Poster abstracts 61
P151 UNSTABLE FORMS OF PSORIASIS – INDICATOR OF AN
INTERMEDIATE STATE OF SYSTEMIC DISEASE Florentina-Silvia Delli State Hospital for Skin and Venereal Diseases- Hippokratia General Hospital, Thessaloniki, Greece
Introduction: Erytrodermic psoriasis, inverse psoriasis and generalized pustular psoriasis are considered three particular clinical forms of psoriasis. Objectives: We present two clinical cases in which it is discussed the possibility of considering these clinical pictures as a manifestation of the immunological switch of psoriasis from an organ-target( skin or joint) disease, to a systemic form of psoriasis. Methods: A 22-year-old-man with erythodermic psoriasis and a history of inverse psoriasis since childhood was successfully treated with 60 mg acitretin, until the diagnosis of psoriatic arthritis at the age of 26. The presence of arthritis determined us to change the therapy. Secukinumab at the classic therapeutic scheme is keeping the patient’ s skin clean of psoriatic lesions, except from the armpits, and without any arthritic symptoms. A 75-year-old-woman with psoriatic arthritis and hyperkeratotic palms and soles nonspecific lesions, under infliximab therapy presented generalized pustular psoriasis. After 3 months of acitretin 40mg and etanercept at the classic dose, the patient remains free of any symptoms. Conclusions: The majority of psoriasis studies focus on chronic plaque psoriasis. We sustain the opinion that the above unstable forms of psoriasis, usually impossible to diagnose by other specialities than Dermatology, should be consider the main step in multidisciplinary approach of psoriasis as a systemic disease. References: 1. Kivelevitch D et al. Pharmacotheraputic approaches for treating psoriasis in difficult-to treat areas. ExpertOpinPharmacother 2018 April; 19( 6); 561-575 2. Sano S et al. Guselkumab, a human interleukin-23 monoclonal antibody in Japanise patients with generalized pustular psoriasis: efficacy and safety analyses of a 52-week, phase 3, multicentre, open-label study. JDermatol 2018 May; 45( 5): 529-539 3. Cafaro G, McInnes IB. Psoriatic arthritis: tissue-directed inflammation? ClinRheumatol 2018 Apr; 37( 4): 859-868.
P152 COULD BIOLOGICAL AGENTS FOSTER SUICIDE THROUGH ITS POTENTIAL ANTIDEPRESSANT MECHANISM? A PSYCHODERMATOLOGICAL
APPROACH Estela M Malatesta Dermatologist and Psychiatrist, Doctor. Arturo Ameghino Mental Health Centre, Buenos Aires, Argentina. President of ADEPSI, Academy of Dermatology and Psychiatry
Introduction: Depression and Psoriasis are associated in up to 60 % of the cases, with an increased risk of attempted and completed suicide in patients with severe forms of the disease. Bipolar Disorder is a biological condition that affects between 2 and 5 % of the population, being an important cause of disability in the world. In spite of this, Bipolar Disorder is often underdiagnosed as Unipolar Depression, which increases the possibility of prescribing errors, as it occurs when administering only antidepressant agents without accompanying them with mood stabilizers, fostering the appearance of episodes of inverse polarity( SWITCHING) which, in turn, raises the risk of suicide. Objectives: The“ Cytokine Hypothesis” as a cause of depression suggests the association between the immune system and depression through the induction of the indolamine 2, 3- dioxygenase enzyme. The objectives of the poster are:
• To raise the need for new studies to confirm this hypothesis as well as the antidepressant effect of biological agents and their potential ability to cause a shift into mania.
• To deepen the criteria for patient selection for both scientific and therapeutic protocols. Methods: This poster reviews the literature for evidence that while biological agents could improve the mood of patients with psoriasis treated with these drugs, this same favourable antidepressant effect on humor may trigger a switch of mood into mania, favouring attempted and completed suicide in undiagnosed bipolar patients treated for psoriasis with IL17-TNF alpha cytokine blockers. Results: Evidence gathered so far suggests that common inflammatory processes could underpin both bipolar and psoriasis. The current literature is lacking of longitudinal and mechanistic studies, as well as comparison studies to explore the magnitude of this relation. Conclusion: Considering both bipolar disorder and psoriasis as a multi-system disorder should help us understand the common physiopathology of this comorbidity so as not to see them as separated disorders. Consequently, it is vital to emphasize the importance of the initial psychiatric evaluation for a correct psychiatric / clinical diagnosis for patients with Psoriasis to be both admitted to a strict control protocol and treated with biological agents.
P153 TREATING THE PAIN, NOT THE PROBLEM? RESULTS FROM A SWEDISH ONLINE SURVEY ON PSORIATIC
ARTHRITIS AND PSORIASIS WITH JOINT PAIN T Norgren, B Bohannan Psoriasisförbundet, Stockholm, Sweden
Introduction: Psoriatic arthritis( PsA) is a chronic inflammatory disease associated with psoriasis, that can cause pain, swelling and, if untreated, severe joint destruction and disability. The knowledge about PsA among both the public and healthcare providers is limited, leading to both underdiagnosis and undertreatment. To raise awareness of PsA and gather relevant data, the Swedish Psoriasis Association( Psoriasisförbundet) and the Swedish Rheumatism Association( Reumatikerförbundet) initiated an educational awareness campaign on a well-visited online health information platform, which also featured a survey on healthcare experiences and Quality of Life. Objectives: The purpose of the survey was to identify gaps or discrepancies in the healthcare provided for individuals diagnosed with PsA and for individuals with psoriasis and joint pain consistent with a PsA diagnosis, as well as understanding the impact on QoL for both groups. Methods: The survey consisted of two questionnaires, one for individuals diagnosed with PsA, group A, and one for individuals diagnosed with psoriasis who have joint pain consistent with a PsA diagnosis( using CASPAR criteria as reference), group B. The survey was open from April 6 2017 to March 31 2018. The total number of respondents in group A was 5 201, and in group B 11 272. It was not mandatory to answer all questions in the survey. One section of the survey focussed on prescribed medication, to specifically identify discrepancies in the treatment of the diagnosed( A) and undiagnosed( B) groups. Limitations: self-reported diagnosis, possible to take survey multiple times using different devices. Results: In response to the question“ Which medication has been prescribed for your joint pain during the past year?” 23.91 % of group B( 214 of 895) answered that they had been prescribed opioid pain medication for their joint pain. In group A only 4.61 % of the respondents( 73 out of 1 582) were prescribed opioid pain medication for their PsA. Conclusions: The results show a large discrepancy between the groups in the prescription of opioid pain medication. The results suggest that individuals with psoriasis that have joint pain consistent with a PsA diagnosis are being over-prescribed potentially addictive pain medication rather than receiving treatment for their underlying condition or inflammatory symptoms apart from pain.
Acta Derm Venereol 2018