GRAPPA 2020 Annual Meeting: Management of Psoriasis and Psoriatic Arthritis During the COVID-19 Pandemic

A plenary session held during the 2020 annual meeting of the Group for Research and Assessment of Psoriasis and Psoriatic Arthritis (GRAPPA) was dedicated to the perspectives of the effect and management of patients with psoriasis and psoriatic arthritis (PsA) during the COVID-19 pandemic. The findings were published in The Journal of Rheumatology.  

Assessment of current clinical practices during the COVID-19 pandemic was based on an interactive poll that included more than 50 conference participants. Poll results indicated that the use of telehealth virtual visits during the pandemic ranged from 83% to 95% for patients with psoriasis and PsA.

Although concerns over increased risk for adverse reactions in patients with COVID-19 was an important cause for modification of systemic medications in patients with psoriasis (47%), the most common reason for dose adjustment or discontinuation was treatment-associated concerns (64%).

Leonard Calabrese, MD, provided an overview of the COVID-19 pandemic and rheumatology, and raised 2 important questions.

The first question was regarding the outcomes of patients with immune-mediated inflammatory disease (IMID) and COVID-19 who were receiving targeted therapies. Available data suggest that in the absence of significant comorbidities, patients with well-controlled rheumatic diseases have COVID-19 disease symptoms that are similar to those of the general population. Patients who were not receiving disease-modifying antirheumatic drugs or those who received treatment with sulfasalazine, rituximab, or prednisone in daily doses of 10 mg or higher were at an increased risk for mortality, while treatment with tumor necrosis factor inhibitors was associated with a lower rate of severe outcomes.

The second question was what providers should tell their patients about taking the COVID-19 vaccine. Dr Calabrese noted that as all currently leading mRNA vaccines for COVID-19 are nonliving, they are believed to be safe for use in patients with IMIDs, despite the lack of data on safety and efficacy in this population.

A survey among patients with psoriasis showed that the majority were concerned about contracting COVID-19 and were more concerned about the risk from immunosuppressive treatment than that from psoriasis. Treatment for psoriasis remained unchanged for patients who did not contract COVID-19. Patients had positive views on the use of telehealth for remote consultations and stated that more reliable information would help them cope better with the pandemic.

Regarding the COVID-19 pandemic, Kevin Winthrop, MD, an infectious disease specialist, stated that the most common question he received was from rheumatologists and patients asking if they should receive the vaccine and if it was safe for them. According to Dr Winthrop, the vaccines are safe and patients should get vaccinated when they are available, though there is a chance that the vaccines may cause a flare of the underlying autoimmune disease. He added that while certain treatments may interfere with the immunologic response to a vaccine, it may be challenging to extrapolate from the experiences with other vaccines to this new mRNA vaccine platform.

During the course of the COVID-19 pandemic, numerous dermatologic findings associated with SARS-CoV-2 infection were described, including blanching and nonblanching rashes, vesicular eruptions, and multisystem inflammatory syndrome in children.

The plenary session had a positive effect on the participants, as approximately half of them (47.4%) reported that the content and discussion of the session changed the way they would discuss COVID-19 and perception risk with their patients; 17.3% of participants felt more confident maintaining an effective systemic therapy for psoriasis.

“Continued vigilance and research should help to address patient and clinician concerns and deepen our understanding of this disease in the context of patients with autoimmune disease,” the authors concluded.

Disclosure: Several authors declared affiliations with the pharmaceutical industry. Please see the original reference for a full list of authors’ disclosures.

Reference

Mease PJ, Calabrese LH, Callis Duffin K, et al. Psoriasis and psoriatic arthritis in the context of the COVID-19 pandemic: a plenary session from the GRAPPA 2020 annual meeting. J Rheumatol. Published online March 15, 2021. doi:10.3899/jrheum.201671