Treatment Strategies for Patients With Comorbidities
Various environmental and genetic risk factors contribute to comorbid conditions among patients with psoriasis. At the 2019 Interdisciplinary Autoimmune Summit (IAS), Joel Gelfand, MD, presented on optimizing treatment decisions for common comorbidities among patients with psoriasis. The presentation included an interactive case study where audience members could participate using the IAS app.1
Well-established comorbidities for psoriasis include heart attack, stroke, cardiovascular death, metabolic syndrome, diabetes, psoriatic arthritis, psychiatric conditions, Crohn disease, and T cell lymphoma, although lymphoma is rare. In addition, a whole host of emerging comorbidities are also being defined in current research including sleep apnea, adverse infectious diseases, nonalcoholic steatohepatitis, chronic obstructive pulmonary disease, chronic and end-stage renal disease, peptic ulcer disease, and sexual dysfunction, according to Dr Gelfand.
Dr Gelfand discussed recommendations from the recently released American Academy of Dermatology and National Psoriasis Foundation guidelines for the screening and prevention of cardiovascular disease, noting that the guidelines recommend more intensive screening for cardiovascular risk factors among patients with psoriasis.
Also, Dr Gelfand reviewed screening for psoriatic arthritis noting that patients should be asked about joint pain, swelling or stiffness, and when these symptoms occur. A simple test for possible psoriatic arthritis, according to Dr Gelfand, is to apply enough pressure to the fingers at the joint to make the top turn white and watch the patient’s facial expression for wincing or other looks of discomfort.
For cancer, patients should be encouraged to stay up to date on appropriate screenings. Those presenting with atypical psoriasis or not responding to treatment should be biopsied for cutaneous T cell lymphoma, said Dr Gelfand. Likewise, patients should be encouraged to stay up to date on vaccinations as those with severe psoriasis are more likely to die from infections.
A global assessment of patients with psoriasis, according to Dr Gelfand, includes determining the subjective impact of the disease by asking about physical and emotional symptoms, obtaining a detailed patient history, performing a physical exam and lab work, consultation with other specialists when needed, and discussing with patients their preferences for treatment.
Reference:
1. Gelfand J. Optimizing Therapeutic Selection for Common Comorbidities and Special Patient Populations with Psoriasis: A Case-Based Approach. Presented at: 2019 Interdisciplinary Autoimmune Summit; April 5-7, 2019; Chicago, IL.
