Humanistic and Economic Impact of Moderate to Severe Plaque Psoriasis in Brazil.

INTRODUCTION: Psoriasis is an immune-mediated, chronic, inflammatory disease, which has a substantial humanistic and economic burden. This study aimed to assess the impact of this disease on health-related quality of life (HRQoL), work productivity, and direct and indirect costs from a societal perspective among Brazilian patients. METHODS: This is a cross-sectional, observational, multicenter study, enrolling patients with moderate to severe plaque psoriasis according to physician evaluation. Data collection was performed from December 2015 to November 2016 through face-to-face interviews using a structured questionnaire and five standardized patient-reported outcomes instruments. Direct costs were estimated by multiplying the amount of resources used (12-month recall period) by the corresponding unit cost. Indirect costs were grouped in two time horizons: annual costs (income reduction and absenteeism) and lifetime costs (demission and early retirement). RESULTS: A total of 188 patients with moderate to severe plaque psoriasis were included, with mean age of 48.0 (SD 13.1). "Anxiety and depression" and "pain and discomfort" were the most impaired dimensions, according to the EuroQol Five-Dimension-Three-Level (EQ-5D-3L). The highest effect was found for "symptoms and feelings" [mean (SD) 2.4 (1.7)] Dermatology Life Quality Index (DLQI) subscale. Psoriatic arthritis (PsA) presence and biologic-naïve status were associated with worse HRQoL. Presenteeism was more frequent than absenteeism, according to the Work Productivity and Activity Impairment questionnaire-General Health (WPAI-GH) [17.4% vs. 6.3%], while physical demands and time management were the most affected Work Limitations Questionnaire (WLQ) subscales [means (SD) 23.5 (28.5) and 17.7 (24.9), respectively]. The estimated annual cost per patient was USD 4034. Direct medical costs accounted for 87.7% of this estimate, direct non-medical costs for 2.4%, and indirect costs for 9.9%. CONCLUSIONS: Results evidenced that moderate to severe plaque psoriasis imposes substantial costs to society. Our data showed that this disease negatively affects both work productivity and HRQoL of Brazilian patients. Subgroups with PsA and biologic-naïve patients presented lower HRQoL, showing the impact of this comorbidity and the relevance of biologics in psoriasis treatment. FUNDING: Novartis Biociências S.A.

Association between psoriasis and coronary calcium score.

BACKGROUND: Emerging data suggests that chronic inflammatory disease, such as psoriasis, may be associated to coronary artery disease (CAD). OBJECTIVE: Analyze the association between psoriasis and subclinical atherosclerosis using coronary calcium score (CAC). METHODS: We investigated 221 participants with psoriasis and 718 age- and sex-matched controls without prior known CAD. All participants completed a questionnaire and underwent laboratory tests and a CAC exam. Logistic regression models adjusted for Framingham risk score (FRS) and C-reactive protein (hs-CRP) were built. CAC was included in the models as a binary variable with different cut off values. RESULTS: Body-mass index, race, hypertension, HDL, LDL and hs-CRP were significantly associated with psoriasis presence and severity. Psoriasis severity was significantly associated with CAC (p = 0.04), particularly for very high CAC (>400) (p < 0.01). The OR for severe psoriasis and CAC >400 was 2.45 (95%CI: 1.26-4.75) in unadjusted models. In a model adjusted for the FRS, this association was no longer significant, but a trend was noted (p = 0.09). No significant changes in the association were noted after the inclusion of hs-CRP in the model. CONCLUSION: Psoriasis is associated with higher CAC values, mainly in individuals with severe psoriasis. The current findings also suggest the potential involvement of other mechanisms beyond classical cardiovascular risk factors and inflammation in this association.

Nutritional status and food intake of patients with systemic psoriasis and psoriatic arthritis associated.

OBJECTIVE: To identify the nutritional status and food intake of individuals with systemic psoriasis and psoriatic arthritis associated. METHODS: This is an exploratory and cross-sectional study with 34 men aged between 19 and 60 years seen at a Psoriasis Center. Participants were divided into systemic psoriasis group and arthritic-systemic psoriasis associated group. For nutritional assessment we used anthropometry, bioelectrical impedance analysis and whole-body plethysmography. Clinical and nutritional information were assessed using the clinical and nutritional history-taking, and the 24-hour dietary recall. For statistics the general linear model test (p < 0.05) was used. RESULTS: According to the body mass index 29.4% patients (n = 10) were eutrophic, 41.2% (n = 14) overweight and 29% (n = 10) obese. Almost all individuals (60%; n = 21) had body fat percentage above normal levels (> 25%) and a high risk for metabolic complications according to the waist circumference and the obesity index, however, there were no statistically significant differences between groups. The mean food intake, total fat, calories and protein were above recommended levels, being 58.8% for lipids (319.17 +/- 241.02 mg of cholesterol and 17.42 +/- 11.4 g saturated fatty acids); 29.4% for calories and 67.6% for proteins. Thus, regardless of the psoriasis type, an excessive consumption of calories, lipids, fatty acids, cholesterol and a higher incidence of overweight were found. CONCLUSION: The sample showed an abnormal nutritional condition, an increased risk for chronic diseases related to obesity, worsening of the psoriatic lesions, and poor quality of life.

Nutritional status and food intake of patients with systemic psoriasis and psoriatic arthritis associated / Estado nutricional e consumo alimentar de pacientes com psoríase dos tipos sistêmica e artropática sistêmica associada

Objective: To identify the nutritional status and food intake of individuals with systemic psoriasis and psoriatic arthritis associated. Methods: This is an exploratory and cross-sectional study with 34 men aged between 19 and 60 years seen at a Psoriasis Center. Participants were divided into systemic psoriasis group and arthriticsystemic psoriasis associated group. For nutritional assessment we used anthropometry, bioelectrical impedance analysis and wholebody plethysmography. Clinical and nutritional information were assessed using the clinical and nutritional history-taking, and the 24-hour dietary recall. For statistics the general linear model test (p < 0.05) was used. Results: According to the body mass index 29.4% patients (n = 10) were eutrophic, 41.2% (n = 14) overweight and 29% (n = 10) obese. Almost all individuals (60%; n = 21) had body fat percentage above normal levels (> 25%) and a high risk for metabolic complications according to the waist circumference and the obesity index, however, there were no statistically significant differences between groups. The mean food intake, total fat, calories and protein were above recommended levels, being 58.8% for lipids (319.17 ± 241.02 mg of cholesterol and 17.42 ± 11.4 g saturated fatty acids); 29.4% for calories and 67.6% for proteins. Thus, regardless of the psoriasis type, an excessive consumption of calories, lipids, fatty acids, cholesterol and a higher incidence of overweight were found. Conclusion: The sample showed an abnormal nutritional condition, an increased risk for chronic diseases related to obesity, worsening of the psoriatic lesions, and poor quality of life.

Objetivo: Identificar o estado nutricional e o consumo alimentar de indivíduos com psoríase sistêmica e artropática associada. Métodos: Pesquisa exploratória e transversal, na qual avaliaram-se 34 homens, de 19 a 60 anos, atendidos em um Centro de Psoríase, separando-os em Grupo PS (com psoríase sistêmica) e Grupo PAS (com sistêmica mais artropática). A avaliação nutricional deu-se pelo emprego da antropometria; bioimpedância e plestimografia de corpo inteiro. Aspectos clínicos e nutricionais foram investigados pela anamnese clínica, nutricional e recordatório de 24 horas. Empregou-se o teste General Linear Model (p < 0,05) para avaliação estatística. Resultados: Segundo Índice de Massa Corporal, 29,4% (n = 10) apresentaram-se eutróficos; 41,2% (n = 14) com sobrepeso e 29% (n = 10) com obesidade. A maioria dos avaliados (60%; n = 21) apresentou valor da porcentagem de gordura (avaliada pela antropometria, bioimpedância e plestimografia de corpo inteiro) acima da normalidade (> 25%) e com risco alto para complicações metabólicas segundo CC e índice de obesidade, sem diferença estatística significativa entre os grupos. O consumo alimentar médio de lipídio, calorias e proteína apresentou-se acima do recomendado, sendo 58,8% para os lípides (319,17 ± 241,02 mg de colesterol e 17,42 ± 11,4 g de ácidos graxos saturados); 29,4% para as calorias e 67,6% para as proteínas. Assim, independentemente do tipo de psoríase, encontrou-se consumo excessivo de calorias, lípides, colesterol e ácidos graxos, além de maior ocorrência de excesso de peso. Conclusão: A amostra apresentou estado nutricional comprometido, aumento do risco para doenças crônicas relacionadas à obesidade, agravamento das lesões e má qualidade de vida.