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      Comorbidity in Adult Psoriasis: Considerations for the Clinician

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          Abstract

          Psoriasis is associated with several comorbidities ranging from cardiovascular comorbidity and mental disorders to other immune mediated inflammatory diseases. However, most of these co-morbidities are often overlooked or diagnosed late. Furthermore, evidence suggests that comorbidities are undertreated. Here, we provide an overview of comorbidities in psoriasis and present a simple rundown of considerations of relevance to the clinician. We hope that this review may raise clinicians’ awareness of comorbidities in psoriasis and provide simple guidance regarding screening tools and treatment decisions in psoriasis with comorbidities.

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          The metabolic syndrome—a new worldwide definition

          K George MM Alberti, Paul Zimmet, Jonathan Shaw (2005)
          Article 0 comments Cited 677 times – based on 0 reviews     Review now
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            Classification criteria for psoriatic arthritis: development of new criteria from a large international study.

            William Taylor, Dafna D. Gladman, Philip Helliwell … (2006)
            To compare the accuracy of existing classification criteria for the diagnosis of psoriatic arthritis (PsA) and to construct new criteria from observed data. Data were collected prospectively from consecutive clinic attendees with PsA and other inflammatory arthropathies. Subjects were classified by each of 7 criteria. Sensitivity and specificity were compared using conditional logistic regression analysis. Latent class analysis was used to calculate criteria accuracy in order to confirm the validity of clinical diagnosis as the gold standard definition of "case"-ness. Classification and Regression Trees methodology and logistic regression were used to identify items for new criteria, which were then constructed using a receiver operating characteristic curve. Data were collected on 588 cases and 536 controls with rheumatoid arthritis (n = 384), ankylosing spondylitis (n = 72), undifferentiated arthritis (n = 38), connective tissue disorders (n = 14), and other diseases (n = 28). The specificity of each set of criteria was high. The sensitivity of the Vasey and Espinoza method (0.97) was similar to that of the method of McGonagle et al (0.98) and greater than that of the methods of Bennett (0.44), Moll and Wright (0.91), the European Spondylarthropathy Study Group (0.74), and Gladman et al (0.91). The CASPAR (ClASsification criteria for Psoriatic ARthritis) criteria consisted of established inflammatory articular disease with at least 3 points from the following features: current psoriasis (assigned a score of 2; all other features were assigned a score of 1), a history of psoriasis (unless current psoriasis was present), a family history of psoriasis (unless current psoriasis was present or there was a history of psoriasis), dactylitis, juxtaarticular new bone formation, rheumatoid factor negativity, and nail dystrophy. These criteria were more specific (0.987 versus 0.960) but less sensitive (0.914 versus 0.972) than those of Vasey and Espinoza. The CASPAR criteria are simple and highly specific but less sensitive than the Vasey and Espinoza criteria.
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              EULAR recommendations for the management of psoriatic arthritis with pharmacological therapies: 2019 update

              Laure Gossec, Xenofon Baraliakos, Andreas Kerschbaumer … (2020)
              Objective To update the European League Against Rheumatism (EULAR) recommendations for the pharmacological treatment of psoriatic arthritis (PsA). Methods According to the EULAR standardised operating procedures, a systematic literature review was followed by a consensus meeting to develop this update involving 28 international taskforce members in May 2019. Levels of evidence and strengths of recommendations were determined. Results The updated recommendations comprise 6 overarching principles and 12 recommendations. The overarching principles address the nature of PsA and diversity of both musculoskeletal and non-musculoskeletal manifestations; the need for collaborative management and shared decision-making is highlighted. The recommendations provide a treatment strategy for pharmacological therapies. Non-steroidal anti-inflammatory drugs and local glucocorticoid injections are proposed as initial therapy; for patients with arthritis and poor prognostic factors, such as polyarthritis or monoarthritis/oligoarthritis accompanied by factors such as dactylitis or joint damage, rapid initiation of conventional synthetic disease-modifying antirheumatic drugs is recommended. If the treatment target is not achieved with this strategy, a biological disease-modifying antirheumatic drugs (bDMARDs) targeting tumour necrosis factor (TNF), interleukin (IL)-17A or IL-12/23 should be initiated, taking into account skin involvement if relevant. If axial disease predominates, a TNF inhibitor or IL-17A inhibitor should be started as first-line disease-modifying antirheumatic drug. Use of Janus kinase inhibitors is addressed primarily after bDMARD failure. Phosphodiesterase-4 inhibition is proposed for patients in whom these other drugs are inappropriate, generally in the context of mild disease. Drug switches and tapering in sustained remission are addressed. Conclusion These recommendations provide stakeholders with an updated consensus on the pharmacological management of PsA, based on a combination of evidence and expert opinion.
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                Author and article information

                Journal
                Journal ID (nlm-ta): Psoriasis (Auckl)
                Journal ID (iso-abbrev): Psoriasis (Auckl)
                Journal ID (publisher-id): ptt
                Title: Psoriasis: Targets and Therapy
                Publisher: Dove
                ISSN (Electronic): 2230-326X
                Publication date (Electronic): 10 June 2022
                Publication date Collection: 2022
                Volume: 12
                Pages: 139-150
                Affiliations
                [1 ]Department of Dermatology and Venereology, Aarhus University Hospital , Aarhus, Denmark
                Author notes
                Correspondence: Christine Daugaard, Department of Dermatology and Venereology, Aarhus University Hospital , Aarhus, Denmark, Tel +45 6169 4806; +45 2157 2778, Email chdaug@rm.dk; Kasper Fjellhaugen Hjuler, Department of Dermatology and Venereology, Aarhus University Hospital, Denmark, Tel +45 23882479, Email kasped@rm.dk
                Author information
                http://orcid.org/0000-0003-1816-4508
                http://orcid.org/0000-0001-6082-5096
                Article
                Publisher ID: 328572
                DOI: 10.2147/PTT.S328572
                PMC ID: 9196664
                PubMed ID: 35712227
                SO-VID: 25fe1b49-70f3-4e11-b703-2c0544d72c49
                Copyright © © 2022 Daugaard et al.
                License:

                This work is published and licensed by Dove Medical Press Limited. The full terms of this license are available at https://www.dovepress.com/terms.php and incorporate the Creative Commons Attribution – Non Commercial (unported, v3.0) License ( http://creativecommons.org/licenses/by-nc/3.0/). By accessing the work you hereby accept the Terms. Non-commercial uses of the work are permitted without any further permission from Dove Medical Press Limited, provided the work is properly attributed. For permission for commercial use of this work, please see paragraphs 4.2 and 5 of our Terms ( https://www.dovepress.com/terms.php).

                History
                Date received : 27 January 2022
                Date accepted : 24 March 2022
                Page count
                Figures: 0, Tables: 0, References: 170, Pages: 12
                Categories
                Subject: Review

                Keywords: psoriasis,comorbidities,clinician guidelines
                Data availability:
                Keywords: psoriasis, comorbidities, clinician guidelines

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