POS0149 MUSCULOSKELETAL PAIN IN PATIENTS WITH PSORIASIS AND THE INFLUENCE ON HEALTH-RELATED QUALITY OF LIFE: RESULTS FROM A DANISH POPULATION-BASED SURVEY
Authors: Kamp Felbo S. , Terslev L. , Sørensen I. J. , Skov L. , Zachariae C. , Østergaard M. 
Published: May 2021

Background:

Psoriasis (PsO) impacts health-related quality of life (HRQoL). The impact of musculoskeletal (MSK) pain in patients without diagnosed psoriatic arthritis (PsA) (1) is poorly understood.

Objectives:

To assess the pattern of MSK pain in patients with PsO, and its influence on important patient-reported outcomes.

Methods:

A nationwide survey of patients with PsO and PsA, covering skin and MSK symptoms, healthcare contacts, self-assessed disease severity, treatment satisfaction, HRQoL (including Dermatology Life Quality Index (DLQI) and European Quality of life-5 Dimensions (EQ5D)) and disability. Respondents were grouped according to MSK pain as shown in Table 1. ‘PsO previous pain’ was combined with ‘PsO no pain ever’ (labeled ‘PsO no pain now’) for some analyses and with ‘PsO pain now’ (labeled ‘PsO pain ever’) for others.

Table 1.

Population and subgroup characteristics

DEMOGRAPHICSAllPsO no pain everPsO previous painPsO pain nowPsAp-value*N561178104130108Male212 (38%)79 (44%)34 (33%)36 (28%)40 (37%)0.02Age (years)58 (43-68)58 (43-68)56 (42-63)53 (43-63)58 (48-68)0.05Body Mass Index27 (24-32)26 (23-30)28 (24-32)29 (25-33)28 (24-33)0.01No current occupation1119 (21%)20 (11%)23 (22%)34 (26%)35 (32%)<0.001PsO/PsA FEATURESAll1. PsO no pain ever2. PsO pain ever3. PsA1 vs. 21 vs. 32 vs. 3N561178234108BSA (%)1 (1-2)1(1-2)1 (1-2)2 (1-2)0.10<0.0010.01Nail psoriasis134 (24%)27 (15%)50 (21%)46 (48%)0.13<0.001<0.001‘Dactylitis’ 2a80 (14%)2 (1%)34 (15%)40 (42%)<0.001<0.001<0.001‘Enthesitis’ 2b74 (13%)4 (2%)30 (13%)39 (41%)<0.001<0.001<0.001QUALITY OF LIFE AND DISABILITYAll1. PsO no pain now2. PsO pain now3. PsA1 vs. 21 vs. 32 vs. 3N561282130108DLQI score (0-30)2 (1-5)1 (1-4)2 (1-5)2 (1-6)0.0010.040.52EQ5D index (0-1)0.797 (0.691-0.859)0.859 (0.768-1)0.732 (0.679-0.859)0.702 (0.598-0.802)<0.001<0.0010.53HAQ score (0-3)0.63 (0-1.25)0.50 (0-0.88)0.88 (0.13-1.38)0.03

Numbers are numbers (%) (binary data), median (interquartile range) (continuous data).

BSA: Body Surface Area (palm-size areas of the body with psoriasis). DLQI: Dermatology life quality index (higher scores = higher impact of disease). EQ5D: European Quality of life-5 Dimensions -5 Domain (higher scores = better health state). HAQ: Health assessment questionnaire. PsA: Psoriatic arthritis. PsO: Psoriasis.

* Multiple groups: Chi-square test/ Kruskal-Wallis test. Pairwise: Fishers exact test/Mann-Whitney U test

1. I.e. work/studies/retirement 2. a. “Swollen entire finger or toe” b. “Tender or swollen tendon”.

Results:

561 respondents with PsO completed the questionnaire. Population and subgroup demographics, clinical PsA/PsO features and HRQoL measures are shown in Table 1. Patients in ‘PsO pain now’ had poorer HRQoL (higher DLQI, lower EQ5D) compared to ‘PsO no pain now’, and similar to patients with PsA. Patients with PsA assessed their PsO severity higher than patients with ‘PsO pain ever’ and ‘PsO no pain ever’ (median (interquartile range) 2 (2-3), 2 (1-3) and 2 (1-2) on a five-level scale, respectively). PsO treatment satisfaction (five-level scale) was lower for ‘PsO pain ever’ (3 (3-4)) than for ‘PsO no pain ever’ (4 (3-4), p=0.03). Figure 1 shows contacts to dermatologists and rheumatologists, where 72% of patients in ‘PsO pain ever’ had never been examined by a rheumatologist. Time from symptom debut to diagnosis was 1.5 (1-3) years for PsO and 7.5 (1.5-12.5) for PsA.

Figure 1.

Contacts to specialists by subgroup

Conclusion:

Patients with PsO and MSK pain have decreased HRQoL compared to patients with PsO without MSK pain, to a similar degree as patients with PsA. Many have never been examined by a rheumatologist, demonstrating an unmet need for adequate evaluation of these patients.

References:

[1]Lebwohl MG et al. Patient perspectives in the management of psoriasis: results from the population-based Multinational Assessment of Psoriasis and Psoriatic Arthritis Survey. J Am Acad Dermatol. 2014.

Acknowledgements:

The authors acknowledge the participants who contributed to this study. The study was financially supported by Amgen/Celgene. The Danish Rheumatism Association, The Danish Psoriasis Research Foundation and The Capital Region of Denmark have supported the work of SKF. The sponsors had no influence on study design, data analysis or manuscript preparation.

Disclosure of Interests:

Sara Kamp Felbo Grant/research support from: Celgene, Lene Terslev Speakers bureau: AbbVie, Janssen, Roche, Novartis, Pfizer, MSD, BMS, Inge Juul Sørensen: None declared, Lone Skov Speakers bureau: AbbVie, Eli Lilly, Novartis, and LEO Pharma, Consultant of: AbbVie, Janssen Cilag, Novartis, Eli Lilly, LEO Pharma, UCB, Almirall, Bristol-Myers Squibb, and Sanofi., Grant/research support from: Novartis, Sanofi, Bristol-Myers Squibb, Janssen Cilag, and LEO Pharma., Claus Zachariae Speakers bureau: Eli Lilly, Jansen Cilag, Novartis, Abbvie, Takeda, Amgen, Almirall, CSL, UCB, Regeneron, MSD, and Leo Pharma, Consultant of: Eli Lilly, Jansen Cilag, Novartis, Abbvie, Takeda, Amgen, Almirall, CSL, UCB, Regeneron, MSD, and Leo Pharma, Mikkel Østergaard Speakers bureau: AbbVie, BMS, Boehringer-Ingelheim, Celgene, Eli-Lilly, Hospira, Janssen, Merck, Novartis, Novo, Orion, Pfizer, Regeneron, Roche, Sandoz, Sanofi and UCB, Consultant of: AbbVie, BMS, Boehringer-Ingelheim, Celgene, Eli-Lilly, Hospira, Janssen, Merck, Novartis, Novo, Orion, Pfizer, Regeneron, Roche, Sandoz, Sanofi and UCB, Grant/research support from: AbbVie, BMS, Boehringer-Ingelheim, Celgene, Eli-Lilly, Hospira, Janssen, Merck, Novartis, Novo, Orion, Pfizer, Regeneron, Roche, Sandoz, Sanofi and UCB