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Psoriasis Comorbidities: Cardiovascular, Psoriatic Arthritis, and Mental Health

Core Concepts
Psoriasis has significant comorbidities affecting cardiovascular health, psoriatic arthritis, and mental well-being.
The content discusses the impact of psoriasis on cardiovascular health, psoriatic arthritis, and mental health. Three experts share insights on each comorbidity, emphasizing the importance of early detection and treatment. The discussion covers the relative risk of cardiovascular events in psoriasis patients, screening recommendations for psoriatic arthritis, and psychological screening for mental health issues related to psoriasis. Cardiovascular Disease and Psoriasis Psoriasis is linked to an increased risk of cardiovascular events. Severe psoriasis can lead to a 50%-60% increased risk of heart attack and stroke. Screening recommendations include checking body mass index, blood pressure, glucose, and cholesterol. Psoriatic Arthritis Psoriatic arthritis affects 25%-30% of psoriasis patients. Screening involves assessing joint pain, stiffness, back pain, and fatigue. Recommendations include using questionnaires and conducting physical exams. Mental Health and Psoriasis Psoriasis has a profound impact on patients' lives, affecting various aspects of functioning. Psychological screening can be done using simple tools like the PHQ-2 questionnaire. Empathy plays a crucial role in patient care, even with advanced treatment options.
"People with severe psoriasis have about a 50%-60% increased risk for heart attack, stroke, and dying from that heart attack or stroke." "If your age is between 40 and 50 years, the relative risk is 1.47 — so, a 47% increase if you have severe psoriasis." "Patients with psoriasis are not diagnosed with PsA but have ongoing musculoskeletal inflammation."
"The younger you are and the more severe your disease is, the more it affects your cardiometabolic health." "Treating the disease is important for improving quality of life." "Empathy goes a long way and psoriasis robs people of control."

Key Insights Distilled From

by Steven R. Fe... at 04-25-2023
S2 Episode 2: Can Psoriasis Care Limit CVD, PsA, and Depression?

Deeper Inquiries

How can the healthcare system improve early detection and treatment of psoriasis comorbidities?

Early detection and treatment of psoriasis comorbidities can be improved by implementing routine screening protocols in dermatology practices. This can involve using simple screening tools like the Patient Health Questionnaire (PHQ-2) to assess psychological impact, along with asking specific questions about joint pain, stiffness, and back pain to screen for psoriatic arthritis. Additionally, integrating musculoskeletal exams and imaging studies like x-rays of hands, feet, and the pelvis can aid in early detection of psoriatic arthritis. Collaboration between dermatologists and mental health professionals, known as "skin emotion specialists," can also enhance the identification and management of psychological impacts associated with psoriasis.

How can the healthcare system improve early detection and treatment of psoriasis comorbidities?

Conducting randomized trials to assess the impact of treating psoriasis on cardiovascular outcomes faces several challenges. One major challenge is the need for large sample sizes and long follow-up periods to observe significant differences in cardiovascular events between treated and untreated groups. Additionally, ensuring proper blinding and randomization procedures in these trials can be complex, especially when dealing with subjective outcomes like quality of life. Another challenge is the ethical considerations of withholding potentially beneficial treatments from participants in the control group. Despite these challenges, well-designed randomized trials are essential to establish the causal relationship between treating psoriasis and improving cardiovascular outcomes.

How can the integration of mental health professionals into dermatology practices enhance patient care for psoriasis?

The integration of mental health professionals into dermatology practices can significantly enhance patient care for psoriasis by addressing the psychological impact of the disease. Mental health professionals can provide specialized interventions like mindfulness meditation and cognitive-behavioral therapy to help patients cope with the emotional burden of psoriasis. By conducting psychological screenings and offering tailored interventions, mental health professionals can improve patient outcomes, adherence to treatment, and overall quality of life. This collaborative approach ensures that patients receive comprehensive care that addresses both the physical and psychological aspects of living with psoriasis.