Department of Dermatology, University of California-Davis, Sacramento.
JAMA Dermatol. 2013 Oct;149(10):1180-5. doi: 10.1001/jamadermatol.2013.5264.
Psoriasis and psoriatic arthritis inflict significant morbidity. Data on undertreatment, treatment use, and treatment satisfaction are paramount to identify priority areas for advocacy, education, and research to improve patient outcomes.
To determine the extent of nontreatment and undertreatment of psoriatic diseases, trends in treatment use, treatment satisfaction, and reasons for medication discontinuation among patients with psoriasis and psoriatic arthritis.
DESIGN, SETTING, AND PARTICIPANTS: We used the national survey data collected by the National Psoriasis Foundation via biannual surveys conducted from January 1, 2003, through December 31, 2011, in the United States. Survey data were collected from randomly sampled patients with psoriasis and psoriatic arthritis in the US population from a database of more than 76,000 patients with psoriatic diseases.
Nontreatment, undertreatment, and treatment trends determined by the use of prescription medication (topical, phototherapeutic, oral systemic, and biologic), as well as treatment satisfaction and reasons for medication discontinuation.
A total of 5604 patients with psoriasis or psoriatic arthritis completed the survey. From 2003 through 2011, patients who were untreated ranged from 36.6% to 49.2% of patients with mild psoriasis, 23.6% to 35.5% of patients with moderate psoriasis, and 9.4% to 29.7% of patients with severe psoriasis. Among those receiving treatment, 29.5% of patients with moderate psoriasis and 21.5% of patients with severe psoriasis were treated with topical agents alone. The most frequently used phototherapy modality is UV-B, whereas methotrexate is the most commonly used oral agent. Although adverse effects and a lack of effectiveness were primary reasons for discontinuing biological agents, the inability to obtain adequate insurance coverage was among the top reasons for discontinuation. Overall, 52.3% of patients with psoriasis and 45.5% of patients with psoriatic arthritis were dissatisfied with their treatment.
Nontreatment and undertreatment of patients with psoriasis and psoriatic arthritis remain a significant problem in the United States. While various treatment modalities are available for psoriasis and psoriatic arthritis, widespread treatment dissatisfaction exists. Efforts in advocacy and education are necessary to ensure that effective treatments are accessible to this patient population.
银屑病和银屑病关节炎会造成严重的发病率。了解治疗不足、治疗使用情况和治疗满意度的数据对于确定优先领域的倡导、教育和研究至关重要，以改善患者的治疗效果。
确定银屑病和银屑病关节炎患者未治疗和治疗不足的程度、治疗使用趋势、治疗满意度以及药物停用的原因。
设计、地点和参与者：我们使用了美国国家银屑病基金会通过 2003 年 1 月 1 日至 2011 年 12 月 31 日期间进行的两次年度调查收集的全国调查数据。调查数据来自美国人群中超过 76000 名银屑病患者数据库中随机抽取的银屑病和银屑病关节炎患者。
未治疗、治疗不足和治疗趋势由处方药物（局部、光疗、口服全身和生物制剂）的使用来确定，以及治疗满意度和药物停用的原因。
共有 5604 名银屑病或银屑病关节炎患者完成了调查。2003 年至 2011 年期间，轻度银屑病患者中未接受治疗的患者比例为 36.6%至 49.2%，中度银屑病患者为 23.6%至 35.5%，重度银屑病患者为 9.4%至 29.7%。在接受治疗的患者中，29.5%的中度银屑病患者和 21.5%的重度银屑病患者仅接受局部治疗。最常用的光疗方式是 UV-B，而甲氨蝶呤是最常用的口服药物。尽管不良反应和无效是停止使用生物制剂的主要原因，但无法获得足够的保险覆盖也是停药的主要原因之一。总体而言，52.3%的银屑病患者和 45.5%的银屑病关节炎患者对他们的治疗不满意。
在美国，银屑病和银屑病关节炎患者的未治疗和治疗不足仍然是一个严重的问题。虽然有多种治疗方法可用于银屑病和银屑病关节炎，但治疗满意度普遍较低。需要进行宣传和教育工作，以确保这一患者群体能够获得有效的治疗。
