Psoriasis is associated with multiple comorbidities, including mental health disorders, psoriatic arthritis (PsA), cardiovascular disease (CVD), metabolic syndrome, depression, nonalcoholic fatty liver disease, and inflammatory bowel disease (IBD).1
At the 2020 Fall Clinical Dermatology Conference, Roger S. Ho, MD, MS, MPH, FAAD, presented on clinically important comorbidities for clinicians treating patients with psoriasis.2 His presentation focused on PsA, CVD (including stroke and myocardial infarction), metabolic syndrome, depression, and IBD. He answered questions for the Autoimmune Learning Network in this interview.
Dr Ho is an associate professor of dermatology and director of resident education with The Ronald O. Perelman Department of Dermatology at New York University Grossman School of Medicine in New York City.
AUTOIMMUNE LEARNING NETWORK: Why is important for clinicians to screen patients with psoriasis for these comorbidities?
ROGER HO: Early detection and treatment with systemic therapy is essential to prevent debilitating PsA, which can manifest as peripheral joint swelling, enthesitis, and dactylitis, but it can also affect the axial skeleton. It is important for dermatologists to be aware of these manifestations, screen for PsA, refer patients to rheumatologists for confirmation, and co-manage these patients accordingly with rheumatologists to improve patient outcomes.
Currently, we cannot say with 100% certainty that biologics can decrease the risk of CVDs, including myocardial infarction and stroke, among patients with psoriasis. However, psoriasis is also associated with metabolic syndrome, which in and of itself is a prominent risk factor for CVDs and cardiovascular mortality. As dermatologists, we are in the best position to educate patients with psoriasis on these cardiovascular and metabolic comorbidities and refer our psoriasis patients to their primary care provider for screening and risk management to improve cardiovascular outcomes in our patients.
ALN: What key takeaways from your presentation would you like to leave with our audience?
RH: Simple screening questions for PsA include asking patients about joint swelling as well as tenderness or morning stiffness of their joints that lasts 30 minutes or longer and improves with activity and worsens with rest. To assess axial skeletal involvement, similar questions can be asked about the neck and back. For the lower back, providers can ask the patient for a history of alternating pain of the sacroiliac joint/buttock which lasts 20 minutes or longer and is worse during the second half of the night. If the patient answers positively to any of these questions, referral to rheumatologist for confirmation is recommended.
Mental health has a significant impact on a patients’ quality of life, which may be invisible to the dermatologist. Using a simple screening questionnaire such as the Patient Health Questionnaire-2 can help determine whether a proper referral to the patient’s primary care provider or psychiatry is necessary and can help guide therapeutic considerations.
1. Takeshita J, Grewal S, Langan SM, et al. Psoriasis and comorbid diseases: epidemiology. J Am Acad Dermatol. 2017;76(3):377-390. doi:10.1016/j.jaad.2016.07.064
2. Ho R. Clinically important psoriasis comorbidities. Presented at: 2020 Fall Clinical Dermatology Conference; November 1, 2020; virtual.