Coordinated Approach with Dermatologists, Internists Leads to Improvement in Psoriasis

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A multidisciplinary approach to psoriasis and associated cardiovascular risk, with coordination between internal medicine physicians and dermatologists, can lead to significant improvement in several measures of the skin disease and its related complications, according to new findings.¹

These findings were the results of new research, led by Ana Julia García-Malinis of the San Jorge University Hospital dermatology unit in Spain, with the research team seeking to assess the impact of a holistic management approach to treatment of psoriasis through a multidisciplinary team of dermatologists and internists.

García-Malinis et al. noted that a prior systemic review had demonstrated that patients with severe cases of psoriasis have a greater risk of all-cause mortality versus those without the chronic skin condition.² They added that this is partially due to an cardiovascular mortality risk increase in such patients.

“Coordination between dermatology and internal medicine departments during the management of psoriatic patients…can substantially improve the course of disease and its associated complications, as well as patient quality of life,” García-Malinis and colleagues wrote. “In this study, we evaluated the effects of the holistic management of patients with psoriasis by a multidisciplinary team consisting of dermatology and internal medicine specialists.”

Background and Methods

The research team used a prospective observational study design, with the research conducted at San Jorge University Hospital in Huesca, Spain, and aimed at subjects drawn from the combined dermatology and internal medicine clinic. The team formed their control group out of randomly selected individuals with diagnoses of moderate-to-severe psoriasis, matched for sex and age.

From October 2016 - December 2019, the investigators gathered data related to simultaneous assessments done by dermatologists and internal medicine specialists over the course of monthly outpatient clinics for 3 hours each. Those in the control arm were provided standard care from their dermatologist and their primary care physician without any other types of interventions.

Follow-up intervals varied between 3 to 6 months based on clinical progress, with referrals from dermatology, rheumatology, and internal medicine departments. Inclusion criteria encompassed a diagnosis of psoriasis and/or psoriatic arthritis along with at least two cardiovascular risk factors like hypertension, hyperlipidemia, diabetes, smoking, and obesity.

During follow-up interactions, outside of managing psoriatic disease, the investigators monitored subjects’ blood pressure, weight, waist circumference, SCORE index for coronary risk assessment, body mass index (BMI), and blood tests. They also looked at lifestyle elements such as tobacco habits, exercise, diet, and alcohol consumption were also tracked.

Health education was provided by a dedicated nurse on psoriasis and related issues, and patient satisfaction and knowledge were evaluated by the research team. The investigators’ analysis of the data involved descriptive qualities for continuous and categorical variables, with comparisons being made between cases and controls.

Findings

There were 27 subjects featured in the case arm of the study and 25 in the control arm, for a total of 52 participants enrolled in the research. Through the use of a multivariate analysis, the research team investigated the correlation between subjects’ 10-year risk of cardiovascular events (SCORE) and several different factors in patients with psoriasis and those in the control group.

Overall, the team reported that smoking (OR, 5.05, CI95% 1.07–27.37; P = .047), subject age (OR, 1.33; CI95% 1.21–1.50; P < .001), Body Surface Area (BSA) (OR, 1.22, CI95% 1.01–1.49; P = .044), Psoriasis Area and Severity Index (PASI) (OR, 7.98, CI95% 2.32–35.86; P = .003), and control group status (OR, 3.26; CI95% .84–13.56; P = .029) were shown to be substantially linked to an elevated 10-year risk of cardiovascular event experiences.

“The limitations of this study include its small sample size and the relatively short follow-up time (<4 years)...” they wrote. “Furthermore, data for certain metabolic variables at baseline were lacking for the control group, and all the patients from the multidisciplinary clinic were included, with no room for randomization, therefore potentially leading to inclusion bias.”

References

1. ^{García-Malinis AJ, Pérez-Gilaberte JB, Gilaberte Y, et al. The Impact of Shared Assistance between Dermatology and Internal Medicine on Patients with Psoriasis. J Clin Med. 2024 Apr 22;13(8):2441. doi: 10.3390/jcm13082441. PMID: 38673714; PMCID: PMC11051363.}
2. ^{Dhana A., Yen H., Yen H., Cho E. All-cause and cause-specific mortality in psoriasis: A systematic review and meta-analysis. J. Am. Acad. Dermatol. 2019;80:1332–1343. doi: 10.1016/j.jaad.2018.12.037.}