Multidisciplinary Perspectives on the Management of Plaque Psoriasis - Episode 3
Mark Lebwohl, MD: I’ll tell you what we use in the skin, but what physical, psychological, and social burdens does psoriatic disease have on patients, and how are these linked? I’m sure you’re aware of an old SF-36 study. SF-36 is a measure of the impact of physical function or psychological function of different diseases. It turns out, when you look at physical functioning, psoriasis had more impact on physical functioning than conditions like cancer and diabetes. Only congestive heart failure had a more negative impact on physical functioning and on psychological functioning, and only depression had a worse impact than psoriasis.
Again, psoriasis had a worse impact on psychological functioning than cancer, diabetes, and many other diseases that, on the face of it, we would think are more sever. Psoriatic arthritis has to be debilitating. What are the psychological, physical, and social burdens of psoriatic arthritis on patients?
Philip J. Mease, MD: Mark, it’s all that you’ve just described and more, and I’ve seen those same SF-36 data, which rank psoriasis and psoriatic arthritis right up there at the top in terms of impairment for quality of life. When you have the double whammy of embarrassing and emotionally distressing skin lesions—especially, for example, if someone has grown up as an adolescent or in their 20s—when they’ve got this social stigma, they’re embarrassed to go to the swimming pool or to the beach. You combine that with the physical disability of painful joints, painful back, and difficulty getting about. It can lead to a severe state of depression, and it’s something we clinicians just never really address adequately, in my opinion.
We are in a bit of a hurry. We realize that if we start to probe with questions about emotional well-being that we can open up a whole can of worms in the discussion with the patient. When we really need to, and they need to share their emotional burden with us as part of the trusting process with us, with the clinician, all I can do is just exhort people who are listening to take the time to inquire, and sometimes—fortunately, rarely in my experience—you’ll pick up suicidal ideation, and 1 of the things that can happen with these 2 diseases or these 2 aspects of 1 disease is that there can be increased suicide rate. That’s something we just don’t want to see.
Mark Lebwohl, MD: I know you must face some of the same challenges we face in the management of patients, but in some cases, because of the cost of treatments, they think any treatment is bad for them.
Transcript Edited for Clarity