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Feature Article

Treatment goals for moderate to severe psoriasis: an Australian consensus

Christopher Baker, ALEXANDRA MACK, Alan Cooper, Gayle Fischer, Stephen Shumack, SHIREEN SIDHU, et al

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Abstract

Background/Objectives: The high incidence of comorbidities in patients with psoriasis, significant impact on quality of life and patients’ dissatisfaction with treatment led a European group to develop a consensus position on psoriasis treatment goals. There is an evident need for similar treatment goals in Australia. The aim of this project was to develop Australian treatment goals that reflect the local environment.
Methods: A panel of 12 representatives was drawn from across Australia consisting of nine dermatologists and a rheumatologist, a dermatology nurse and a general practitioner (GP)/dermatology trainee. The group met on three occasions between September 2011 and March 2012. The panel undertook a literature review and critically examined available evidence-based treatment goals. A questionnaire relating to psoriasis assessment and specific treatment outcomes was developed. Following discussion and debate, recommended treatment goals for psoriasis patients in Australia were determined.
Results: The panel agreed by consensus on recommended psoriasis treatment goals in the Australian environment. There was recognition that in addition to psoriasis area and severity index (PASI) assessment, a quality of life assessment was highly relevant in determining psoriasis severity and treatment outcome. Mild psoriasis was defined as PASI ≤10 and a dermatology life quality index (DLQI) ≤10, with moderate to severe psoriasis defined as PASI >10 and/or DLQI >10. The presence of certain defined clinical features would elevate a patient’s classification from mild to moderate/severe. The target for treatment was defined as a maintained change in PASI ≥75% improvement and DLQI ≤5. These largely concurred with the European treatment goals. A flow chart for psoriasis management in Australia based on outcome measures was developed.
Conclusions: There is a need to identify and articulate treatment goals for psoriasis. Assessment of psoriasis severity requires both physical scoring (PASI) and consideration of quality of life measures (DLQI). Identification of treatment goals will guide clinicians in treatment decision-making, enhance the availability and appropriate use of therapies and increase patient satisfaction with their care.

Complete list of authors
Christopher Baker, Alexandra Mack, Alan Cooper, Gayle Fischer, Stephen Shumack, Shireen Sidhu, H. Peter Soyer, Jason Wu, Jonathan Chan, Peter Nash, Morton Rawlin, Barbara Radulski and Peter Foley

Reproduced from the 'Australasian Journal of Dermatology' 2013; 54: 148-154 with the permission of the authors, the Australasian College of Dermatologists and the publisher Wiley Publishing Asia Pty Ltd. © 2013 The Authors © 2013 The Australasian College of Dermatologists.

Article Extract

Introduction

Once thought to be a benign dermatological disorder with few serious complications, psoriasis is now viewed as a systemic disease and there is growing evidence linking moderate to severe psoriasis with an increased risk of various comorbidities. These include inflammatory arthritis, inflammatory bowel disease, cardiovascular disease, the metabolic syndrome and lymphoma, which occur at higher rates among psoriasis patients than in the general population.1 The risk of myocardial infarction in younger patients is particularly elevated.2 This is in addition to the decrease in health-related quality of life (HRQOL) associated with the disease, which is comparable to that seen in medical conditions such as cancer and diabetes.3 Significant psychological difficulties – such as depression and anxiety, and a negative impact on interpersonal relationships – are also more prevalent among patients with severe psoriasis compared with controls and with patients who have mild psoriasis.4

Picture credit: © Peg Gerrity.

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