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5 th World Psoriasis & Psoriatic Arthritis Conference 2018
and treatment, psoriasis patients were often separated from the general population for fear of them contaminating others. People with psoriasis – thousands in medieval Europe – were forced to warn others of their arrival by ringing a clapper. It wasn’ t until the early 1800’ s that psoriasis was determined to be a condition separate from leprosy. In the cultural movement of Renaissance some authors mentioned the diseases psora and lepra in their books. In the 18th century hospitals or dispensaries were opened only for treatment of skin or venereal diseases giving to the physicians the opportunity to study more cases of skin diseases and psoriasis as well, while the end of the 19th century psoriatic micro morphology was already described. In 20th century many authors studied the genetic alteration, and today there is undisputed evidence that the disease is multifactorial. Psoriasis, as a common disease, has a significant socio-economic impact on the individual and on the society. Last decades numerous immunological researches accumulate evidence of presence of alteration of the innate and adaptive immune response in psoriatic patients. This imply a primary disregulation of the immune system and permitts a better understanding and new insight in the pathogenesis and as well new possibilities in the management of psoriasis. This article shows a retrospective view of development of our knowledge on psoriasis through history.
P148 COMORBIDITIES AND TREATMENTS IN PATIENTS
WITH INVERSE PSORIASIS Mia Schneeweiss, Joseph Merola Brigham and Women’ s Hospital
Introduction: Inverse( intertriginous) psoriasis is an underdiagnosed, often untreated phenotype of psoriasis( PsO) with a high burden of illness. Inverse PsO may occur in up to 23 % of subjects with psoriasis, higher than previously reported. Objectives: To characterize the frequency of inverse PsO and patient characteristics and their treatment in a large commercial insurance claims database. Methods: We used longitudinal claims data from commercially insured patients in the US between 10 / 2015 and 12 / 2016 to identify adults with a diagnosis of flexural psoriasis( ICD-10-CM: L40.8,“ other psoriasis” which is“ recommended to be used for flexural PsO”) associated with an outpatient or inpatient encounter. A 180- day enrollment period was required before the first diagnosis of AD. Among those diagnosed we computed the risk of initiating immunomodulating medications during the following 6 months. All analyses were conducted using the Aetion Evidence Platform. Results: Of 1.5million patients with at least one code for PsO, after excluding patients with concomitant other autoimmune conditions, we identified 5,310 patients with an ICD-10 code of L40.8 used for inverse PsO( 4 / 1,000) with a median age of 52 years and an equal gender distribution. Half of the patients were 41 – 60 years old. Of those, 0.3 % generalized pustular, 0.5 % guttate, and 0.2 % pustulosis palmaris et plantaris. Prevalent comorbidities included depression( 7 %), anxiety( 6.5 %), and cardiovascular conditions( 5 %). 20 % received antidepressants. Within 180 days after the diagnosis of flexural PsO, 81 % were using high-potency topical corticosteroids, 66 % phototherapy, 8.6 % calcipotriene, 5.6 % ustekinumab, 7.2 % methotrexate, 7.3 % adalimumab, 3.3 % etanercept, 1.3 % acitretin, 0.8 % infliximab, 0.9 % Cyclosporine, 0.1 % Sulfasalazine, 0.02 % topical tacrolimus, 0.5 % topical pimecrolimus. In patients 60 +, 83 % used high-potency topical corticosteroids, 7.8 % phototherapy, 8.8 % calcipotriene, 3.1 % ustekinumab, 6.9 % methotrexate, 4.8 % adalimumab, 2.9 % etanercept, 1.5 % acitretin, 0.5 % infliximab, 0.9 % Cyclosporine, 0.6 % topical pimecrolimus. Limitations: Although the ICD-10-CM code L40.8 is recommended for flexural PsO, its sensitivity / specificity for validating cases of flexural PsO has not been established, it may not encompass all aspects of inverse / intertiginous disease and the code may be highly underutilized. Conclusions: Using the code ICD-10-CM L40.8, which is recommended to be used for inverse“ flexural” PsO leads to lower prevalence estimates of inverse PsO than previously reported; this underscores the known underreporting and underdiagnosis of this condition. Among those patients diagnosed and coded, most received topical corticosteroids and / or phototherapy, others received calcipotriene, ustekinumab, methotrexate, adalimumab, etanercept, and acitretin. Further work is needed to understand how best to capture inverse( intertriginous) / flexural psoriasis for clinical research work.
P150 DEVELOPMENT OF THE“ PSO SLEEPY-Q” AND THE“ PSA SLEEPY-Q”: TWO QUESTIONNAIRES TO CHARACTERIZE SLEEP IN PATIENTS WITH
PSORIATIC DISEASE Lourdes Perez-Chada Harvard Medical School- Brigham and Women’ s Hospital
Introduction: Substantial evidence suggests that psoriasis( PsO) and psoriatic arthritis( PsA) are independently associated with sleep disturbance, which may result in serious health consequences including cardiovascular events and mortality. However, the validity of the sleep measures used in these studies is unknown as they have not been validated in patients with psoriatic disease or included psoriatic patients during their development process. There is a need for validated disease-specific Patient-Reported Outcome Measures( PROMs) to accurately characterize sleep in this population and to measure the effect of psoriatic therapies on sleep disturbance. Objectives: This study aimed to develop and establish the content validity of 2 new sleep PROMs: the“ PsO Sleepy-Q” and the“ PsA Sleepy-Q”. Methods: Following FDA PROM-development guidance, our study:( i) hypothesized a conceptual framework and identified domains through literature review and patient semi-structured interviews using a saturation model( n = 30);( ii) rated domains for importance by patients( n = 42) and an international expert panel including dermatologists, rheumatologists and sleep experts( n = 45);( iii) selected final domains based of the patients’ preference;( iv) generated item pools and the preliminary versions of the instruments. Results: Psoriatic patients reported that sleep maintenance, adequacy, quantity and quality were the most important aspects of disordered sleep. Regarding causes of disturbed sleep: itch, skin and joint pain, stiffness, taking care of psoriatic lesions before bedtime, worsening of psoriatic symptoms at night, feeling uncomfortable in bed due to PsA and sleep apneawere the most outstanding factors selected. Finally, patients reported that disturbed sleep may increase psoriatic signs and symptomsas well as fatigue, cognitive impairment and psychological stress. Overall, patients with PsA expressed a higher burden of sleep disturbance compared to patients with PsO. Preliminary versions of the“ PsO Sleepy- Q” and“ PsA Sleepy-Q” including 18 and 24 items, respectively, were created. These questionnaires intend to measure the degree of sleep disturbance, the potential causes of sleep disturbance and the impairment related to sleep disturbance. Conclusion: This study establishes the content validity of the“ PsO Sleepy-Q” and“ PsA Sleepy-Q”, two patient-derived PROMs to characterize sleep in patients with psoriatic disease in research and clinical settings. These questionnaires will undergo cognitive debriefing and further psychometric testing to define the final instrument forms. www. medicaljournals. se / acta