University of Utah School of Medicine, Salt Lake City, Utah, USA,
Corrona, LLC, Waltham, Massachusetts, USA.
Dermatology. 2021;237(1):46-55. doi: 10.1159/000504841. Epub 2020 Jan 21.
Real-world studies evaluating patients with challenging-to-treat localizations of psoriasis (scalp, nail, and palmoplantar) are limited.
To characterize patients with versus without psoriasis in challenging-to-treat areas seen in routine US clinical practice.
This retrospective observational study included all adult patients with psoriasis enrolled in the Corrona Psoriasis Registry between April 2015 and May 2018 who initiated a biologic therapy at registry enrollment. Patients were stratified by the presence of scalp, nail, or palmoplantar psoriasis (nonmutually exclusive groups). Patient demographics, clinical char-acteristics, disease activity, and patient-reported outcome measures (pain, fatigue, itch, EuroQol visual analog scale [EQ VAS], Dermatology Life Quality Index [DLQI], and Work Productivity and Activity Impairment questionnaire [WPAI]) were assessed at registry enrollment and compared between patients with versus without each challenging-to-treat area using nonparametric Kruskal-Wallis tests for continuous variables and χ2 or Fisher exact tests for categorical variables. Generalized linear regression models were used to estimate differences in disease activity and patient-reported outcomes between patients with versus without each challenging-to-treat area.
Among 2,042 patients with psoriasis (mean age [±SD], 49.6 ± 14.7 years; 51.5% male), 38.4% had psoriatic arthritis (PsA), 38.1% had scalp psoriasis, 16.0% had nail psoriasis, 10.9% had palmoplantar psoriasis, and 26.2% had a combination of ≥2 challenging-to-treat areas and PsA; only 34.2% had body plaque psoriasis without PsA or challenging-to-treat areas. Patients in all challenging-to-treat groups reported higher (mean [95% CI]) itch (scalp, 58.01 [57.62-58.40] vs. 54.35 [53.99-54.72]; nail, 56.42 [56.02-56.81] vs. 55.59 [55.20-55.97]; palmoplantar, 60.22 [59.86-60.59] vs. 55.15 [54.79-55.54]) and lower EQ VAS (scalp, 68.12 [67.78-68.48] vs. 69.46 [69.12-69.81]; nail, 66.21 [65.89-66.55] vs. 69.48 [69.14-69.83]; palmoplantar, 66.21 [66.07-66.75] vs. 69.29 [68.94-69.94]) scores than those without the respective challenging-to-treat localization. Patients with nail or palmoplantar psoriasis reported higher pain, fatigue, and DLQI scores than those without. Higher proportions of patients with scalp or palmoplantar psoriasis reported work impairment compared with those without.
Two-thirds of patients with psoriasis who initiated biologic therapy had PsA and/or ≥1 challenging-to-treat area. Patients with challenging-to-treat areas had worse patient-reported outcome scores than those without, indicating a significant burden of challenging-to-treat areas on patients' quality of life.
评估治疗困难部位（头皮、指甲和掌跖）银屑病患者的真实世界研究有限。
描述在常规美国临床实践中观察到的治疗困难部位的银屑病患者与非银屑病患者的特征。
本回顾性观察性研究纳入了 2015 年 4 月至 2018 年 5 月期间在 Corrona 银屑病登记处登记并开始生物治疗的所有成年银屑病患者。根据头皮、指甲或掌跖银屑病（非互斥组）的存在对患者进行分层。在登记时评估患者的人口统计学、临床特征、疾病活动度和患者报告的结局测量（疼痛、疲劳、瘙痒、EuroQol 视觉模拟量表 [EQ VAS]、皮肤病生活质量指数 [DLQI] 和工作生产力和活动障碍问卷 [WPAI]），并使用非参数 Kruskal-Wallis 检验比较有和无各治疗困难部位患者之间的差异，对于分类变量则使用 χ2 或 Fisher 确切检验。使用广义线性回归模型估计有和无各治疗困难部位患者之间疾病活动度和患者报告结局的差异。
在 2042 例银屑病患者中（平均年龄 [±标准差]，49.6 ± 14.7 岁；51.5%为男性），38.4%患有银屑病关节炎（PsA），38.1%患有头皮银屑病，16.0%患有指甲银屑病，10.9%患有掌跖银屑病，26.2%患有≥2 个治疗困难部位和 PsA；仅有 34.2%的患者患有无 PsA 或治疗困难部位的身体斑块状银屑病。所有治疗困难部位组的患者报告的瘙痒程度更高（平均值 [95%CI]）：头皮（58.01 [57.62-58.40] vs. 54.35 [53.99-54.72]）；指甲（56.42 [56.02-56.81] vs. 55.59 [55.20-55.97]）；掌跖（60.22 [59.86-60.59] vs. 55.15 [54.79-55.54]）；报告的 EQ VAS 评分更低：头皮（68.12 [67.78-68.48] vs. 69.46 [69.14-69.83]）；指甲（66.21 [65.89-66.55] vs. 69.48 [69.14-69.83]）；掌跖（66.21 [66.07-66.75] vs. 69.29 [68.94-69.94]）。与无相应治疗困难部位的患者相比，指甲或掌跖银屑病患者的疼痛、疲劳和 DLQI 评分更高。与无头皮或掌跖银屑病的患者相比，有更多的银屑病患者报告工作障碍。
开始生物治疗的银屑病患者中有三分之二患有 PsA 和/或≥1 个治疗困难部位。有治疗困难部位的患者比无治疗困难部位的患者报告的患者报告结局更差，表明治疗困难部位对患者的生活质量有显著影响。
