Patients with Psoriatic Disease Report Discordance with Provider over Treatment Goals

Joseph Merola, MD, MMSc
Credit: Brigham and Women's Hospital

An analysis of survey data from more than 1000 patients and 200 providers is shining a spotlight on the discordance between advances in management of psoriatic disease and patient satisfaction in the US.

An analysis of data from the Understanding Psoriatic Disease Leveraging Insights for Treatment (UPLIFT) survey, results of the study indicate more than half of patients surveyed with psoriatic arthritis believed they were not aligned at all with their rheumatologist on treatment goals, with investigators also noting a similar proportion of patients with psoriatic arthritis reported a “strong” need for better treatments.¹

“The 2020 UPLIFT survey emphasized the consistent significant disease burden of US patients with PsO and/or PsA, even in those with localized disease. The findings were largely similar between the US and global populations,” wrote investigators.¹ “Survey responses highlighted the need for treatment optimization as well as alignment between patients and [health care providers].”

With a well-documented impact on mental health and quality of life, management of psoriatic disease, particularly, psoriatic arthritis represents a challenge for modern clinicians. As a result of this obvious impact on quality of life, the field has paid deliberate attention to monitoring and assessing quality of life for these patients, including the UPLIFT survey and the 2012 MAPP survey.^2,3

The UPLIFT survey was a web-based, 30-minute survey conducted between March 2, 2020-June 3, 2020, in Canada, France, Germany, Italy, Japan, Spain, the UK, and the US. The UPLIFT survey had more than 260,000 global responders. Led by Joseph Merola, MD, director of the Center for Skin and Related Musculoskeletal Diseases at Brigham and Women’s Hospital, investigators Limited their study to US respondents and identified cohorts of 1006 patients and 216 physicians for inclusion. Further eligibility criteria for the study required eligible physicians to have had a primary or secondary specialty in dermatology or rheumatology where they spent 50% or more of their professional time directly treating patients and saw at least 20 adults with psoriasis or psoriatic arthritis in a typical month. Of note, investigators pointed out US patients accounted for 26.4% of the 3806 global respondents reporting psoriasis or psoriatic arthritis.¹

The patient cohort had a mean age of 46.3 years, 51.3% were women, and 58.6% had a BMI equal to or greater than 25 kg/m2. When examining disease characteristics, investigators found 53.2% (n=535) had psoriasis, 39.7% (n=399) had psoriasis and psoriatic arthritis, and 7.1% (n=72) had psoriatic arthritis alone. Overall, 115 of the 216 physicians were dermatologists and the remaining 101 were rheumatologists.¹

Upon analysis, results indicated 66.4% of patients reported a body surface area (BSA) of 3 or more, with 56.2% of these patients rating their disease as moderate or severe. In subgroup analysis, the majority of patients (60.8%-86.1%) across BSA subgroups had a Dermatology Life Quality Index score of 6 or greater, which investigators pointed out indicates at least a moderately impacted quality of life.¹

Among those with psoriasis, results suggest 40.1% felt they were somewhat closely aligned with their dermatologist on treatment goals and 49.3% felt closely aligned. Among those with psoriatic arthritis, only 32.1% reported not feeling too closely aligned with their rheumatologist while 59.3% reported feeling like they were not aligned at all. When examining the desire for better treatments, 35.5% and 31.8% with psoriasis and psoriatic arthritis, respectively, reported a moderate need for better treatments while 47.7% of those with psoriasis and 53.9% of those with psoriatic arthritis reported a strong need for better treatments.¹

“Despite more treatments being available at the time of the UPLIFT survey versus the MAPP survey, UPLIFT responses demonstrate a continued unmet need for better disease management. In addition, differing perceptions among patients and physicians about treatment goals require additional research to understand how patients and physicians can collaboratively make management decisions to optimize overall care,” investigators wrote.¹

References:

1. Merola JF, Ogdie A, Gottlieb AB, et al. Patient and Physician Perceptions of Psoriatic Disease in the United States: Results from the UPLIFT Survey [published online ahead of print, 2023 May 15]. Dermatol Ther (Heidelb). 2023;1-18. doi:10.1007/s13555-023-00929-9
2. Turkiewicz AM, Calabrese LH, Desai S, Orbai A-M. Impact of PSA on quality of life. HCP Live. November 23, 2021. Accessed May 18, 2023. https://www.hcplive.com/view/impact-of-psa-on-quality-of-life.
3. Lebwohl MG, Kavanaugh A, Armstrong AW, Van Voorhees AS. US Perspectives in the Management of Psoriasis and Psoriatic Arthritis: Patient and Physician Results from the Population-Based Multinational Assessment of Psoriasis and Psoriatic Arthritis (MAPP) Survey. Am J Clin Dermatol. 2016;17(1):87-97. doi:10.1007/s40257-015-0169-x