Evaluating practice patterns for managing moderate to severe plaque psoriasis: role of the family physician.

OBJECTIVE: To describe practice patterns for care of Canadian patients with moderate to severe plaque psoriasis. DESIGN: Online survey of a consumer panel. SETTING: Participants were drawn from a population-wide Canadian consumer database. PARTICIPANTS: To be eligible to participate, respondents had to have been diagnosed with plaque psoriasis within the past 5 years, and to have had body surface area involvement of 3% or greater in the past 5 years, or to have psoriasis on a sensitive area of the body (hands, feet, scalp, face, or genitals), or to be currently receiving treatment with systemic agents or phototherapy for psoriasis. MAIN OUTCOME MEASURES: Proportion of respondents with psoriasis managed by FPs and other specialists, psoriasis therapies, comorbidities, and patient satisfaction. RESULTS: Invitations were sent to 3845 panelists with self-reported psoriasis, of which 514 qualified to complete the survey. Family physicians were reported to be the primary providers for diagnosis and ongoing care of psoriasis in all provinces except Quebec. Overall physician care was reported to be satisfactory by 62% of respondents. Most respondents receiving over-the-counter therapies (55%) or prescribed topical therapies (61%) reported that their psoriasis was managed by FPs. Respondents receiving prescription oral or injectable medications or phototherapy were mainly managed by dermatologists (42%, 74%, and 71% of respondents, respectively). Ongoing management of respondents with body surface area involvement of 10% or greater was mainly split between dermatologists (47%) and FPs (45%), compared with rheumatologists (4%) or other health care professionals (4%). Of those respondents receiving medications for concomitant health conditions, treatment for high blood pressure was most common (92%), followed by treatment for heart disease (75%) and elevated cholesterol and lipid levels (68%). CONCLUSION: Patient-reported practice patterns for the diagnosis and management of moderate to severe psoriasis vary among provinces and in primary and secondary care settings.

A Canadian online survey to evaluate awareness and treatment satisfaction in individuals with moderate to severe plaque psoriasis.

BACKGROUND: Psoriasis is a chronic inflammatory disease associated with comorbidities and decreased quality of life. This survey is aimed to better understand the impact of disease on Canadian patients, and to examine awareness and use of available treatment options. METHODS: An online survey was conducted using a consumer panel. Eligible subjects reported diagnoses of psoriasis and moderate/severe/very severe plaque psoriasis within the past 5 years, and either: psoriasis covering ≥ 3% of body surface area; psoriasis on a sensitive area, or current use of systemic and/or phototherapy or light therapy for psoriasis. RESULTS: A total of 514 panelists completed the survey; 65% reported current moderate/severe/very severe psoriasis. Awareness of available treatment options ranged from 98% for prescription topical agents to 75% for photo/light therapy, and < 50% for prescription oral (49%) or injectable (35%) medications. A total of 92% of respondents had been treated with and 61% were currently taking prescription topical agents. Photo/light therapy had been used by 38% and was currently used by 7% of respondents. Prescribed oral medication had been taken by 25% and was currently used by 8%. Few subjects had been treated with injectables in the past (10%) or currently (5%). Overall, 24% of respondents were very satisfied with their current treatment. A total of 63% of respondents taking injectables were very satisfied, compared with 38% of those taking prescribed oral medication and 21% of those receiving photo/light therapy.Conclusions Most respondents with moderate to severe psoriasis were unaware of all treatment options; systemic treatments were not commonly utilized. Treatment satisfaction rates were low, highlighting the need to ensure greater patient education on and use of available therapeutic options.

Epidemiology of moderate-to-severe plaque psoriasis in a Canadian surveyed population.

BACKGROUND: limited data are available on the epidemiologic features of psoriasis in Canada. OBJECTIVE: to investigate the epidemiologic features and burden of moderate-to-severe psoriasis in a Canadian population. METHODS: an online survey was conducted using a consumer panel. Eligible respondents indicated a diagnosis of psoriasis and plaque-type psoriasis of at least moderate severity. Eligibility was validated according to self-reported body surface area (BSA) involvement, sensitive areas affected, and/or current treatment. RESULTS: of the 514 respondents who completed the survey, 62% estimated a BSA involvement of >/= 3% within the past 5 years. Onset of psoriasis occurred earlier in females than in males. Nail involvement was more commonly reported in individuals with psoriatic arthritis compared to those without. Several symptoms were more likely described as "constantly" or "near constantly" experienced by females than by males. Comorbidities commonly reported were hypertension, dyslipidemia, and overweight or obesity. CONCLUSIONS: the findings are consistent with a substantial burden attributed to moderate-to-severe plaque psoriasis in a Canadian population.

Kinetics of internalization and degradation of N-type voltage-gated calcium channels: role of the alpha2/delta subunit.

The contribution of voltage-gated calcium channels to excitable cell function depends, critically, upon the mechanisms that control their expression at the cell surface. While co-assembly of the pore forming alpha(1) and auxiliary beta subunits enhances channel surface expression, the levels are still only 30-40% of those seen with the core alpha(1B)/beta(1b)/alpha(2)delta calcium channel complex. To rationalize this observation, it has been suggested that the alpha(2)/delta subunit might stabilize calcium channel expression at the cell surface. To test this notion, we have resolved the effect of the alpha(2)/delta subunit on the rates of binding, internalization and degradation of defined N-type calcium channel surface complexes expressed in HEK293 cells, through pulse-labeling with the selective, cell impermeable, radioligand [(125)I]-omega-CgTx. Through detailed kinetic and sensitivity analysis we show that alpha(1B)/beta(1b)/alpha(2)delta complexes are internalized slowly (k(int) 0.4/h), whereupon, most become degraded (k(deg) 0.02/h). In contrast, alpha(1B)/beta(1b) complexes are internalized more rapidly (k(int) 0.8/h), following which they are either quickly degraded (k(deg) 0.1/h) or are sequestered slowly (k(tra) 0.1/h) to a pool that is metabolically stable within the time-frame of our experiments (24h). In neither case did we find evidence for recycling via the cell surface. Thus, our data argue for a novel mechanism where complexes lacking an alpha(2)/delta subunit are cleared from the cell surface and are rapidly degraded or stored, possibly for further attempts at complexation as new alpha(2)/delta subunits become available. The slower rate of internalization of complexes containing the alpha(2)/delta subunit rationalizes the stabilizing effect this subunit has upon calcium channel surface expression and suggests a mechanism by which alpha(2)delta mutations may cause severe neurological deficits.