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Quality-of-life issues in psoriasis and psoriatic arthritis: Outcome measures and therapies from a dermatological perspective

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Psoriasis and psoriatic arthritis are inflammatory immune-mediated skin and joint conditions with major impacts on patients' health-related quality of life (HRQOL). Physical manifestations include unsightly, scaly, pruritic plaques and inflamed joints for patients with psoriatic arthritis. These symptoms can severely impair physical functioning and occupational capability and negatively affect psychosocial domains. Consequently, patients often experience feelings of embarrassment, helplessness, and depression. Recent therapies, including the biologics, have been shown to improve not only the physical signs and symptoms of these conditions, but also patients' HRQOL. To accurately assess these improvements, standardized and validated instruments are needed. However, there are currently a limited number of feasible and validated tools available in dermatology for measuring HRQOL and function. Valuable insights can be acquired from the rheumatology field, and refinement of existing outcome measures through a cooperative and consensus building process between dermatologists and rheumatologists will lead to standardization of assessment tools in the years ahead.

Section snippets

Impact of psoriasis and psoriatic arthritis on quality of life

Measurement of disease activity and impact involves assessment of both physical signs as well as subjective experience. A 75% reduction in the Psoriasis Area and Severity Index (PASI 75) is considered a primary end point in clinical trials of psoriasis.15, 16, 17 PASI is a calculation based on the parameters of erythema, scaling, and induration in 4 body areas using the rule of 9's.18 However, a 50% improvement (PASI 50) has recently been shown to be a valid and clinically meaningful measure.19

Lessons learned from rheumatology

Several rheumatology studies have shown that the mechanisms underlying the pathogenesis of psoriasis and other rheumatic diseases, including adult and juvenile RA, PsA, and ankylosing spondylitis are mediated by a similar network of proinflammatory cytokines (eg, tumor necrosis factor-α [TNF-α] and interleukin 1) and cellular components (eg, T cells, fibroblasts, and macrophages).34, 35 In many cases, therapeutic approaches that are successful in treating RA and other musculoskeletal diseases

Measures of quality of life in psoriasis and psoriatic arthritis

Over the past few years, assessments of HRQOL in patients with skin conditions have become more common in clinical trials. The increased attention to HRQOL is a consequence of a greater understanding within the dermatology community that more comprehensive outcome measures can lead to better treatment strategies by providing valuable information that assists clinicians and patients. To accurately assess HRQOL, precise and reliable psychometric instruments are needed. Currently, there is no

Improving quality of life: treatment of psoriasis and psoriatic arthritis

It is important to understand that HRQOL instruments provide not only assessments of the impact of a disease but also its treatment. Studies demonstrating significant improvements in HRQOL have been very limited for older therapies, such as phototherapy and traditional systemic therapy. This is primarily because until now these treatments have only been modestly used as monotherapy, especially in patients with moderate to severe disease, and many have not been satisfactory with respect to

Conclusions

A review of the literature on psoriasis and PsA demonstrates the significant adverse effects that the diseases have on quality of life. New therapies are emerging that have greatly improved patients' quality of life, as well as the ability to control skin and joint disease, which therefore behooves us to more accurately measure this domain as well as other more clinical disease domains. On the basis of our survey of the literature, it is quite apparent that there is currently a lack of

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    Funding sources: Supported by Amgen Inc and Wyeth.

    Disclosure: Dr Mease has received research support from and is a consultant and/or lecturer for Abbott Laboratories, Amgen Inc, Aventis, Biogen/Idec, Centocor Inc, Genentech Inc, Merck, Novartis, Pfizer, and Wyeth. Dr Menter has received research support from and is a consultant and/or a lecturer for Abbott Laboratories, Allergan Inc, Allermed, Amgen Inc, Astralis Inc, Berlex Inc, Biogen/Idec, Centocor Inc, Collagenex Pharmaceuticals, Connetics Corporation, Dermik Laboratories, Doak Dermatologics, Dow, Ferndale Laboratories Inc, Fujisawa Healthcare Inc, Galderma, Genentech Inc, GlaxoSmithKline, Ligand Pharmaceuticals, Medicis, MedImmune Inc, Novartis Pharmaceuticals, Otsuka Pharmaceuticals Inc, Serono, Synta Pharma, Thermosurgery, 3M Pharmaceuticals, and XOMA.

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    Copyright © 2006 American Academy of Dermatology, Inc. Published by Mosby, Inc. All rights reserved.