Psoriasis (PsO), recognized as a chronic inflammatory multisystem disease, can have a tremendous impact on affected patients’ lives. Speaking at the DEF Biologic & Small Molecule NP/PA CME Bootcamp this spring, Sandri Johnson, MSN, FNP-BC, said a holistic approach to patient care, centered on robust communication between providers and patients, is essential to ensure a full understanding of the disease and its far-reaching impacts.
Psoriasis is associated with a range of comorbidities, including inflammatory bowel disease, psoriatic arthritis, metabolic syndrome, cardiovascular disease, hepatic disease, and malignancies. These conditions not only complicate the management of psoriasis but also significantly impact patients’ quality of life and overall health. Data show that patients with psoriasis may have a three-to-five-year reduction in life expectancy compared to those without the disease.
“I tell my patients, ‘I am in the business of buying you your five years.’ That’s what I plan to do with them,” Ms. Johnson said.
Recognition of psoriatic joint disease through in-office screening is essential. The prevalence of psoriatic arthritis (PsA) among psoriasis patients is approximately 30-33%. Skin disease precedes joint disease in the vast majority of patients. “We need to be really comfortable prescribing patients a therapy that will protect their joints or send them to someone that will,” Ms. Johnson said.
Patients with this condition often experience significant mental health challenges. Studies have shown that psoriatic patients are significantly more likely to suffer from depression and anxiety compared to the general population. This mental health burden is exacerbated by the visible nature of the disease and the stigma associated with it. Addressing mental health is thus a critical component of comprehensive care for psoriatic patients, Ms. Johnson stressed.
Cardiovascular risks associated with psoriasis cannot be overlooked. Psoriasis patients have a higher prevalence of cardiovascular disease (CVD), metabolic syndrome, and its components¾such as obesity, hypertension, dyslipidemia, and type 2 diabetes. The link between chronic inflammation in psoriasis and increased cardiovascular risk underscores the importance of early and aggressive treatment of psoriasis to potentially mitigate these risks. Ms. Johnson highlighted a study showing that, compared to patients 10 years older with dyslipidemia, psoriasis patients have higher rates of coronary artery plaque prone to rupture and cause myocardial infarction.
Nonalcoholic fatty liver disease (NAFLD) is another significant comorbidity in psoriasis patients, particularly those with more severe skin disease. A cohort study found that the prevalence of NAFLD was significantly higher in psoriasis patients compared to healthy controls. Early identification and management of liver disease in psoriasis patients can influence treatment choices and improve outcome. The link between psoriasis and NAFLD is not fully known, “But the big picture is that we need to be aware of the increased prevalence of nonalcoholic fatty liver disease in patients with psoriasis and try to identify it early,” Ms. Johnson says.
Ms. Johnson stressed the importance of educating patients about potential comorbidities and encouraging lifestyle choices that can improve longterm outcomes. Dermatology health care providers should inform patients about the risks, benefits, and alternatives of each treatment modality, involving them in a shared decision-making process. This approach not only enhances patient satisfaction and compliance but also empowers patients to take an active role in their care.
A multidisciplinary approach to managing psoriasis that involves regular screening for comorbidities, addressing mental health issues, and using a patient-centered approach to treatment allows providers can significantly improve the quality of life and overall health outcomes for patients with psoriasis, Ms. Johnson said.
Want to learn more about psoriasis and its management? Come to the DEF Biologic & Small Molecule NP/PA CME Bootcamp November 9, 2024 at the Hyatt Regency Huntington Beach, CA! Earn free CME as you learn from leading experts and interact with peers in-person.
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