For Psoriasis or Psoriatic Arthritis Patients, Symptom Severity Relates to Quality of Life

Patients with psoriasis, psoriatic arthritis, or both conditions felt that their quality of life decreased if they experienced condition symptoms in more parts of their body.

As the severity of psoriasis and psoriatic arthritis symptoms increases, patients’ perceptions of their quality of life tends to drop, the results of a recent study suggest.

The study, published in the May 2014 edition of the Journal of the American Academy of Dermatology, also determined that 46% of participants felt that available therapies for psoriasis and psoriatic arthritis were worse than the conditions, and most—85%—felt that better therapies were needed.

Researchers assessed patient quality of life according to the Dermatology Quality of Life index, and found that most participants with psoriasis reported a significant impact on their daily life, which increased if more of their body was affected.

Meanwhile, participants with psoriatic arthritis who experienced joint pain and soreness reported a more significant impact on their lives as the number of affected joints increased. Patients with more than 4 joints affected tended to say basic activities, such as bending down to pick clothing up from the floor, walking on flat ground, and getting in and out of bed or the car, were performed with “much difficulty” or that they were unable to complete the tasks.

Researchers interviewed 3426 participants from North American and Europe, and found a current psoriasis diagnosis in 79% of participants, and psoriatic arthritis with or without psoriasis in 21% of participants. Within the United States, the results showed a household prevalence of 4.0% and a population prevalence of 2.2%.

In general, the study participants with psoriasis alone reported an average delay of 2 years between symptom onset and diagnosis. Participants with psoriatic arthritis, meanwhile, reported an average of 5 years between symptom onset and diagnosis.

Researchers noted that within participants who were diagnosed with both psoriatic arthritis and psoriasis, 72% developed joint symptoms first, 7% developed skin and joint symptoms at the same time, and 27% were diagnosed with both conditions at the same time.

Approximately 50% of participants with psoriatic arthritis and 27% of participants with psoriasis rated their disease as severe. Participants with psoriasis tended to consider their disease as more severe if larger areas of their body had psoriasis symptoms. Researchers did not find a similar correlation in participants with psoriatic arthritis, who reported disease severity regardless of the amount of their body affected by skin symptoms.

Itching, and location and size, of skin lesions were the most important factors influencing disease severity in participants with psoriasis. Participants with psoriatic arthritis considered pain and swelling of the joints and itching as the most important factors influencing disease severity.

Itching was the most commonly reported symptom in all participants, followed by scales, redness, and flaking. Participants with psoriatic arthritis reported pain accompanying their skin symptoms, researchers noted.

In addition, 89% of participants with psoriatic arthritis tended to report joint pain, whereas 44% of participants with psoriasis but not psoriatic arthritis reported the same symptom. Just under half of participants with joint pain—42%—reported having more than 4 joints affected, and 12% reported having pain in a single joint.

Participants receiving traditional oral therapies tended to discontinue therapy due to safety and tolerability problems and loss of effectiveness. Approximately half of the participants who received oral therapies at some point during their disease cited adverse effects, inconvenience, and the need for laboratory monitoring as particularly burdensome.

Participants receiving biologic therapies tended to discontinue those therapies for the same reasons as participants receiving traditional therapy. Participants receiving biological therapy cited anxiety or fear over self-injection, physical preparation for injection, inconvenience, and adverse effects as therapy burdens.

Despite these findings, 25% of participants receiving traditional oral therapies said they were very satisfied overall. Although 21% of participants receiving oral therapies were satisfied with long-term safety, and an additional 26% were satisfied with efficacy over time, half of participants were concerned about health risks associated with long-term oral therapy.

A greater percentage of participants—45%—receiving biologic therapy reported being very satisfied with the therapy, with 29% reporting satisfaction with long-term safety, and 46% reporting satisfaction with efficacy over time. Despite this, health risks associated with long-term biologic therapy concerned 53% of participants.