In adult patients with plaque psoriasis, metabolic syndrome and psoriatic arthritis (PsA) were highly prevalent comorbidities, along with dyslipidemia, hypertension, obesity, and type 2 diabetes, according to study findings published in The Journal of Dermatology. Health-related quality of life (HRQoL) was negatively affected by the presence of these comorbid conditions in people with psoriasis vulgaris.
As an immune-mediated disease, psoriasis is often accompanied by several other comorbidities. However, the literature on psoriatic comorbidities and HRQoL is sparse. Investigators sought to explore these comorbid relationships in an effort to optimize therapy and support the establishment of relevant guidelines.
A cross-sectional observational study enrolled 293 participants (mean age, 52.0 years; 51.9% men) between April 2014 and May 2015. A total of 244 (83.3%) participants had severe psoriasis; 46 (15.7%) and 13 (4.4%) had family histories of metabolic syndrome and PsA, respectively. Patients were seen at 3 monthly visits, when they were examined and had imaging and serology performed.
At the first visit, in addition to a dermatologic assessment, participants were interviewed and answered 3 HRQoL questionnaires: the Dermatological Life Quality Index (DLQI), the 36-Item Short Form Health Survey (SF-36), and the EuroQol Five-Dimension Questionnaire Three-Level version (EQ-5D-3L). The second visit included a rheumatologic examination and PsA diagnosis when applicable. At the final visit, patients were provided with all testing results and advised whether medical follow-up was necessary.
Metabolic syndrome and PsA were diagnosed in 141 (50.0%; 95% CI, 44.2%-55.8%) and 118 (41.8%; 95% CI, 36.0%-47.6%) patients, respectively, of which 75.9% and 44.9%, respectively, were new cases. Of the secondary clinical outcomes considered, dyslipidemia had the highest prevalence at 74.5%, while hypertension, obesity, and type 2 diabetes were diagnosed in 61.8%, 52.5%, and 30.9% of participants, respectively.
The mean DLQI score was 6.5, the mean SF-36 mental and physical component summary scores were 45.5 and 45.2, respectively, and the EQ-5D-3L mean scores were 72.7 for the visual analog scale and 0.68 for the mean utility index.
Study limitations included a cross-sectional design that precluded temporal evaluations and the potential lack of generalizability. The investigators also noted that patients at tertiary care centers tend to be more severe cases, which may result in a higher rate of comorbidities.
“These findings emphasize the relevance of diagnosis and treatment of patients with [psoriasis] beyond the care of skin lesions,” noted the authors, adding, “Our results emphasize the role played by emotional aspects in the quality of life of patients with [psoriasis].” They recommended that HRQoL scores be utilized routinely to gauge treatment response.
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Souza CS, Castro CCSD, Carneiro FRO, et al. Metabolic syndrome and psoriatic arthritis among patients with psoriasis vulgaris: Quality of life and prevalence [published online November 26, 2018]. J Dermatol. doi:10.1111/1346-8138.14706