Diagnosis and management of psoriasis and psoriatic arthritis in adults: summary of SIGN guidance

Burden, A. D.; Boon, Michele Hilton; Leman, Joyce; Wilson, Hilary; Richmond, Ruth; Ormerod, AD

doi:10.1136/bmj.c5623

Cited by 47 publications

(33 citation statements)

References 20 publications

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“…The rapidity of the onset of a treatment has rarely been taken into consideration as a specific outcome in the clinical trials. Current guidelines do not consider time until the onset of action (TOA) as a criterion for drug selection (Smith et al, 2005;Pathirana et al, 2009;Burden et al, 2010;Scottish Intercollegiate Guidelines Network (SIGN), 2010;Nast et al, 2011).…”

Section: Discussionmentioning

confidence: 99%

“…Many different aspects have to be considered when choosing an appropriate antipsoriatic treatment for a patient. The current guidelines suggest taking efficacy, safety, practicability for physicians and patients, as well as costs into consideration (Burden et al, 2010;Nast et al, 2011). However, the time necessary for a patient to achieve a significant improvement in the skin disease has been an aspect largely neglected in existing reviews and guidelines.…”

Section: Introductionmentioning

confidence: 99%

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Which Antipsoriatic Drug Has the Fastest Onset of Action?—Systematic Review on the Rapidity of the Onset of Action

Nast¹,

Sporbeck²,

Rosumeck³

et al. 2013

Journal of Investigative Dermatology

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The time necessary for a treatment to become effective is crucial for patients and physicians but has been largely neglected in the reporting and comparison of clinical trials in dermatology. The aim of this systematic review is to determine the time until the onset of action (TOA) of systemic agents approved for moderate-to-severe psoriasis. Primary outcome is the TOA defined as the weighted mean time until 25% of the patients achieved a psoriasis area and severity index (PASI) 75 response. Among the biologics, infliximab has the shortest TOA (3.5 weeks), followed by ustekinumab (high dose 4.6/low dose 5.1 weeks/not weight adapted), adalimumab (4.6 weeks), etanercept (high dose 6.6/low dose 9.5 weeks), and alefacept (high dose 15.4 weeks/low dose: no data). Among the conventional treatments, good data are available for cyclosporine A (CsA; TOA: 6.0 weeks) and limited data are found for methotrexate (MTX; TOA: high dose 3.2/low dose 9.9 weeks). No data are available for fumaric acid esters and retinoids. This systematic review provides clinically relevant information on the onset of action of antipsoriatic agents, although the data currently available allow only a limited assessment. Psoriasis trials should consider including TOA as an additional outcome measure.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Which Antipsoriatic Drug Has the Fastest Onset of Action?—Systematic Review on the Rapidity of the Onset of Action

Nast¹,

Sporbeck²,

Rosumeck³

et al. 2013

Journal of Investigative Dermatology

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show abstract

“…This should include consideration of the pattern of joint involvement [15] and stiffness (>30 min in the morning for inflammation, stiffening on rest in OA) [15], presence of swelling [15], relationship of symptoms to use (the stronger the relationship the more likely the problem is mechanical or degenerative) [15], extra-articular features (fatigue and classic associations with seronegative arthritis such as psoriasis, inflammatory bowel disease and uveitis), assessment for synovitis using the 'squeeze test' (if squeezing the metacarpal/metatarsal joints produces discomfort, referral is indicated) and degree of tenderness. PCPs should be encouraged to use the Psoriasis Epidemiology Study Screening questionnaire for patients with PsA [16]. Other, primary care-validated screening tools should be developed to assist with the detection of IA.…”

Section: Recommendationsmentioning

confidence: 99%

Inflammatory arthritis: case review and primary care perspectives

2012

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Inflammatory arthritis (IA) has significant physical, psychosocial and economic consequences. Delays in diagnosis and initiation of treatment significantly impact on prognosis. The infrequent, variable, non-specific and, sometimes, indolent presentation make recognition of IA by primary care physicians (PCPs) challenging. To undertake an in-depth case review assessing the diagnostic trajectory of patients diagnosed with IA to inform development of practical recommendations to facilitate timely recognition and referral of suspected IA to specialist services, a case review was undertaken in one UK general practice using a proforma to collect information on patient demographics, diagnostic activities (presentation to PCP, specialist referral and final diagnosis) and documentation of disease-specific features for all patients diagnosed with IA between January 2000 and February 2011. Cases were excluded if consultation notes, a definitive diagnosis or evidence of specialist assessment were absent. Twenty-four cases were included in the final analysis. Duration from first primary care presentation to specialist rheumatological referral ranged from 4 to 2,165 days. Undertaking radiographs significantly lengthened delays from presentation to referral. Patients with IA attended between 2 and 41 primary care appointments before being referred. None of the cases identified had a comprehensive record of symptoms documented in the medical record. Once patients present to primary care, specialist referral is not always in accordance with the urgency necessitated in current guidelines. Improving PCPs' knowledge and awareness of IA, development of screening tools and improvement in record keeping are proposed to facilitate early recognition and referral of IA and subsequently reduce the disease burden of IA.

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“…53 PsA should be suspected in patients with psoriasis who have stiffness on waking that lasts > 30 min, spinal stiffness that improves with exercise, joint swelling or tenderness, or dactylitis. 67 Nail dystrophy, scalp lesions and intergluteal/perianal psoriasis are also associated with an increased likelihood of PsA. 68 Ultrasound examination is useful for detecting signs of inflammation and 69 X-ray examination of hands and feet is important to detect PsA-typical erosions and/or osteoproliferation, and to differentiate PsA from other joint diseases such as osteo-arthritis.…”

Section: Assessing Cardiovascular and Metabolic Risk In Patients Withmentioning

confidence: 99%

Management of Psoriasis in Africa and the Middle East: A Review of Current Opinion, Practice and Opportunities for Improvement

et al. 2011

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Psoriasis is a common, chronic, systemic, inflammatory disease of the skin that is often associated with inflammatory musculoskeletal disease. Psoriasis impacts on affected individuals and on society at many levels, being associated with considerable economic burden and impaired quality of life. This article aims to provide dermatologists and their allied healthcare professionals, particularly those practicing in Africa and the Middle East, with a review of the current understanding of psoriasis, its treatment and impact, as a backdrop for further discussion of the management of psoriasis in these regions. Insight into the real-life, day-to-day challenges and unmet needs currently facing dermatologists in Africa and the Middle East is provided by the authors, most of whom are experienced dermatologists practicing in this region.

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Diagnosis and management of psoriasis and psoriatic arthritis in adults: summary of SIGN guidance

Cited by 47 publications

References 20 publications

Which Antipsoriatic Drug Has the Fastest Onset of Action?—Systematic Review on the Rapidity of the Onset of Action

Which Antipsoriatic Drug Has the Fastest Onset of Action?—Systematic Review on the Rapidity of the Onset of Action

Inflammatory arthritis: case review and primary care perspectives

Management of Psoriasis in Africa and the Middle East: A Review of Current Opinion, Practice and Opportunities for Improvement

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