50

Fee: None

Expiration Date: September 30, 2011

Multimedia: Audio/Slides

After presenting a few slides on psoriasis, quality of life, and “emerging scientific data support[ing] the existence of comborbid conditions associated with psoriasis,” Kristine Kucera, PA-C, MPAS, DHS, of the Dermatology Center of Frisco uses the case history of a 38-year-old woman with severe plaque psoriasis to highlight conventional systemic therapies and biologic agents and their limitations and adverse effects, as well as the need to focus on cardiovascular disease and metabolic syndrome risk in this patient population.

Physicians will find more expired content here than not, but whereas Psoriasis HQ has a few extra goodies for physicians, is basically a repository of old activities. This is not necessarily a bad thing, especially if one just wants to learn about best practices, but “the ultimate CME channel” really isn’t doing much to live up to its name.

Meet the Experts Case-based Learning Discussion

Credits: 1.25

Fee: None

Expiration Date: November 1, 2011

Multimedia: Audio/Video/Slides

Four presenters—Wolfran Sherry, MD, Clinic of Dermatology Allergy and Venerology, Charité University; Knud Kragballe, MD, Ph.D, Department of Dermatology, Århus University Hospital; Craig Leonardi, MD, St. Louis University School of Medicine; Alan Menter, MD, Baylor Research Institute—discuss both clinical and scientific data pertaining to psoriasis research and “present critical case studies to further examine” that data. The educational objectives largely deal with distinguishing among and describing the roles of newer and biologic agents for psoriasis management. is probably what Psoriasis HQ used to look like. Fresh content updated regularly, and useful resources beyond a large body of still-active CME programs. Under “Suggested Reading” physicians can find nine sets of psoriasis management guidelines and a host of selected references that comprise important research.

Cases and Commentaries in Psoriasis

Credits: 1.00

Fee: None

Expiration Date: January 31, 2012

Multimedia: None

“This Biologic Bulletin presents three clinical scenarios and examines the selection and rationale for the best management options for each patient.” The activity will challenge clinicians to “formulate a practical plan for the integration of agents with new mechanisms of action into clinical practice…develop strategies for managing a diverse set of patients with psoriasis…explain the pathology of interleukin (IL)-12 immunodeficiency and implement appropriate screening, monitoring, and vaccinations in patients receiving IL-12/23 inhibitors…[and] compare safety issues relating to the various systemic therapies used to treat moderate to severe psoriasis.”

Clinical Trials

Prevalence of Sleep Disturbances in Psoriasis

Evaluating the Prevalence of Non-alcoholic Fatty Liver Disease among Patients with Psoriasis

Effectiveness of Adalimumab in the Treatment of Scalp and Nail Affection in Patients with Moderate to Severe Plaque Psoriasis

Pediatric Metabolic Syndrome in Psoriasis

From the Literature

Assessment of Osteoporosis in Psoriasis with and without Arthritis: Correlation with Disease Severity

An evaluation of “50 patients, with or without psoriatic arthritis for the presence and degree of osteoporosis” found that serum osteoprotegrin levels were “significantly increased in psoriasis patients” and that patients with psoriatic arthritis “had a higher degree of osteoporosis in the femur neck and wrist.”

Adalimumab for Treatment of Moderate to Severe Chronic Plaque Psoriasis of the Hands and Feet

In their attempt to determine “the efficacy, safety, and sustainabilityof response to adalimumab therapy for moderate to severe chronicplaque psoriasis involving hands and/or feet,” researchers found that Physician’s Global Assessment of hands and/or feet scores were “clear or almost clear” in far greater numbers for patients on adalimumab compared to those on placebo. “Adverse events in both groups were generally mild to moderate” and efficacy was “largely maintained to 28 weeks.”

Prevalence of the Metabolic Syndrome in Psoriasis

Results from the National Health and Nutrition Examination Survey, which “included 6549 participants aged 20 to 59 years,” indicate that “the prevalence of the metabolic syndrome was 40% among psoriasis cases and 23% among controls. The authors stress that “this frequent comorbidity should be recognized and taken into account in the long-term treatment of individuals with psoriasis.”

Systemic Therapy of Plaque-type Psoriasis Ameliorates Endothelial Cell Function

“Eight of ten patients showed a PASI-50 response” while “two of three patients with clinical insulin resistance showed normal insulin responsiveness at the end of the study.” Because this was “the first prospective study documenting an amelioration of endothelial cell function” in this patient population, the authors recommend that future studies “compare the cardioprotective effects of different treatment modalities, based on hard end points such as the rate of myocardial infarction.”

Nail Psoriasis: A Retrospective Study on the Effectiveness of Systemic Treatments

Out of 84 patients, 75% had fingernails affected by their psoriasis “and the mixed form was the most frequent subtype.” 58.3% received classical treatment and 41.7% received biological treatment. Improvement was significant using both therapies, but was “significantly higher in cyclosporin.”

The Educated PatientTM

It Works for Me

This resource from the National Psoriasis Foundation is entirely patient-authored and “includes hundreds of helpful tips and treatment reports from people who've tried just about everything to manage their psoriasis and/or psoriatic arthritis.”

Shoe Tips for Feet Affected by Psoriatic Arthritis

This article explains how both arthritis and osteoporosis can negatively affect the feet of the patient with arthritis, details “shoe-shopping smarts,” and explains why a person would need either accommodative or functional orthotics.

Psophisticated Style

Timm Gunn, mentor to the designers on the reality show “Project Runway,” and Susan C. Taylor, MD, Assistant Clinical Professor of Dermatology, College of Physicians and Surgeons, Columbia University, provide this “style guide” which helps patients overcome fashion challenges that arise when trying to dress oneself while living with psoriasis. Watch the videos and “learn how you can embrace your personal style and live fashionably with psoriasis.”

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