Psoriasis beyond the skin: an expert group consensus on the management of psoriatic arthritis and common co-morbidities in patients with moderate-to-severe psoriasis

Authors


  • Conflicts of interest

    • Prim. Associate Prof. Robert Strohal serves on speaker bureaus for Pfizer, Schülke and Mayer, Lohmann and Rauscher, Meda Pharmaceuticals, Menarini Pharmaceuticals, Stockhausen, and Smith and Nephew. He has consulting agreements with Pfizer, Astellas, Novartis, Lohmann and Rauscher, Urgo, Chemomedica, Schülke and Mayer, and Pantec Biotechnologies. He receives research and educational grants from Pfizer, Stockhausen, 3M-Woundcare, Smith and Nephew, Lohmann and Rauscher, Enjo Commercials, Urgo, Chemomedica, and Schülke and Mayer. Prof. Brian Kirby receives research support/Principle Investigator (clinical trials) from Janssen, Abbvie, Serono and Pfizer. He acts as consultant for Merck Sharpe & Dohme (MSD), Pfizer, Janssen and Abbvie. He has received honoraria from Janssen, Pfizer, Abbvie, and has acted as a scientific advisory board member for Pfizer and Abbvie. Prof. Lluís Puig has participated as Principal Investigator in clinical trials sponsored by Abbvie, Amgen, Janssen, Lilly, Novartis, Pfizer and VBL. He has received consultancy/speaker honoraria from Abbvie, Amgen, Celgene, Janssen, Eli Lilly, Merck, Merck-Serono, Novartis and Pfizer. Prof. Giampiero Girolomoni has received honoraria for lectures, manuscript preparation, development of educational programmes and/or board membership, and has participated as Principal Investigator in clinical trials sponsored by Abbvie, Celgene, Galderma, Janssen, Eli Lilly, Merck-Serono, Otsuka, MSD, Novartis and Pfizer. Prof. Knud Kragballe has acted as an advisor, investigator and/or speaker for Abbott, Amgen, Janssen-Cilag, Leo-Pharma, MSD and Pfizer. Prof. Thomas Luger has participated as Principal Investigator in clinical trials sponsored by Novartis, Lilly, Pfizer and Janssen. He has received consultancy/speaker honoraria from Novartis, Abbvie, MEDA Pharma and Janssen, and has acted as scientific Advisory Board member for Abbvie, Celgene, Janssen, Pfizer, MEDA Pharma and Galderma. Prof. Frank Nestle has received consultancy/speaker honoraria from Abbvie, Celgene, Janssen, Novartis, Takeda and Pfizer. Prof. Prinz has served as a consultant, investigator, speaker or advisory board member for Biogen-Idec (formerly Biogen), Novartis, Wyeth, Pfizer, Merck-Serono (formerly Serono), Essex Pharma, MSD, Galderma, Centocor, Abbott, Janssen-Cilag/Janssen-Ortho. Furthermore, he has received an unrestricted research grant from Biogen-Idec and Wyeth in the past. Prof. Mona Ståhle has received consultancy/speaker honoraria from Janssen, Pfizer, Serono, Novartis and Abbvie. She has received unrestricted research support from Pfizer and Janssen. Prof. Nikhil Yawalkar has participated as Principal or Co-Investigator in clinical trials sponsored by Abbvie, Amgen, Novartis, MSD and Pfizer. He has received consultancy/speaker honoraria from Abbvie, Amgen, Janssen, Eli Lilly, MSD, Novartis and Pfizer.

    Funding source

    • This study was developed by an unrestricted grant from Pfizer Inc.
  • This study was developed by an unrestricted grant from Pfizer Inc. Medical writing support was provided by Synergy Medical.

Abstract

Background

Psoriatic arthritis (PsA) and co-morbidities of psoriasis represent a significant clinical and economic burden for patients with moderate-to-severe psoriasis. Often these co-morbidities may go unrecognized or undertreated. While published data are available on the incidence and impact of some of them, practical guidance for dermatologists on detection and management of these co-morbidities is lacking.

Objective

To prepare expert recommendations to improve the detection and management of common co-morbidities in patients with moderate-to-severe psoriasis.

Methods

A systematic literature review was conducted on some common co-morbidities of psoriasis–cardiovascular (CV) diseases (including obesity, hypertension, hyperglycaemia and dyslipidaemia), psychological co-morbidities (including depression, alcohol abuse and smoking) and PsA–to establish the incidence and impact of each. Data gaps were identified and a Delphi survey was carried out to obtain consensus on the detection and management of each co-morbidity. The expert panel members for the Delphi survey comprised 10 dermatologists with substantial clinical expertise in managing moderate-to-severe psoriasis patients, as well as a cardiologist and a psychologist (see appendix) with an interest in dermatology. Agreement was defined using a Likert scale of 1–7. Consensus regarding agreement for each statement was defined as ≥75% of respondents scoring either 1 (strongly agree) or 2 (agree).

Results

The expert panel members addressed several topics including screening, intervention, monitoring frequency, and the effects of anti-psoriatic treatment on each co-morbidity. Consensus was achieved on 12 statements out of 22 (3 relating to PsA, 4 relating to psychological factors, 5 relating to CV factors). The panel members felt that dermatologists have an important role in screening their psoriasis patients for PsA and in assessing them for psychological and CV co-morbidities. In most cases, however, patients should be referred for specialist management if other co-morbidities are detected.

Conclusion

This article provides useful and practical guidance for the detection and management of common co-morbidities in patients with moderate-to-severe psoriasis.

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