Addressing the Visible and “Invisible” Symptoms of Psoriasis

When many people think of psoriasis (PsO), the inflamed, scaly skin plaques that are the hallmark of the disease come to mind. But for a large portion of the estimated 125 million people worldwide who live with PsO, it’s the symptoms beyond the skin that can have a devastating effect on their daily functioning and wellbeing. (1,2) People living with PsO can struggle with depression and social isolation due to insecurities about body image. (3) The disease can also cause fatigue, which can be severe in some patients, and often goes under-addressed. (2) PsO may also negatively affect intimate relationships by impairing sexual function among both men and women. (3)

#MyCompany has been undertaking important research to understand the profound effect PsO has on patients’ wellbeing. At this week’s American Academy of Dermatology (AAD) Annual Meeting, Janssen will present abstracts on our research addressing both the physical and psychological manifestations of moderate to severe plaque PsO.

Debilitating physical symptoms

Plaque PsO is an immune-mediated disease resulting in an overproduction of skin cells, which causes inflamed skin lesions that may be itchy or painful. (1) Between 25-30 percent of people with PsO also develop active psoriatic arthritis (PsA). (4) In addition to skin lesions, active PsA can present with a myriad of other clinical symptoms including joint and tissue inflammation. (1, 5-8) The painful and swollen joints in active PsA patients can also affect people’s ability to physically function and exercise, which may exacerbate other comorbidities, such as obesity, metabolic syndrome and increased risk for cardiovascular diseases that can occur in both plaque PsO and active PsA patients. (8)

Nearly half all patients with psoriasis suffer from fatigue.

Though nearly half all patients with PsO suffer from fatigue, little attention has been paid to the presence and severity of it. (9) People with psoriatic disease often experience clinically important fatigue, especially among those with active PsA, for whom fatigue has been significantly correlated with the duration of disease, the severity of skin lesions, and the number of painful joints. (10,11) Severe fatigue affects 28 percent of patients with active PsA and 17 percent of those with plaque PsO, and corresponds to reduced quality of life. (11)

Social isolation and loss of employment due to perceived weakness and lack of motivation from fatigue are just some of the distressing quality of life burdens associated with plaque PsO and active PsA. (11,12)

Devastating psychological and social burdens

Beyond physical challenges, living with plaque PsO can impact emotional health, relationships, and the ability to handle the stressors of life for both people with the disease as well as their loved ones. (13-14) For those living with active PsA, sleep disorders, stress, depression, mood and behavioral changes, poor body image, and reduced work productivity are some of the additional burdens of the disease. (12)

Sexual dysfunction can impact more than 40 percent of people with psoriasis.

Plaque PsO can also affect interpersonal relationships, intimacy, and sexual health. (3, 15-18) Plaque PsO may contribute to sexual dysfunction, which can impact more than 40 percent of those with the disease. (3) The effect of plaque PsO on sexual health may be linked to the disease’s impact on physical appearance, decreased libido, and peeling skin (caused by both the condition and topical treatment). (3) Feelings of embarrassment, low self-esteem, and stigmatization are common among plaque PsO patients and may also contribute to avoiding starting a family due to the concern of children inheriting the disease. (3)  

Researchers and providers continue to investigate these important patient needs to develop long-term treatment solutions that can address the myriad burdens people experience throughout their journey with psoriatic disease. At Janssen Immunology, we are committed to the goal of improving the everyday lives of people living with immune-mediated diseases through transformational research and therapies.

#AAD #Dermatology

Since we’re on LinkedIn, I invite you to explore our career opportunities in immunology at Janssen: https://bit.ly/2WKDJLd  

References 

1. National Psoriasis Foundation. About Psoriasis. https://www.psoriasis.org/about-psoriasis. Accessed March 2022.

2. National Psoriasis Foundation. Statistics. https://www.psoriasis.org/psoriasis-statistics/. Accessed March 2022.

3. Duarte GV, Calmon H, Radel G, de Fátima Paim de Oliveira M. Psoriasis and sexual dysfunction: links, risks, and management challenges. Psoriasis (Auckl). 2018 Dec 10;8:93-99. https://doi.org/10.2147/PTT.S159916.

4. Epidemiology Review & US Claims Analysis. Triangulation of diagnosed claims & prevalence citations.

5. Belasco, J., & Wei, N. Psoriatic Arthritis: What is Happening at the Joint? Rheumatology and Therapy, 2019: 6(3), 305–315. https://doi.org/10.1007/s40744-019-0159-1  

6. Donvito, T., CreakyJoints: What Is Enthesitis? The Painful Arthritis Symptom You Should Know About. Available at: https://creakyjoints.org/symptoms/what-is-enthesitis/. Accessed January 2022.  

7. Donvito, T., CreakyJoints: What Is Dactylitis? The ‘Sausage Finger’ Swelling You Should Know About. Available at: https://creakyjoints.org/symptoms/what-is-dactylitis/. Accessed January 2022.  

8. Haddad, A., Zisman, D. Comorbidities in Patients with Psoriatic Arthritis. Rambam Maimonides Med J 2017;8(1):e0004.

9. Skoie, I.M., Dalen, I., Ternowitz, T., Jonsson, G., Kvivik, I., Norheim, K., Omdal, R.. Fatigue in psoriasis: a controlled study. Br J Dermatol. 2017 Aug;177(2):505-512. https://doi.org/10.1111/bjd.15375.

10. Merola, J.F., et al. An Analysis of Fatigue in Patients With Psoriatic Disease Utilizing SF-36 Vitality Scores: Results Through Week 24 in Phase 3 Trials in Patients With Psoriasis and Psoriatic Arthritis. Presented at 2022 AAD Annual Meeting, March 25-29. 

11. Krajewska-Włodarczyk, M., Owczarczyk-Saczonek, A., Placek, W. Prevalence and severity of fatigue in psoriasis and psoriatic arthritis. Postepy Dermatol Alergol. 2020;37(1):46-51. https://doi.org/10.5114/ada.2019.83629.

12. Husni, M.E., Merola, J.F., Davin, S. The psychosocial burden of psoriatic arthritis. Semin Arthritis Rheum. 2017 Dec;47(3):351-360. https://doi.org/10.1016/j.semarthrit.2017.05.010.

13. National Psoriasis Foundation. Life with Psoriasis. https://www.psoriasis.org/life-with-psoriasis/. Accessed March 2022. 

14. Dalgard, F.J., Gieler, U., Tomas-Aragones, L., et al. The psychological burden of skin diseases: a cross-sectional multicenter study among dermatological out-patients in 13 European countries. J Invest Dermatol. 2015;135(4):984-991. https://doi.org/10.1038/jid.2014.530.

15. Zill, J.M., Dirmaier, J., Augustin, M., et al. Psychosocial Distress of Patients with Psoriasis: Protocol for an Assessment of Care Needs and the Development of a Supportive Intervention. JMIR Res Protoc. 2018;7(2):e22. https://doi.org/10.2196/resprot.8490.

16. Kolli, S.S., et al. Psychosocial impact of psoriasis: a review for dermatology residents. Cutis. 2018 Nov;102(5S):21-25.

17. González-Parra, S., Daudén, E. Psoriasis and Depression: The Role of Inflammation. Actas Dermosifiliogr (Engl Ed). 2019 Jan-Feb;110(1):12-19. English, Spanish. https://doi.org/10.1016/j.ad.2018.05.009.

18. Armstrong, A.W., Read, C. Pathophysiology, Clinical Presentation, and Treatment of Psoriasis: A Review. JAMA. 2020 May 19;323(19):1945-1960. https://doi.org/10.1001/jama.2020.4006.