Treat the whole patient in psoriasis

October 23, 2018

From obesity to heart disease, patients with psoriasis have a host of comorbidities and most rely on their dermatologist for comprehensive care.

CHICAGO―Psoriasis rarely presents solo in patients. To know how to provide the most appropriate treatments, residents should learn about frequently occurring comorbidities.

During the 20th annual Residents Meeting of the National Psoriasis Foundation, Laura Ferris, M.D., Ph.D., a dermatologist from the University of Pittsburgh, addressed the need for residents to be able to recognize psoriasis-associated comorbidities, as well as develop treatment plans appropriately.

“Comorbidities are one of the most important topics in the field of psoriasis,” she said. “We have lots of new data showing our patients with psoriasis are also affected by a lot of other diseases, such as heart disease, kidney disease, and the metabolic syndrome.”

Residents should be prepared to approach each patient as if they were treating more than just psoriasis. Patients in this group not only frequently struggle with obesity, but a 2013 study published in JAMA Dermatology found that among 9,035 psoriasis patients with mild, moderate and severe psoriasis, the condition was associated with a higher prevalence of chronic pulmonary disease, diabetes mellitus, diabetes with systemic complications, mild liver disease, myocardial infarction, peptic ulcer disease, peripheral vascular disease, renal disease, and rheumatologic disease. The study found the more severe the condition, the more common comorbid conditions.

Even though psoriasis patients are typically under the care of a primary care provider, Dr. Ferris said, many don’t see those doctors as frequently as they see their dermatologists. Seeing these patients more often means residents should train to be well verse in recognizing various comorbidities.

“We need to be aware of the other conditions our patients might have,” she said. “Not only can we encourage them to keep up with their primary care provider, but we can also think about their comorbidities when picking which treatment options might be best for each patient.”

At the very least, she said, residents should be able to prescribe treatments that don’t interact negatively with a comorbidity and make things worse, and, at best, they should attempt to find a therapy option that bring improvement.

Dr. Ferris also explained with a better understanding of comorbidities, residents can establish better interactions with other specialties, including primary care, cardiology, or hepatology. They can become partners in patient care management.

Although comorbidities can create significant problems, existing data also shows psoriasis is an independent risk factor for death. Research shows there are 2.56 more deaths per 1,000 patient years among psoriasis patients even when accounting for age, gender, smoking status, diabetes, and heart disease.

“It’s really important to understand the seriousness of psoriasis as a disease on its own,” she said. “When you add in a comorbid condition, the patient is at a higher risk of dying. We’re in a position to play an important role in preserving their health.”

REFERENCE
Ferris, L. “Comorbidities in Psoriasis,” 20th Resident Meeting National Psoriasis Foundation, Chicago, Illinois, Oct. 21, 8-8:45 am.