Results of a systematic review published in Arthritis Care & Research indicate that patients with psoriasis and psoriatic arthritis (PsA) often face psychosocial challenges due to life disruption, fear of deterioration, perception of their mental health burden, and unmet treatment needs.
Investigators performed a comprehensive search of MEDLINE, Embase, PsycINFO, and CINAHL from database inception to April 29, 2018 for qualitative studies of patient experiences with psoriasis and PsA. Epidemiologic studies, case reports, basic science, and non-primary research articles were excluded from the review. Independent assessment of eligible studies was performed by 3 separate reviewers; discrepancies were resolved through discussion with a fourth party. Thematic synthesis was performed according to the Enhancing Transparency of Reporting the Synthesis of Qualitative research framework. Investigators developed a coding structure with the preliminary concepts of each article; all study text was then coded with respect to primary themes and subthemes.
A total of 56 studies were selected for inclusion in the review, comprising a pooled cohort of 1484 patients with either psoriasis (n=1147) or PsA (n=337). The majority of studies used interviews (61%) or focus groups (21%) and patient age ranged from 18 to 18 years. Investigators identified 6 primary themes across studies: loss of control and ongoing upheaval; psychiatric burden, including disease-related depression and anxiety; feelings of shame and fear of judgement; disappointment with treatment inadequacies and the burden of therapy; gaining control of their conditions by accepting their health status and attuning themselves to their bodies; and making confident treatment decisions by familiarizing themselves with available options and relying on the input of others.
Overall, patients with psoriasis and PsA endorsed a significant disease-related disruption of functioning and life course. Unmet treatment expectations were commonly reported; specifically, patients were dissatisfied with the lack of personalized care, lack of perceived treatment benefit, and the use of unpalatable or inconvenient treatment. Patients tended to feel empowered when they developed an understanding of the pathophysiology of their disease and gained insight into their treatment options. Results were generally consistent across all patient populations.
According to these results, investigators advocated for increased focus on therapeutic relationships and psychosocial support in the treatment of psoriasis and PsA. Addressing low treatment expectations and fear of adverse medication effects may improve medical therapy uptake and quality of life in these patient populations.
Sumpton D, Kelly A, Tunnicliffe DJ, et al. Patients’ perspectives and experience of psoriasis and psoriatic arthritis: a systematic review and thematic synthesis of qualitative studies [published online March 30, 2019]. Arthritis Care Res. doi:10.1002/acr.23896