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. 2015 Oct;29(10):2002-10.
doi: 10.1111/jdv.13150. Epub 2015 Apr 16.

Physician perspectives in the management of psoriasis and psoriatic arthritis: results from the population-based Multinational Assessment of Psoriasis and Psoriatic Arthritis survey

P C M van de Kerkhof  1 , K Reich  2 , A Kavanaugh  3 , H Bachelez  4 , J Barker  5 , G Girolomoni  6 , R G Langley  7 , C F Paul  8 , L Puig  9 , M G Lebwohl  10
Affiliations

Physician perspectives in the management of psoriasis and psoriatic arthritis: results from the population-based Multinational Assessment of Psoriasis and Psoriatic Arthritis survey

P C M van de Kerkhof et al. J Eur Acad Dermatol Venereol. 2015 Oct.

Abstract

Background: Available literature on psoriasis and psoriatic arthritis (PsA) demonstrates a tremendous burden of disease and suggests underdiagnosis and undertreatment.

Objective: To obtain real-world physician perspectives on the impact of psoriasis and PsA and its treatment on patients' daily lives, including perceptions of, and satisfaction with, current therapies.

Methods: The Multinational Assessment of Psoriasis and Psoriatic Arthritis (MAPP) surveyed dermatologists (n = 391) and rheumatologists (n = 390) in North America (Canada and the United States) and Europe (France, Germany, Italy, Spain and United Kingdom).

Results: Dermatologists classified 20.3% and 25.7% of their patients as having severe psoriasis and severe PsA respectively; rheumatologists indicated that 48.4% of their PsA patients had active disease. Of the psoriasis patients complaining of joint pain, only 33.0% had a diagnosis of PsA. An impact on daily activities or social/emotional well-being was recognized by 57.2% to 79.3% of physicians. In patients with moderate-to-severe psoriasis, dermatologists reported 74.9% were receiving topical therapy, 19.5% conventional oral therapy and 19.6% biologics. Dermatologists and rheumatologists reported similar rates of topical (≈45%) and biologic (≈30%) therapy utilization for their PsA patients; conventional oral therapy was more often prescribed by rheumatologists (63.4%) vs. dermatologists (35.2%). Reasons for not initiating or maintaining systemic therapies were related to concerns about long-term safety, tolerability, efficacy and costs (biologics).

Conclusion: Physicians in North America and Europe caring for patients with psoriasis and PsA acknowledge unmet treatment needs, largely concerning long-term safety/tolerability and efficacy of currently available therapies; evidence suggests underdiagnosis of PsA and undertreatment of psoriasis among dermatologists.

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Figures

Figure 1
Figure 1
Top five most important factors contributing to psoriasis (a) and psoriatic arthritis (b) disease severity. QoL, quality of life.
Figure 2
Figure 2
Greatest challenge in managing psoriasis (a) and psoriatic arthritis (b) patients.
Figure 3
Figure 3
Top five most commonly cited limitations for initiating conventional oral therapy (a), continuing conventional oral therapy (b) and patient concerns regarding the use of conventional oral therapy (c).
Figure 4
Figure 4
Top five most commonly cited limitations for initiating (a) and continuing (b) patients on biologic therapy and burdensome tasks/steps associated with biologic therapy (c).
Figure 5
Figure 5
Most important factors contributing to psoriasis disease severity, as reported by physicians and patients.8
See this image and copyright information in PMC

References

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