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Vol. 103. Issue S1.
Pages 1-64 (January 2012)
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Vol. 103. Issue S1.
Pages 1-64 (January 2012)
DOI: 10.1016/S1578-2190(12)70829-6
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Integrated Approach to Comorbidity in Patients With Psoriasis
Abordaje integral de la comorbilidad del paciente con psoriasis
Visits
...
E. Daudéna, S. Castañedab, C. Suárezc, J. García-Campayod, A.J. Blascoe,??
Corresponding author
ablasco@taiss.com

Corresponding author.
, M.D. Aguilare, C. Ferrándizf, L. Puigg, J.L. Sánchez-Carazoh, representing the Working Group on Comorbidity in Psoriasis *
a Dermatology Department, IIS-Princesa, Hospital Universitario La Princesa, Madrid, Spain
b Rheumatology Department, IIS-Princesa, Hospital Universitario La Princesa, Madrid, Spain
c Internal Medicine Department, IIS-Princesa, Hospital Universitario La Princesa, Madrid, Spain
d Department of Psychiatry, Hospital Miguel Servet, Zaragoza, Spain
e Técnicas Avanzadas de Investigación en Servicios de Salud, Madrid, Spain
f Dermatology Department, Hospital Germans Trias i Pujol, Badalona, Spain
g Dermatology Department, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
h Dermatology Department, Hospital General, Valencia, Spain
Article information
Abstract

The relationship between psoriasis and associated diseases has drawn particular interest in recent years. To provide appropriate management of psoriasis from an early stage, it is necessary to include prompt diagnosis of concomitant disease and to prevent and treat any comorbidity found. Such an integrated approach also serves to ensure that the drugs used to treat associated diseases do not interfere with the management of psoriasis, and vice versa.

This clinical practice guideline on the management of comorbidity in psoriasis has been drawn up to help dermatologists to achieve an integrated approach to this inflammatory disease. The guide focuses primarily on the diseases most often found in patients with psoriasis, which include psoriatic arthritis, cardiovascular disease, nonalcoholic fatty liver disease, inflammatory bowel disease, lymphoma, skin cancer, anxiety, and depression. Cardiovascular disease is approached through the study of its major risk factors (obesity, diabetes mellitus, hypertension, dyslipidemia, and metabolic syndrome). Other cardiovascular risk factors related to lifestyle, such as smoking and alcohol consumption, are also discussed.

The overall aim of this guide is to provide the dermatologist with a precise, easyto- use tool for systematizing the diagnosis of comorbidity in these patients and to facilitate decisions regarding referral and treatment once associated diseases have been found. The specific objectives are as follows: a) to review the most common diseases associated with psoriasis, including the prevalence of each one and its importance to the dermatologist; b) to provide guidelines for the physical examination, diagnostic tests, and clinical criteria on which to base a preliminary diagnosis; c) to establish criteria for the appropriate referral of patients with suspected comorbidity; d) to provide information on how therapies for psoriasis may modify the course of associated diseases, and e) to provide information concerning treatments prescribed for associated diseases that may have an impact on the course of psoriasis.

This guide has been written by a working group of guideline methodologists and clinical experts. The selection of the diseases included was based on a systematic review of the literature and a summary of available evidence; information on the prevalence of each comorbidity was also taken from the literature. The recommendations on diagnostic criteria are based on the main clinical practice guidelines for each of the diseases discussed and on the recommendations of the expert advisory group. The information regarding the repercussions of psoriasis treatments on comorbid diseases was obtained from the summary of product characteristics of each drug. The statements concerning the impact on psoriasis of the associated diseases and their treatment are based on the review of the literature.

Keywords:
Psoriasis
Comorbid disease
Psoriatic arthritis
Diabetes
Obesity
Cardiovascular disease
Hypertension
Dyslipidemia
Metabolic syndrome
Fatty liver
Cancer
Lymphoma
Inflammatory bowel disease
Anxiety
Depression
Smoking
Alcohol consumption
Abbreviations Used:
ALT
AST
BMI
CAGE
CASPAR
GGT
GRAPPA
HR
IBD
IL
MCV
MINI
MRI
NAFLD
NASH
NMSC
NYHA:
PAPPS
PAQ
PASE
PASI
PEST
PsA
PUVA
SPC
TNF
Resumen

En los últimos años, se está prestando especial importancia a la relación de la psoriasis con otras enfermedades concomitantes. El manejo temprano y adecuado del paciente con psoriasis se ha de contemplar, por tanto, desde un punto de vista integral, tanto para el diagnóstico temprano de la comorbilidad, como para su prevención y tratamiento, así como para evitar que los medicamentos utilizados en las enfermedades asociadas puedan interferir el curso de la psoriasis, o viceversa.

Como ayuda a este abordaje integral de la psoriasis, se plantea la elaboración de esta guía de práctica clínica enfocada específicamente hacia el manejo de la comorbilidad, y dirigida especialmente a dermatólogos. Esta guía se centra en las enfermedades más prevalentes en la psoriasis: artritis psoriásica, enfermedad cardiovascular a través del estudio de sus principales factores de riesgo (obesidad, diabetes mellitus, hipertensión arterial, dislipemia y síndrome metabólico), hígado graso no alcohólico, enfermedad inflamatoria intestinal, linfoma y cáncer de piel, ansiedad y depresión. También se consideran otros factores de riesgo cardiovascular relacionados con los hábitos de vida, como el consumo de tabaco y de alcohol.

El objetivo principal de esta guía es proporcionar al dermatólogo una herramienta ágil y precisa que protocolice el diagnóstico de la comorbilidad y le facilite la toma de decisiones en relación con la derivación y el tratamiento del paciente con alguna enfermedad asociada. Los objetivos específicos son: a) documentar sobre la comorbilidad más frecuente en psoriasis, aportando datos sobre la prevalencia y la importancia de cada una de estas enfermedades en el ámbito de la consulta de dermatología; b) orientar en el protocolo de exploración física, pruebas diagnósticas y criterios clínicos que permitan realizar un diagnóstico de sospecha de estas enfermedades; c) establecer los criterios de derivación de los pacientes con sospecha de comorbilidad al especialista correspondiente; d) informar sobre los tratamientos utilizados en el manejo de la psoriasis que modifican el curso de cada una de las enfermedades asociadas, e e) informar sobre los tratamientos utilizados en el manejo de estas enfermedades que pueden influir en el curso de la psoriasis.

La guía ha sido elaborada por un grupo de trabajo constituido por metodólogos y expertos. La selección y la documentación sobre las enfermedades a incluir y los datos de prevalencia de cada una se han basado en una revisión sistemática de la bibliografía científica y en la síntesis de la evidencia disponible. Las recomendaciones sobre criterios diagnósticos se han basado en las principales guías de práctica clínica de cada una de las enfermedades y en recomendaciones del grupo de expertos. La información sobre las repercusiones terapéuticas de la psoriasis en la comorbilidad se ha obtenido a partir de la ficha técnica de los diferentes fármacos, y de las diferentes enfermedades en la psoriasis a partir de los artículos encontrados en la revisión.

Palabras clave:
Psoriasis
Comorbilidades
Artritis psoriásica
Diabetes mellitus
Obesidad
Enfermedad cardiovascular
Hipertensión arterial
Dislipemia
Síndrome metabólico
Hígado graso
Cáncer
Linfoma
Enfermedad inflamatoria intestinal
Ansiedad
Depresión
Tabaco
Alcohol
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I. Belinchón, X. Bordas, L. Borrego, J.M. Careaga, V. García-Patos, J.M. Hernánz, E. Herrera, J.L. López-Estebaranz, J.C. Moreno, M. Ribera, M.A. Rodríguez-Prieto, and A. Zulaica

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