Age at Onset, Psoriatic Arthritis Influence Life Decisions in Patients with Psoriasis

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Sex, age at disease onset, and psoriatic arthritis were associated with the greatest impact on major life-changing decisions in patients with psoriasis.

A cross-sectional study of patients with psoriasis at a hospital psoriasis clinic in Spain is providing an overview of the disease’s impact on major life-changing decisions and clinical factors associated with those choices.

Findings revealed female sex, younger age at disease onset, and psoriatic arthritis (PsA) were associated with several major life-changing decisions related to jobs, education, personal relationships, paternity/maternity, and other lifestyle choices among patients with psoriasis.1

“To date, some published articles refer to the concept of [major life-changing decisions], and also to a proposal of a validated scale to explore [major life-changing decisions], the Major Life Changing Decision Profile,” wrote investigators.1 “However, there are no research studies evaluating how patients with psoriasis are affected in terms of [major life-changing decisions], nor which clinical and sociodemographic factors are associated with a greater or lesser impact of the disease over the patients’ lifetime in terms of [major life-changing decisions].”

An immune-mediated disease causing bodily inflammation, psoriasis affects more than 7.5 million adults in the US. Given its chronic nature, the effects of psoriasis often span beyond physical health. It can also impact patients’ emotional health, relationships, and stress, prompting further research into the effects of psoriasis on day-to-day life and decision-making.2

To explore the impact of psoriasis on major life-changing decisions and associated clinical factors, Salvador Arias-Santiago, MD, PhD, director of the cell production and tissue engineering unit and principal investigator at the Biosanitary Institute of Granada, and colleagues asked patients seen at the psoriasis clinic of Virgen de las Nieves University Hospital in Spain between August 2022 and January 2023 questions about the impact of their disease on life-changing decisions. Adult patients with a clinical diagnosis of psoriasis, regardless of the severity of the disease and treatment followed, who provided informed consent were eligible for inclusion in the study. Investigators noted patients with any other major disease potentially impacting their life decisions were excluded.1

In total, investigators asked 134 patients to participate in the study. Of these, 113 patients were included in the study. This cohort had a mean age of 51.8 (Standard deviation [SD], 13.78) years and who were 52.2% male were included. Among the cohort, the mean disease duration was 23.33 (SD, 16.51) years, the mean body surface affected was 5.56% (SD, 12.7) and the mean psoriasis area severity index score was 3.75 (SD, 9.78). Investigators pointed out most (79.64%) patients were on biologic treatment and 30.9% had psoriatic arthritis.1

Participants were asked about the impact psoriasis had had on their life-changing decisions. Responses were measured on a 4-point Likert scale ranging from “0: No impact at all” to “4: Significant impact.” Variables of interest explored in the questions were decisions related to patients’ jobs, education, personal relationships, paternity/maternity, and other choices about housing, clothes, activities, and drug/alcohol use.1

Upon analysis, the major life-changing decisions most affected by psoriatic disease were associated with career choice (median score, 3; interquartile range [IQR], 2–4), social relationships (median score, 2; IQR, 1–3), and choice of clothing (median score, 2; IQR, 1-3). Other affected domains were job performance, absenteeism days, choice of holiday destination, sexual activity, and family relationships (all median score, 1; IQR, 0–2). Investigators pointed out salary, decision to retire early, educational performance and level of education achieved, choice of partner (all median score, 0; IQR, 0–1), and choice of house characteristics (median score, 0; IQR, 0–0) were not significantly impacted by psoriasis.1

Univariate analyses were performed to explore the clinical and sociodemographic factors associated with the most commonly affected decisions, including career choice, job performance, absenteeism days, social relationships, choice of clothing, and choice of holiday destination.1

Female sex was associated with a greater impact of psoriasis on decisions regarding social relationships, choice of clothing, and holiday destination (all P < .005), while early age at onset was associated with an increased impact of psoriasis on absenteeism, social relationships, choice of clothing, and holiday destination (P < .05). Psoriatic arthritis was related to a greater impact on all major life-changing decisions explored (P < .04) except holiday destination.1

Additional univariate analyses of salary, choice of a place to live, decision to have children, and anxiolytic drugs taken revealed female sex was associated with a greater impact of psoriasis on lifetime salary, choice of place to live, and anxiolytic drugs taken (P < .05). Investigators also pointed out the impact of younger age on the choice of a place to live and the decision to have children (P < .01) and the impact of psoriatic arthritis on salary, decision to have children, and anxiolytic drugs taken (P < .01) in patients with psoriasis.1

“The detection of factors associated with greater impact on MLCD, such as female sex, psoriatic arthritis, or early age of onset, is crucial for limiting the long-term negative effects of the disease on patients,” concluded investigators.1


  1. Sanchez-Diaz M, Díaz-Calvillo P, Soto-Moreno A, Molina-Leyva A, Arias-Santiago S. Factors Influencing Major Life-Changing Decisions in Patients with Psoriasis: A Cross-sectional Study. Acta Derm Venereol. 2023;103:adv11640. Published 2023 Oct 10. doi:10.2340/actadv.v103.11640
  2. National Psoriasis Foundation. Life with Psoriasis. November 17, 2022. Accessed October 19, 2023.