Analysis of the relationship between psoriasis symptom severity and quality of life, work productivity, and activity impairment among patients with moderate-to-severe psoriasis using structural equation modeling

Abstract

BackgroundPlaque psoriasis is a chronic disease characterized by scaly plaques on the skin that can itch and bleed. Psoriasis covering over 10% of the body is classified as moderate to severe, and can impact patient quality of life.ObjectivesTo assess the relationship between plaque psoriasis self-reported severity symptoms and health-related quality of life, work productivity, and activity impairment among patients with moderate-to-severe psoriasis.MethodsThe study sample included 199 patients recruited from internet panels, of which 179 respondents had plaque psoriasis and 20 had plaque and inverse psoriasis. Itching, pain, and scaling symptoms were studied. A structural equation modeling framework was used to estimate the effect of these symptoms on patient outcomes. First, each severity variable was regressed on a set of covariates to generate a predicted severity score. These predicted values were placed in a second-stage model with patient mental and physical scores (Short-Form 12 questionnaire), work productivity, and activity impairment indicators as dependent variables.ResultsItching severity had a marginal negative effect (P < 0.06) on patients’ Short-Form 12 physical and mental component scores. Pain severity also negatively affected physical and mental health scores (P < 0.02). Patients were more likely to miss work because of itching (odds ratio [OR]: 2.31, 95% confidence interval [CI]: 1.30, 4.10), pain (OR: 1.78, 95% CI: 1.25, 2.52), and scaling (OR: 2.15, 95% CI: 1.31, 3.52) symptoms. These symptoms also lowered self-reported productivity. As itching (OR: 1.74, 95% CI: 1.03, 2.95), scaling (OR: 1.84, 95% CI: 1.16, 2.90), and pain symptoms (OR: 1.53, 95% CI: 1.12, 2.09) increased, so did the odds that a patient would be less productive at work.ConclusionPlaque psoriasis significantly affects patient quality of life. In addition to greater mental and physical pain, patients are more likely to miss work and have diminished productivity as symptom severity increases.

Association between physical activity and risk of prevalent psoriasis

“…[ 25 ] Several studies have investigated the relationship between physical activity and psoriasis, and some of these studies have found contradictory data. [ 26 – 30 ] Some scholars believe that physical activity is likely to aggravate the severity of psoriasis, while others believe that psoriasis is likely to improve following a course of voluntary exercise. In our clinic, a large number of patients with psoriatic skin symptoms and mental health problems (anxiety, tension, low self-esteem, isolation, and depression) showed improvements in their condition following varying degrees of physical activity.…”

The experience of pain and redness in patients with moderate to severe plaque psoriasis

“…Pain has been self-reported as a symptom in 17–83% of patients with plaque psoriasis ( 1–4 ). Skin redness is also a common symptom in patients with plaque psoriasis and has been self-reported in 71–79% of patients ( 3 , 5 ). Patients with psoriasis who experience pain are more likely than patients without pain to miss work (odds ratio [OR] = 1.78; 95% confidence interval [CI] = 1.30–4.10), experience reduced productivity while at work (OR = 1.53; 95% CI = 1.12–2.09) and have difficulty performing daily activities (OR = 1.53; 95% CI = 1.19–1.96) ( 3 ).…”

“…Skin redness is also a common symptom in patients with plaque psoriasis and has been self-reported in 71–79% of patients ( 3 , 5 ). Patients with psoriasis who experience pain are more likely than patients without pain to miss work (odds ratio [OR] = 1.78; 95% confidence interval [CI] = 1.30–4.10), experience reduced productivity while at work (OR = 1.53; 95% CI = 1.12–2.09) and have difficulty performing daily activities (OR = 1.53; 95% CI = 1.19–1.96) ( 3 ). Notably, pain associated with psoriasis has a severe negative effect on sleep, which profoundly affects health-related quality of life (HRQoL) ( 1 , 6 , 7 ).…”

Effect of tofacitinib withdrawal and re‐treatment on patient‐reported outcomes: results from a Phase 3 study in patients with moderate to severe chronic plaque psoriasis

“…This finding is particularly pertinent given recent reports from a population‐based survey, in which 43% of more than 3000 patients with psoriasis indicated that pruritus was the most bothersome symptom 10, 34. In addition, pruritus is more likely to result in the absence from work than pain or scaling, and leads to reduced productivity 35. Therefore, for patients with psoriasis who are distressed by pruritus, tofacitinib may potentially represent an important future treatment option.…”