New Psoriasis and Psoriatic Arthritis Guidelines

The American Academy of Dermatology (AAD) recently released an updated version of its guidelines outlining the recommended approach to treating patients with mild to severe cases of psoriasis. According to a news release from the AAD, the latest guidelines “[build on] the evidence-based findings of five previously published guidelines of care that examine the use of a variety of medical therapies for the management and treatment of psoriasis and psoriatic arthritis.”

The guidelines, available online here, review “key findings from the five previously published sections that focused on general recommendations for the treatment of psoriasis and psoriatic arthritis, as well as the use of biologic, topical, systemic and ultraviolet (UV) light therapies.”

AAD President Ronald L. Moy, MD, FAAD, said “There are many factors that dermatologists must consider when treating psoriasis, including the severity of the disease, overall health of the patient, tolerability of therapies and potential side effects, and the patient’s level of satisfaction with the treatment regimen… These guidelines provide a very comprehensive assessment of the available therapies for psoriasis, while stressing the importance of tailoring treatments to meet individual patients’ needs and monitoring the patient for any other commonly associated medical problems.”

The AAD news release notes that “Although psoriasis was previously thought to be a disease affecting primarily the skin and the joints, a growing body of research suggests that psoriasis patients are at an increased risk of developing serious medical conditions, including heart disease, type 2 diabetes, lymphoma and obesity.” If left unchecked, these conditions can lead to serious health consequences for psoriasis patients. Recent evidence suggests “an overall increased risk of mortality in patients with severe psoriasis, especially those who have autoimmune and cardiovascular diseases.”

Based on this information, Moy noted that “It is important for psoriasis patients to seek treatment for psoriatic arthritis early and to discuss any warning signs of this potentially debilitating condition with their dermatologist… If left untreated, psoriatic arthritis can result in persistent inflammation, joint damage, severe physical limitations and even disability in some patients.”

According to the overview, the guidelines “address the treatment of both adult and childhood psoriasis and psoriatic arthritis. This document will include the various treatments of psoriasis including topical modalities, ultraviolet (UV) light therapies, systemic agents, and the biologic therapies.” The guidelines also review “quality of life (QOL) parameters, the type of psoriasis, and the presence of comorbidities such as obesity and other associations of the metabolic syndrome.” The guidelines are subdivided into five separate documents:

• An overview of psoriasis classification, comorbidities, and assessment tools, as well as the biologic treatments for psoriasis
• Treatments for psoriatic arthritis, with an emphasis on the biologics
• Topical therapies
• UV light therapy and systemic nonbiologic therapies
• An overall approach to the treatment of patients with psoriasis with an emphasis on decision-making criteria

The introduction to the guidelines notes that although the guideline is compartmentalized, with each section focusing on a specific aspect of diagnosis and/or treatment, it is important for dermatologists to address psoriasis “in its entire scope of manifestations.” This guideline does not cover “the effectiveness of treatments for the less common subtypes of psoriasis, such as guttate, pustular, inverse, and erythrodermic.”