Blauvelt Andrew, Gondo George C, Bell Stacie, Echeverría Cristina, Schmitt-Egenolf Marcus, Skov Lone, van de Kerkhof Peter, McCormick Howard Leah, Strober Bruce
Oregon Medical Research Center, Portland, OR, USA.
National Psoriasis Foundation, Portland, OR, USA.
J Psoriasis Psoriatic Arthritis. 2023 Jul;8(3):100-106. doi: 10.1177/24755303231160683. Epub 2023 Mar 17.
Psoriasis severity has traditionally been categorized as mild, moderate, and severe. Commonly, cut-offs for severe disease require a body surface area (BSA) involvement of ≥10% or a Psoriasis Area Severity Index (PASI) > 10. However, clinical experience challenges these traditional measures and requirements, as patients with less extensive psoriasis may have disease that severely impacts quality of life.
The objective of the present study was to further explore the extent of patient burden when psoriasis affects special locations.
A total of 69,190 individuals living in the U.S were invited to participate in a patient advocacy survey by telephone and or web interviews over the course of 3 years (2019-2021). The survey instrument consisted of validated patient-reported outcome measures, measuring disease-specific quality of life (Dermatology Life Quality Index, DLQI), depression (Patient Health Questionnaire (PHQ)-2 and (PHQ)-9), and the ability to participate in social roles and activities (PROMIS Ability to Participate in Social Roles and Activities (SF-4a). Chi-square tests were performed to explore association between psoriasis involvement on special locations and patient outcomes and multivariate logistic regression models were then constructed, to assess impact of having psoriasis on special locations patient outcomes, controlling for potential confounding factors.
A total of 4129 individuals completed the survey. 3594 (84.4%) of patients surveyed reported psoriasis involving special areas of the bodysuch as the scalp, face, hands, feet, or genitalia. Involvement of special areas is associated with worse quality of life and depression. 35-71% of patients with 10% or less total BSA involvement experienced a moderate-to-extremely large effect on these life function domains. When adjusting for age, sex, and body surface area, psoriasis involvement of a special location was associated with poorer patient reported outcomes, including a 46% less likelihood of reporting their skin disease as having "no or only a small effect on QoL," a 30% less likelihood of having a "normal l ability to participate in social roles and activities," and a 126% higher likelihood of f having depression.
Real-world data presented here demonstrate that psoriasis involving special areas is associated with adverse life consequences, including poor quality of life and depression.
传统上，银屑病的严重程度分为轻度、中度和重度。通常，重度疾病的界定标准要求体表面积（BSA）受累≥10%或银屑病面积严重程度指数（PASI）>10。然而，临床经验对这些传统指标和要求提出了挑战，因为银屑病累及范围较小的患者可能也患有严重影响生活质量的疾病。
本研究的目的是进一步探讨银屑病累及特殊部位时患者负担的程度。
在3年（2019 - 2021年）的时间里，通过电话和/或网络访谈邀请了总共69190名居住在美国的个体参与一项患者宣传调查。调查工具包括经过验证的患者报告结局指标，用于测量疾病特异性生活质量（皮肤病生活质量指数，DLQI）、抑郁（患者健康问卷（PHQ）-2和（PHQ）-9）以及参与社会角色和活动的能力（PROMIS参与社会角色和活动的能力（SF - 4a））。进行卡方检验以探讨银屑病累及特殊部位与患者结局之间的关联，然后构建多因素逻辑回归模型，以评估银屑病累及特殊部位对患者结局的影响，并控制潜在的混杂因素。
共有4129名个体完成了调查。3594名（84.4%）接受调查的患者报告银屑病累及身体的特殊部位，如头皮、面部、手部、足部或生殖器。特殊部位受累与较差的生活质量和抑郁相关。总BSA受累10%或以下的患者中，35% - 71%在这些生活功能领域受到中度至极大的影响。在调整年龄、性别和体表面积后，银屑病累及特殊部位与较差的患者报告结局相关，包括报告其皮肤病对生活质量“无影响或仅有轻微影响”的可能性降低46%，“正常参与社会角色和活动的能力”的可能性降低30%，以及患抑郁症的可能性增加126%。
此处呈现的真实世界数据表明，银屑病累及特殊部位与不良生活后果相关，包括生活质量差和抑郁。
