Relato de experiência da atuação da fisioterapia em pacientes com psoríase / Experience report of physiotherapy performance in patients with psoriasis

A psoríase é uma condição dermatológica crônica e inflamatória que se manifesta por pápulas ou placas eritematosas na pele, sendo imunomediada e associada a fatores genéticos, ambientais, sociais e psicológicos. Inserida nas psicodermatoses, sua relação com eventos traumáticos e fatores psicossomáticos. A prevalência no Brasil é de 1,31%, com maior incidência no sexo feminino, relacionada a condições ambientais e predisposição. Foi realizado um relato de experiência da atuação da fisioterapia em um hospital público no interior de São Paulo em pacientes com psoríase, no qual pode associar a Psoriase a finalizações de ciclos ou percas e situações psicossomáticas, onde o individuo passa a se abster de participar de atividades e interações em grupo, o consumo de tabaco pode influenciar o processo de renovação celular, consequentemente o tempo de alta médica, é de grande importância a atuação do fisioterapeuta para as orientações do posicionamento adequado e a realização de exercícios que estimulem e auxiliem a cicatrização e o ganho de ADM. Conclui-se que a abordagem terapêutica deve ser multidisciplinar, portanto, não deve se restringir apenas aos aspectos fisiopatológicos, mas também considerar a dimensão física, psicológica e social

Psoriasis is a chronic and inflammatory dermatological condition that manifests itself as erythematous papules or plaques on the skin, being immune-mediated and associated with genetic, environmental, social and psychological factors. Inserted in psychodermatoses, their relationship with traumatic events and psychosomatic factors. The prevalence in Brazil is 1.31%, with a higher incidence in females, related to environmental conditions and predisposition. An experience report was carried out on the performance of physiotherapy in a public hospital in the interior of São Paulo on patients with psoriasis, which can associate Psoriasis with completion of cycles or losses and psychosomatic situations, where the individual starts to abstain from participating in group activities and interactions, tobacco consumption can influence the cell renewal process, consequently the time of medical discharge. The importance of the physiotherapist's intervention is highlighted, providing guidance on appropriate positioning and implementing exercises that stimulate healing and promote gain in range of motion. It is concluded that the therapeutic approach must be multidisciplinary, therefore, it must not be restricted only to pathophysiological aspects, but also consider the physical, psychological and social dimensions.

Influence of Non-pharmacological Treatment on Pain, Morning Stiffness, Fatigue, and Physical Function in Patients with Psoriatic Arthritis.

Naphthalanotherapy (NT) is a therapeutic procedure that uses mineral oil obtained from petroleum. The aim of this study was to investigate the influence of the duration of NT combined with an individually adjusted rehabilitation program (IARP) on pain, morning stiffness (MS), fatigue, and physical function in patients with psoriatic arthritis (PsA). A total of 29 consecutive patients with PsA were divided into two groups. Group 1 (n=17) participated in a two-week and Group 2 (n=12) in a three-week intervention program. Pain (using the Visual Analogue Scale - VAS), fatigue (VAS and Functional Assessment of Chronic Illness Therapy-Fatigue - FACIT-F), duration of MS (minutes), and physical function (Health Assessment Questionnaire - HAQ) were assessed before and after therapy. Statistical analysis was performed using SPSS version 20, with P<0.05. There was a significant improvement in VAS-pain, VAS-fatigue, MS, HAQ, and FACIT-F before vs after therapy: Group 1:5.88±1.62 vs 3.94±1.25, P=0.001; 6.59±1.73 vs 4.35±1.73, P=0.001; 35.47±31.64 vs 23.71±29.30, P=0.001; 1.43±0.78 vs 1.23±0.74, P=0.001; 25.88±10.89 vs 30.71±10.65, P=0.009; Group 2: 6.17±1.27 vs 3.92±1.44, P=0.001; 6.50±1.93 vs 3.75±1.71, P=0.001; 38.42±32.00 vs 21.25±17.31, P=0.006; 1.47±0.79 vs 0.93±0.54, P=0.008; 25.00±9.87 vs 36.83±7.20, P=0.001, respectively. Regarding the length of the therapy, significant difference was reached only in FACIT-F (P=0.009). Two-week and three-week NT combined with IARP are equally efficient in reduction of pain and MS, as well as in improving physical function in patients with PsA. The three-week program showed an additional effect on reducing fatigue assessed by the FACIT-F score.

Effects of psychosocial interventions on patient-reported outcomes in patients with psoriasis: a systematic review and meta-analysis.

BACKGROUND: Psoriasis can lead to high psychosocial burden, and the occurrence of psoriasis is related to psychological distress. OBJECTIVES: This study provides an overview of psychosocial interventions for patients with psoriasis and examines their effects on patient-reported outcomes. METHODS: A systematic search of four electronic databases (CENTRAL, MEDLINE, Embase and PsycINFO) was conducted in January 2017. All trials on psychosocial interventions for patients with psoriasis that used patient-reported outcomes and a comparison group were included. Data were extracted on intervention, study population and outcomes. Risk of bias was assessed according to the Cochrane Handbook. A meta-analysis on quality of life, depression and anxiety was performed. This review was registered on PROSPERO (CRD42016037934). RESULTS: Nineteen studies were included. Interventions primarily used cognitive behavioural or mindfulness-based techniques. Risk of bias was mostly rated 'unclear' due to nontransparent reporting (e.g. no study protocols were published, only one study reported blinding of patients). Meta-analysis using standardized mean differences between the intervention and control groups showed significant, small-to-medium effects (given with 95% confidence intervals) on quality of life (0·28, 0·04-0·51; six studies, n = 664) and anxiety (0·36, 0·15-0·57; six studies, n = 363). The effect on depression was not significant (0·37, -0·05 to 0·80; five studies, n = 326). CONCLUSIONS: Psychosocial interventions offer an effective means to improve quality of life and anxiety in patients with psoriasis. Although the importance of such psychosocial aspects for psoriasis is unquestioned, there is a lack of high-quality evaluation studies. Nontransparent reporting of risk of bias, low power and a lack of replication studies make it difficult to reach confident conclusions from the evidence. What's already known about this topic? Psoriasis symptoms and psychosocial burden reinforce one another. Different psychosocial interventions for patients with psoriasis exist to address this problem. Most studies report positive effects on psoriasis severity, and some also on certain patient-reported outcomes such as quality of life. Only a very few interventions have been subject to rigorous testing. Further research is needed on the evaluation of the effects and the methodological quality of these interventions. What does this study add? This review provides a comprehensive overview of psychosocial interventions for patients with psoriasis. It evaluates the effects of the interventions on patient-reported outcomes and rates the methodological quality of their evaluation studies. It underlines the importance and effectiveness of addressing psychosocial burden in patients with psoriasis by identifying adequate interventions. The results of this study show that further research, especially with adequately tested interventions, is strongly needed.

Balneotherapy in Psoriasis Rehabilitation.

BACKGROUND/AIM: This study aimed to report a balneotherapy-based psoriasis rehabilitation protocol and assess its effectivity. PATIENTS AND METHODS: Eighty psoriatic patients who underwent a 3-week-long inward balneotherapy-based rehabilitation were enrolled. Psoriasis Area and Severity Index (PASI) score and high sensitivity C-reactive protein (CRP) were determined on admission and before discharge. RESULTS: The mean PASI score and CRP level -determined on admission and before discharge-decreased significantly after the 3-week-long rehabilitation 7.15±7.3 vs. 2.62±3.05 (p<0.001) and 4.1±3.8 vs. 3.5±3.1 (p=0.026). A negative correlation was found between PASI delta and the number of spa therapies received (r=-0.228). CONCLUSION: After completing the 3-week-long spa therapy based rehabilitation, both PASI score and CRP levels showed improvement of psoriasis. The complex spa therapy used during the rehabilitation is an effective tool to reduce the symptoms of psoriasis and improve the patient's well-being.

Chronic stress experience and burnout syndrome have appreciable influence on health-related quality of life in patients with psoriasis.

BACKGROUND: Psoriasis has a negative impact on health-related quality of life (HRQoL) and may favour mental comorbidity. OBJECTIVE: To investigate the contribution of chronic stress and burnout experience to HRQoL and how mental health influences the efficacy of an inpatient rehabilitation measure in psoriasis patients. METHODS: Eighty-four psoriasis patients taking part in a 3-week inpatient rehabilitation measure participated in the study. Severity of psoriasis was assessed with the Psoriasis Area and Severity Index (PASI) and by patients' self-evaluation at the beginning and end of treatment. The following aspects of mental health were explored using validated questionnaires. Symptoms of chronic stress and burnout experience: Trier Inventory for the Assessment of Chronic Stress (TICS) and Shirom Melamed Burnout Measure (SMBM). Symptoms of depression: depression scale of the Patient Health Questionnaire in the German version (PHQ-D). HRQoL: Dermatology Life Quality Index (DLQI) and Short Form Health Survey-8 (SF-8). RESULTS: Linear regression analyses revealed that chronic stress, burnout experience and perceived symptom severity but not clinician-assessed severity of psoriasis had independent negative effects on HRQoL. Patients who achieved a PASI reduction of <75% at discharge from the rehabilitation measure had lower baseline QoL and showed more symptoms of depression, chronic stress and burnout than patients who achieved a PASI improvement of ≥75. CONCLUSION: Chronic stress and burnout have appreciable influence on HRQoL and may adversely affect treatment success in psoriasis patients. Our data underscore the importance of a multidimensional approach in the management of psoriasis.

Occupational palmoplantar psoriasis: a clinical case series with consideration of the S1 guidelines on expert medical assessments of occupational psoriasis.

BACKGROUND: Constitutional diseases represent a challenge in the expert assessment of occupational diseases. It is necessary to distinguish professional causes from the spontaneous course of the disease. Recently, a guideline for the assessment of work-related psoriasis has been consented in Germany. We present a case series in which it was applied. PATIENTS AND METHODS: 129 expert assessments from the Department of dermatology University hospital Erlangen and court cases in established juridical databases were researched for cases with psoriasis and the applicability of the guideline. RESULTS: The guideline was applicable in the n = 6 (3.6 %) identified medical expert opinions. They were fully recognized by the workers compensation boards. The search for law sentences on work-related psoriasis in German court cases yielded a total of four sentences, in one of which the psoriasis was recognized as an occupational disease (BK 5101). CONCLUSIONS: In comparison with hand eczema psoriasis of the hands is rare. As has been demonstrated in our case series psoriasis as a constitutional disease may be recognized as an occupational disease (BK 5101) according to the legal system in Germany, if the influence of occupational exposure can be made sufficiently probable and other legal conditions of an occupational disease are met.

Development and design of a multidisciplinary training program for outpatient children and adolescents with psoriasis and their parents.

INTRODUCTION: To describe and illustrate in a case-study design the development and design of a multidisciplinary training program for outpatient children and adolescents with psoriasis and their parents. METHODS: For the development of the program, a steering group was assembled, systematic semi-structured interviews were held and the literature was reviewed. RESULTS: Aim of the training program was to strengthen patients and their parents in coping with and diminishing psoriasis-related problems in an outpatient setting. The program included treatment modules of medical information and skin care, itch and scratch problems, psychological issues in coping with the psoriasis, sleep hygiene and relapse prevention. Descriptive results in the case patient showed improvement of all outcome variables in the expected direction. CONCLUSION: This is the first multidisciplinary training program for outpatient children and adolescents with psoriasis and their parents. It aims at improving coping skills and self-management and could be a promising addition to regular treatment.

Methotrexate versus traditional Chinese medicine in psoriasis: a randomized, placebo-controlled trial to determine efficacy, safety and quality of life.

BACKGROUND: Psoriasis is a common and chronic immune-mediated skin disorder, for which there is currently no cure. To our knowledge, this is the first randomized placebo-controlled trial comparing methotrexate and traditional Chinese medicine (TCM) in terms of efficacy, safety, and quality of life for the treatment of psoriasis. METHODS: In total, 61 patients with moderate to severe plaque psoriasis were randomized to receive treatment with methotrexate, TCM or placebo for 6 months. The primary outcome measure was the Psoriasis Area and Severity Index (PASI), and secondary outcome measures were the Physician's Global Assessment (PGA) and the Psoriasis Disability Index (PDI). RESULTS: In all, 50 patients completed the study and were included in the analysis. Dropout rates were highest in the TCM group. Mean PASI change from baseline at 6 months revealed an improvement of 73.9% of the methotrexate group, 15.1% of the TCM group and 32.0% of the placebo group. There was a significant difference between the three groups, with methotrexate showing greater effectiveness than the other two groups. No significant difference was found between the TCM and placebo groups. The methotrexate group also had greater improvement when assessed using the PGA and PDI. CONCLUSIONS: Our results verify the therapeutic effect of methotrexate for the management of psoriasis. Despite widespread belief and use of TCM in Asia for the treatment of psoriasis, we were unable to confirm the efficacy of TCM in this study.

Representações psíquicas do paciente com psoríase: do diagnóstico ao tratamento / Mental representations of patients with psoriasis: from diagnosis to treatment

A maneira como o paciente compreende sua doença é fundamental para que desenvolva maneiras de lidar com seu adoecimento. Este estudo tem como objetivo analisar as representações psíquicas do paciente com psoríase, que compreende seu universo simbólico através do qual ele dá sentido as suas experiências, verificando de que maneira tais concepções influenciam no seu tratamento. Para isso, foi realizado um estudo de caso, e atrvés de uma entrevista semi-estruturada, foram abordadas as percepções da paciente diante dos diferentes momentos do processso de adoecimento e o percurso do seu tratamento, as quais foram analisadas de acordo com a metodologia da pesquisa clínico-qualitativa e com o referencial teórico psicanalitico.

[Natural physical factors of the Kuban' Black Sea coastal area in the rehabilitative treatment of children with psoriasis and concomitant ophthalmoherpes].

The primary objective of this study was to optimize the process of remedial treatment at health reports of Sochi, Gelendzhik, and Anapa by introducing sun, air, and sea water baths in the system of sanatorium-and-spa treatment of the children with various nosologic forms of psoriasis and concomitant ophthalmoherpes that necessitated keratoplastic surgery. The study included children at the age of 7-13 years with plaque and nummular psoriasis vulgaris who received rehabilitative treatment after keratoplasty for ophthalmoherpes. The children were randomly allocated to two groups. One comprised patients based at the specialized children's sanatoria "Yunost", "Vulan", and "Bimlyuk" (Roszdrav) (group 1, n = 278). Patients of the control group were given conventional treatment in municipal outpatient settings in compliance with the existing standards (group 2, n = 278). The study showed a 2.39-fold decrease of the psoriasis area and severity index (PASI) in the children of group 1 compared with its 1.38-fold decrease in group 2. It is concluded that a combination of natural physical factors of the Kuban' Black Sea coastal area has highly beneficial effect on the outcome of postoperative treatment of children with plaque and nummular psoriasis vulgaris and concomitant ophthalmoherpes responsible for corneal ulceration that requires corrective keratoplastic surgery.

Association of psoriasis and alcoholism: psychodermatological issue.

Psoriasis is a chronic, hereditary disease generally characterized by eruption of erythematous, silvery-scaled plaques, predominantly on the elbows, knees, scalp and trunk, affecting between 1-2% of the population worldwide. Psoriasis is a multifactorial disease of unknown etiology. It has been shown that in some patients alcohol abuse has been associated with psoriasis. Chronic alcohol abuse results in the impairment of health-related, social and occupational functioning. Therefore the association of psoriasis and alcoholism represents one of the major psychodermatological issues where a multidisciplinary approach (including dermatologist, psychiatrist, psychologist and others) is crucial for optimal outcome.

[Comparison of patients with psoriasis vulgaris vs. psoriatic arthritis with regard to the reported quality of life]. / Vergleich von Patienten mit Psoriasis vulgaris vs. Psoriasis-Arthritis im Hinblick auf die berichtete Lebensqualität.

The present study investigates possible differences in quality of life impairment of patients with psoriasis vulgaris and psoriatic arthritis. One hundred and sixteen patients who were admitted for inpatient rehabilitation to the Fachklinik Bad Bentheim were asked to fill in a self-assessment questionnaire. This questionnaire comprised the SF-12, the German version of the Health Assessment Questionnaire, questions regarding the occupational and the social situation as well as additional questions for identification of specific disease-related burden. Altogether, both groups exhibited impairments of the quality of life. As was to be expected, the arthritis patients suffered from considerably more functional impairment than the patients who only had skin involvement. Interestingly, however, the psychic burden attributable to the disease is equal in patients with isolated skin involvement in comparison to patients with additional arthritis. Summarizing, a different proportion between the extent of psychic and physical impairment is found in the two groups, which might be due to a different pattern of coping with the disease. Taking this aspect into account is imperative when assessing the severity of the disease.

Introducción: adalimumab en el tratamiento de la psoriasis / No disponible

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[Psychosocial factors in psoriasis. A pilot study]. / Psychosoziale Belastungen bei Psoriasis vulgaris. Eine Pilotstudie.

BACKGROUND: The successful treatment of patients with chronic plaque psoriasis depends not only on the method of therapy but also on psychosocial factors. METHODS AND RESULTS: A pilot study was performed on 22 patients with chronic plaque psoriasis. The psychosocial stress, psychiatric features and their changes were assessed over a 3-week inpatient rehabilitation stay in a specialty clinic. The severity of the psoriasis, the subjective degree of suffering and the psychometric variables related to psychosomatic symptoms were assessed before and at the end of the treatment. After the hospitalization, the severity of disease and anger were both significantly decreased, along with an increased interest in social interactions. CONCLUSION: In psoriasis patients, one can distinguish between different psychosocial factors, some of which are more likely to change. Stable attributes such as personality style can impact on compliance as well as on coping behaviors, thereby influencing treatment success. Our study shows that even within a rather short inpatient treatment period of 3 weeks not only the disease severity but also negative psychosocial stressors can be improved.

European patient perspectives on the impact of psoriasis: the EUROPSO patient membership survey.

BACKGROUND: EUROPSO (European Federation of Psoriasis Patient Associations) undertook a Europe-wide survey examining quality of life and patients' perspectives on treatment and their disease. OBJECTIVES: To explore patients' perspectives of psoriasis on their lifestyle and well-being and to gain insight into the effectiveness of and satisfaction with currently available therapies for psoriasis. METHODS: Self-administered questionnaires (n = 50,500) were mailed to members of psoriasis patient associations in Belgium, the Czech Republic, Finland, France, Germany, Italy and the Netherlands. RESULTS: Responses were received from 18,386 patients (36%), of whom 17,990 had psoriasis. Mean age at onset of psoriasis was 30.5 years, 59% of respondents had self-reported moderate to severe psoriasis (3% or greater body surface area involvement) and 30% had been diagnosed with psoriatic arthritis. The mean Psoriasis Disability Index score was 12.2 (25% of the maximum score), increasing to 21 (44%) in patients with more than 10% body surface area involvement. The greatest impact was on activities of daily living, especially affecting clothing choice, bathing routine and sporting activities. Overall, 77% replied that psoriasis was a problem or a significant problem. While patients were satisfied with the information and care from their dermatologist (40% highly satisfied), available treatment options were less satisfactory, with over 70% reporting only low to moderate satisfaction. CONCLUSIONS: This is the largest survey of people with psoriasis in Europe and shows that psoriasis has a profound impact on quality of life.

Work limitations and productivity loss are associated with health-related quality of life but not with clinical severity in patients with psoriasis.

BACKGROUND: According to current guidelines the cost of productivity loss should be considered in pharmacoeconomic analyses. The cost of health-related productivity loss in psoriasis patients is unknown. OBJECTIVE: To estimate the cost of productivity loss in psoriasis and its association with health-related quality of life and clinical disease severity. METHODS: Cross-sectional study, recruitment of adult participants through Internet advertisements. 201 (72.3%) out of 278 eligible participants completed the study. Health-related work productivity loss, quality of life and clinical severity of psoriasis were assessed by standardized instruments. RESULTS: Indirect costs of productivity loss clearly exceed the total direct cost. In contrast to objective clinical disease severity, health-related quality of life (measured by the Dermatology Life Quality Index) is an independent predictor of work productivity. CONCLUSIONS: There is good reason to believe that intervention can reduce health-related productivity loss by improving patients' quality of life. Savings from increased work productivity might offset comparatively high acquisition costs of biological agents.

Improvement in quality of life with infliximab induction and maintenance therapy in patients with moderate-to-severe psoriasis: a randomized controlled trial.

BACKGROUND: Psoriasis has a well-documented, markedly negative effect on patient quality of life. OBJECTIVES: To evaluate the impact of long-term infliximab maintenance therapy on health-related quality of life (HRQoL) in patients with psoriasis. METHODS: The Dermatology Life Quality Index (DLQI) and 36-item Short Form Health Survey (SF-36) were administered as part of the pivotal double-blind, placebo-controlled efficacy and safety EXPRESS study of infliximab in chronic plaque psoriasis. In total, 378 patients with moderate-to-severe psoriasis were enrolled at 32 centres in Europe and Canada. Patients were randomized to receive either placebo or infliximab 5 mg kg(-1) induction at weeks 0, 2 and 6 followed by maintenance every 8 weeks; placebo patients crossed over at week 24 to receive the infliximab induction and maintenance regimen. RESULTS: At week 10, infliximab-treated patients had significantly greater improvement in DLQI scores (P < 0.001) and SF-36 physical and mental component summary scores (P < 0.001) than placebo-treated patients. Significant improvement (P < 0.001) was also seen in all eight SF-36 subscales, and was greatest for the "Bodily Pain" and "Social Functioning" scales. Significant improvement in HRQoL persisted with maintenance infliximab treatment at week 24 (P < 0.001), with patients achieving a Psoriasis Area and Severity Index score of 0 reporting the greatest benefit. Treatment-related HRQoL improvement remained substantial at week 50. CONCLUSIONS: Infliximab induction and maintenance regimens resulted in rapid, substantial, sustained and clinically meaningful improvement in both dermatology-specific and general quality of life indices in patients with psoriasis, with total clearance resulting in maximum improvement.