Effects of rheumatoid arthritis on household chores and leisure-time activities.

The aim of the study was to determine household chores and leisure-time activities most affected by rheumatoid arthritis (RA) and to evaluate the perceived impact on performing these activities. Also, our aim was to estimate the required and received assistance for household chores. In an interview study via telephone, 124 patients with moderate-to-severe RA, visiting a tertiary-level dermatological clinic, listed spontaneously without predefined list the household chores and leisure-time activities that they considered were particularly affected by the RA. Ability to perform household chores and leisure-time activities were asked. The need for outside assistance with household chores and help received were also determined. Rheumatoid arthritis affected wide range of everyday household activities, with tasks related to cleaning of the house mentioned most often. Eleven of the categories out of 16 were similar to those included in the HAQ index. The majority of the patients (84.6 %) reported disadvantage in performing household chores because of RA. More than half of the patients (55.7 %) received assistance with household chores, women significantly more often than men (69.0 vs. 26.3 %, p < 0.01). Most of the household chores mentioned were physically demanding. Leisure-time activities listed by respondents as affected by RA were mostly related to sport. The majority of patients (77.2 %) had either reduced or completely given up at least one leisure-time activity. When estimating the total burden of the disease, the impact on both household chores and leisure-time activities should be taken into account.

Influence of Psoriasis on Household Chores and Time Spent on Skin Care at Home: A Questionnaire Study.

INTRODUCTION: Previous studies have shown that psoriasis has a significant effect on patients' health-related quality of life. The impact of psoriasis on household chores and the need for assistance with such tasks are not well documented. The aim of this study was to estimate the impact of psoriasis on the ability to carry out household chores, the time spent on skin care at home and the assistance that patients with psoriasis require with these activities. METHODS: In a questionnaire study 262 patients with moderate-to-severe psoriasis, visiting a tertiary level dermatological clinic during a 1-year study period, listed household chores which they considered were particularly affected by psoriasis. This was done without a predefined list of chores. Questions on their ability to perform household chores as well as time spent on skin care at home were asked. The need for outside assistance with household chores and help received were also determined. RESULTS: More than half of the patients (57.8%) reported difficulties with household chores because of psoriasis. Psoriasis affected a wide range of everyday household activities, with physically demanding tasks and those involving contact with water mentioned most often. Most of the patients (84.6%) reported that they have increased the time spent on skin care because of psoriasis, on average by 87 min per week. A quarter of patients received assistance in household chores. Women received more assistance than men (p < 0.01). The need for additional assistance was reported by a fifth of patients, women more often than men (p < 0.05). CONCLUSION: When estimating the overall burden of psoriasis, considering only the economic and productivity consequences may underestimate the impact of the disease. The impact on everyday life events such as the ability to perform household chores should also be taken into account. FUNDING: This study was supported by unconditional grants from the research funds of the Hospital District of Southwest Finland. Hospital District of Southwest Finland's research permission K44/10/EVO13043.

How much of the productivity losses among psoriasis patients are due to psoriasis.

BACKGROUND: In previous studies, productivity losses have been measured specifically due to psoriasis or generally due to health problems in psoriasis patients. There is no information on the proportion of health related productivity losses that are due to psoriasis. The aim of this study was to estimate the proportion of productivity losses due to psoriasis and due to other medical problems among employed psoriasis patients. METHODS: Patients visiting a tertiary level dermatological clinic during a one-year period due to psoriasis or psoriasis arthritis, who were employed, were selected to the study. A questionnaire was used to assess productivity losses during the previous month. RESULTS: Psoriasis accounted for 38% of the total lost productivity costs. One fifth of patients had been on sick leave (absenteeism) due to psoriasis and a third of patients worked despite being sick with psoriasis (presenteeism). Men had higher costs of presenteeism, but the costs of absenteeism due to psoriasis were lower for men than for women. CONCLUSIONS: Productivity losses should be assessed disease specifically to avoid overestimations of the role of the disease on indirect costs. Our study shows that about a third of the lost productivity costs are due to psoriasis.

Treatment costs of psoriasis in a tertiary-level clinic.

BACKGROUND: The costs of psoriasis to a tertiary-level clinic vary considerably depending on the country of study and methods used. Hospitalisation and phototherapy have been significant cost components. This study was performed to estimate the distribution and relative magnitude of the costs of psoriasis to a tertiary-level clinic. METHODS: Based on 233 patients, outpatient and phototherapy visits and the days hospitalised were collected from the treatment provider's records. The visit costs represented true costs, used to charge the final payers. Patients were analysed according to their treatment modalities. RESULTS: On average, hospitalised patients (3.4%) had 31-fold higher total costs than non-hospitalised patients (p < 0.0001). The costs of hospitalisations formed 45% of all the treatment costs to the entire study population. Phototherapy accumulated 19% of the overall treatment costs. Patients receiving biological drugs or both phototherapy and traditional systemic therapy had the highest costs of treatment. CONCLUSIONS: The current study indicates that a small percentage of all psoriasis patients generate a large proportion of the overall costs to a tertiary-level hospital. Treatment modality has a significant effect on the costs to a tertiary-level hospital.

Perceived impact of psoriasis on leisure-time activities.

BACKGROUND: Psoriasis has an influence on various aspects of patients' everyday life. When estimating the total burden of the disease, the influence on leisure-time should also be taken into account. OBJECTIVES: To evaluate the perceived impact of psoriasis on leisure-time activities. MATERIAL AND METHODS: The questionnaire study was based on 262 patients with psoriasis. The patients were asked to list their leisure-time activities, any activities they had reduced or given up completely because of psoriasis, the time spent on current leisure-time activities and the time they would have spent in a hypothetical situation if they did not have psoriasis. Using a visual analogue scale (VAS) of 0-100, the patients assessed how well they could currently perform their leisure-time activities and how well in a hypothetical situation without psoriasis. The difference between the VAS scores depicted the level of disadvantage caused by psoriasis. RESULTS: More than half the patients (51.9%) had reduced or completely given up at least one leisure-time activity. The disadvantage score (VAS) of psoriasis was 16.9. Younger age was associated with higher disadvantage (r = 0.154, p<0.05). Sports activities were completely given up by 30.2% and reduced by 23.7%. Social activities and those which could be expected to cause embarrassment were given up by 29.0% and reduced by 21.4% of the patients. CONCLUSION: A majority of patients with psoriasis reduce or give up leisure-time activities because of their condition, so the influence of psoriasis on leisure-time is considerable.

The costs of psoriasis medications.

INTRODUCTION: Psoriasis is a chronic disease, which contributes to the economic burden on health care. The distribution of psoriasis medication costs and the quality of life in these patients has been estimated to be around 20% of total costs. OBJECTIVES: To estimate the economic distribution of medications and the impact of multiple treatment options on a patient's quality of life. MATERIALS AND METHODS: The study was based on 236 Finnish psoriasis patients. The Finnish Social Insurance Institution had databases for all psoriasis related medications purchased. Each purchase, during the 1-year study period (1 October 2009-30 September 2010), was recorded and analyzed. The dermatological quality-of-life index was collected from the medical records. RESULTS: Total medication costs were 1,083 per year per patient. Topical treatments were the most often purchased medication and they comprised 18% of the total medication costs. Ten percent of the patients needed 3 or more medication changes during the 1-year study period. Biologics were used only by 5% of patients, but they produced 67% of total medication costs. Patients needing various treatments had higher medication costs and a poorer quality of life. CONCLUSION: A small number of patients generated a great sum of medication costs partly due to the need to change medications. These patients had the worst quality-of-life index scores. Biologics formed a major cost component.

Influence of psoriasis on work.

BACKGROUND: Previous research indicates that psoriasis has an impact on early retirement, sick leave days and reduced work performance. OBJECTIVES: To evaluate the disadvantages at work caused by psoriasis. MATERIAL AND METHODS: The sample was based on patients visiting the dermatology outpatient clinic in Turku University Hospital. 262 returned a mailed questionnaire. The subjects were asked how many hours they were on a sick leave (absenteeism) and working while sick (presenteeism) due to psoriasis and other health reasons. RESULTS: Of the retired, 17.0% felt they were retired due to psoriasis. Those in the active work force reported on average 4.5 hours absenteeism and 8.3 hours of presenteeism due to psoriasis during the last 4 weeks. Psoriasis caused 27.0% of the total absenteeism and 39.0% of presenteeism. More than a quarter (28.9%) had been forced to modify their work due to psoriasis, most frequently to make the work less irritating for the skin. CONCLUSION: Psoriasis has a negative effect on patients' work in many ways, causing early retirement from work, sick leave days, change of occupation and work modifications.

Perceived disadvantages caused by low back pain.

OBJECTIVE: To evaluate the perceived disadvantages caused by low back pain in work, household chores and leisure-time activities, as expressed by patients themselves. DESIGN AND SUBJECTS: Structured telephone interviews, carried out among a sample of 39 physician referrals (29 women and 10 men) for non-specific chronic low back pain to University Hospital, Turku, covered how low back pain affected their daily living, with separate sections for work, household chores and leisure time. Disadvantages in daily activities were measured using numeric rating scales (0-100). The differences between scores for ability to perform with low back pain and for expected performance if the subject did not have low back pain were used to depict the disadvantage in each activity. RESULTS: Men reported a greater disadvantage than women in work, household chores and leisure-time activities. The ability to perform in any of the 3 daily activities was associated with an ability to perform in the others. Good performance at work was reported by 81.0% of the women and 42.9% of the men. Because of low back pain, leisure-time activities had been reduced by 82.1% of the patients and, out of them, 64.1% had completely given up at least one leisure-time activity. CONCLUSION: When estimating the overall burden of low back pain, the measure of work-related loss of productivity should be complemented by measures of performance in household chores and limitations to leisure-time activities. To depict extensively the burden to the patients, such measures should be based on the activities the patients consider important. These are best determined by using the phrasings and expressions the patients themselves use.