Seeking to bring increased attention to the comorbidities associated with psoriasis, new guidelines from the American Academy of Dermatology (AAD) and the National Psoriasis Foundation (NPF) address the “management of extracutaneous manifestations of psoriasis in adults, including comorbid conditions, mental health, psychosocial wellness, and quality of life (QoL).” Published online in the Journal of the American Academy of Dermatology in February, the guidelines addressing comorbidities, along with guidelines focused on the treatment of psoriasis with biologics, are the first two of a total of six planned guidelines to be released for psoriasis.
While psoriasis is a common inflammatory disease of adults and children, affecting up to 3.2 percent of adults in the US, focus on comorbidities has expanded significantly in the last decade or so. Today psoriasis is recognized, “as a chronic, multisystem inflammatory disorder,” guidelines state.
Roughly one-third of patients with psoriasis also have psoriatic arthritis (PsA). The joint disease is now recognized as a key component of therapeutic decision-making, experts note. Guidelines call for screening psoriasis patients for PsA at every visit. In an interview, dermatologist April Armstrong, MD, MPH has stated that the presence of PsA can be a key driver of therapeutic selection for the psoriasis patient.
When approaching psoriasis treatment selection, “It’s very important to know the clinical data and make sure that the decision is based on evidence-based medicine,” she says. She calls for weighing efficacy and safety “in concert together…Safety is especially important because [psoriasis] is a disease that is chronic and therefore choosing a therapy with the mindset of how long the patient needs to be on the therapy is very important.”
Comorbidities “Will often-times drive the initial treatment selection,” Dr. Armstrong says. She specifically points to the presence of PsA as a factor that may lead to the selection of a certain biologic therapy over others.
Patient preference is also a critical consideration for treatment planning, she says.
“It is critical for both patients and doctors to understand the complexity of psoriasis. It is not just a skin disease; it is a serious condition that can affect all aspects of a patient’s health,” says Randy Beranek, president and CEO of the NPF. “Our goal in establishing these guidelines is to help health care professionals educate their patients on the best way to treat their disease and mitigate the effects psoriasis can have on a patient’s overall health and well-being.”
“We believe this guideline will be a vital resource in the treatment of psoriasis,” says board-certified dermatologist Craig A. Elmets, MD, FAAD, co-chair of the work group that developed the guidelines.