Psoriasis natural history, complications and prognosis: Difference between revisions

Jump to navigation Jump to search
VisualWikitext
No edit summary
No edit summary
Line 3: Line 3:


==Overview==
==Overview==
If left untreated, patients with psoriasis may progress to develop [[psoriatic arthritis]], [[joint]] erosions and [[conjunctivitis]]. Common complications of psoriasis include [[depression]], [[psoriatic arthritis]], [[Inflammatory bowel disease|chronic inflammatory bowel disease]], [[non-alcoholic fatty liver disease]], [[celiac disease]], [[sensorineural hearing loss]], [[osteopenia]] and [[osteoarthritis]]. Psoriasis is a life-long disease with multiple [[Relapse|relapses]] and [[Remission (medicine)|remissions]]. Symptoms can be controlled by medications.
If left untreated, patients with psoriasis may progress to develop [[psoriatic arthritis]], [[joint]] erosions, and [[conjunctivitis]]. Common complications of psoriasis include [[depression]], [[psoriatic arthritis]], [[Inflammatory bowel disease|chronic inflammatory bowel disease]], [[non-alcoholic fatty liver disease]], [[celiac disease]], [[sensorineural hearing loss]], [[osteopenia]], and [[osteoarthritis]]. Psoriasis is a life-long disease with multiple [[Relapse|relapses]] and [[Remission (medicine)|remissions]]. Symptoms can be controlled by medications.


==Natural History==
==Natural History==
Natural history of psoriasis differs according to the clinical sub-type. The symptoms of psoriasis usually develop in the second decade of life, and start with symptoms such as [[skin lesions]] characterized by [[erythema]] and scales covering the lesions. The chronicity of psoriasis may lead to significant [[distress]] for the affected patient and leads to a decrease in quality of life.<ref name="pmid21550135">{{cite journal |vauthors=Rehal B, Modjtahedi BS, Morse LS, Schwab IR, Maibach HI |title=Ocular psoriasis |journal=J. Am. Acad. Dermatol. |volume=65 |issue=6 |pages=1202–12 |year=2011 |pmid=21550135 |doi=10.1016/j.jaad.2010.10.032 |url=}}</ref>
Natural history of psoriasis differs according to the clinical sub-type. The symptoms of psoriasis usually develop in the second decade of life, and start with symptoms such as [[skin lesions]] characterized by [[erythema]] and scales covering the [[lesions]]. The chronicity of psoriasis may lead to significant [[distress]] for the affected patient and leads to a decrease in quality of life.<ref name="pmid21550135">{{cite journal |vauthors=Rehal B, Modjtahedi BS, Morse LS, Schwab IR, Maibach HI |title=Ocular psoriasis |journal=J. Am. Acad. Dermatol. |volume=65 |issue=6 |pages=1202–12 |year=2011 |pmid=21550135 |doi=10.1016/j.jaad.2010.10.032 |url=}}</ref>


=== Plaque-Type Psoriasis ===
=== Plaque-Type Psoriasis ===
Line 14: Line 14:


=== Guttate Psoriasis ===
=== Guttate Psoriasis ===
* Guttate psoriasis presents with spontaneous [[Remission (medicine)|remissions]] occurring over the course of weeks to months. In adults, the lesions of guttate psoriasis may become chronic and progress to plaque-type psoriasis.
* Guttate psoriasis presents with spontaneous [[Remission (medicine)|remissions]] occurring over the course of weeks to months. In adults, the [[lesions]] of guttate psoriasis may become [[chronic]] and progress to plaque-type psoriasis.
* It may be aggravated by extrinsic factors for example, smoking, excessive alcohol, pregnancy, [[HIV AIDS|HIV infection]] and stress.
* It may be aggravated by extrinsic factors for example, smoking, excessive alcohol, pregnancy, [[HIV AIDS|HIV infection]] and stress.


Line 55: Line 55:
! align="center" style="background:#4479BA; color: #FFFFFF;" + |Percentage of patients affected
! align="center" style="background:#4479BA; color: #FFFFFF;" + |Percentage of patients affected
! colspan="4" align="center" style="background:#4479BA; color: #FFFFFF;" + |Radiological features<ref name="urlPsoriatic Arthritis Mutilans: Clinical and Radiographic Criteria. A Systematic Review | The Journal of Rheumatology">{{cite web |url=http://www.jrheum.org/content/42/8/1432.long |title=Psoriatic Arthritis Mutilans: Clinical and Radiographic Criteria. A Systematic Review &#124; The Journal of Rheumatology |format= |work= |accessdate=}}</ref>
! colspan="4" align="center" style="background:#4479BA; color: #FFFFFF;" + |Radiological features<ref name="urlPsoriatic Arthritis Mutilans: Clinical and Radiographic Criteria. A Systematic Review | The Journal of Rheumatology">{{cite web |url=http://www.jrheum.org/content/42/8/1432.long |title=Psoriatic Arthritis Mutilans: Clinical and Radiographic Criteria. A Systematic Review &#124; The Journal of Rheumatology |format= |work= |accessdate=}}</ref>
! align="center" style="background:#4479BA; color: #FFFFFF;" + |Hsitopathological features<ref name="pmid15899044">{{cite journal |vauthors=Kruithof E, Baeten D, De Rycke L, Vandooren B, Foell D, Roth J, Cañete JD, Boots AM, Veys EM, De Keyser F |title=Synovial histopathology of psoriatic arthritis, both oligo- and polyarticular, resembles spondyloarthropathy more than it does rheumatoid arthritis |journal=Arthritis Res. Ther. |volume=7 |issue=3 |pages=R569–80 |year=2005 |pmid=15899044 |pmc=1174942 |doi=10.1186/ar1698 |url=}}</ref><ref name="pmid11592363">{{cite journal |vauthors=Fraser A, Fearon U, Reece R, Emery P, Veale DJ |title=Matrix metalloproteinase 9, apoptosis, and vascular morphology in early arthritis |journal=Arthritis Rheum. |volume=44 |issue=9 |pages=2024–8 |year=2001 |pmid=11592363 |doi=10.1002/1529-0131(200109)44:9<2024::AID-ART351>3.0.CO;2-K |url=}}</ref><ref name="pmid12563678">{{cite journal |vauthors=Fearon U, Griosios K, Fraser A, Reece R, Emery P, Jones PF, Veale DJ |title=Angiopoietins, growth factors, and vascular morphology in early arthritis |journal=J. Rheumatol. |volume=30 |issue=2 |pages=260–8 |year=2003 |pmid=12563678 |doi= |url=}}</ref>
! align="center" style="background:#4479BA; color: #FFFFFF;" + |Histopathological features<ref name="pmid15899044">{{cite journal |vauthors=Kruithof E, Baeten D, De Rycke L, Vandooren B, Foell D, Roth J, Cañete JD, Boots AM, Veys EM, De Keyser F |title=Synovial histopathology of psoriatic arthritis, both oligo- and polyarticular, resembles spondyloarthropathy more than it does rheumatoid arthritis |journal=Arthritis Res. Ther. |volume=7 |issue=3 |pages=R569–80 |year=2005 |pmid=15899044 |pmc=1174942 |doi=10.1186/ar1698 |url=}}</ref><ref name="pmid11592363">{{cite journal |vauthors=Fraser A, Fearon U, Reece R, Emery P, Veale DJ |title=Matrix metalloproteinase 9, apoptosis, and vascular morphology in early arthritis |journal=Arthritis Rheum. |volume=44 |issue=9 |pages=2024–8 |year=2001 |pmid=11592363 |doi=10.1002/1529-0131(200109)44:9<2024::AID-ART351>3.0.CO;2-K |url=}}</ref><ref name="pmid12563678">{{cite journal |vauthors=Fearon U, Griosios K, Fraser A, Reece R, Emery P, Jones PF, Veale DJ |title=Angiopoietins, growth factors, and vascular morphology in early arthritis |journal=J. Rheumatol. |volume=30 |issue=2 |pages=260–8 |year=2003 |pmid=12563678 |doi= |url=}}</ref>
|-
|-
| rowspan="2" |Classical psoriatic arthritis
| rowspan="2" |Classical psoriatic arthritis
Line 62: Line 62:
* Involvement of [[Nail (anatomy)|nails]]
* Involvement of [[Nail (anatomy)|nails]]
| rowspan="2" |~5 %
| rowspan="2" |~5 %
|'''[[X-ray|Xray]]'''
|'''[[X-ray]]'''
|'''[[Ultrasonography]]'''
|'''[[Ultrasonography]]'''
|'''[[Computed tomography|CT scan]]'''  
|'''[[Computed tomography|CT scan]]'''  
Line 126: Line 126:
==Prognosis==
==Prognosis==
* Psoriasis is a lifelong condition.<ref>{{cite journal|author=Jobling R|title=A patient's journey:Psoriasis|journal=Br Med J|year=2007|volume=334|pages=953&ndash;4|doi=10.1136/bmj.39184.615150.802}}</ref> There is currently no cure but various treatments can help to control the symptoms.  
* Psoriasis is a lifelong condition.<ref>{{cite journal|author=Jobling R|title=A patient's journey:Psoriasis|journal=Br Med J|year=2007|volume=334|pages=953&ndash;4|doi=10.1136/bmj.39184.615150.802}}</ref> There is currently no cure but various treatments can help to control the symptoms.  
* Many of the most effective agents used to treat severe psoriasis carry an increased risk of significant morbidity including [[skin cancer]]s, [[lymphoma]] and [[liver disease]]. However, the majority of people's experience of psoriasis is that of minor localized patches, particularly on the [[elbows]] and [[knees]], which can be treated with [[topical]] medication.  
* Many of the most effective agents used to treat severe psoriasis carry an increased risk of significant morbidity including [[skin cancer]]s, [[lymphoma]], and [[liver disease]]. However, the majority of people's experience of psoriasis is that of minor localized patches, particularly on the [[elbows]] and [[knees]], which can be treated with [[topical]] medication.  
* Psoriasis does get worse over time but it is not possible to predict who will go on to develop extensive psoriasis or those in whom the [[disease]] may appear to vanish. Individuals will often experience flares and remissions throughout their lives.   
* Psoriasis does get worse over time but it is not possible to predict who will go on to develop extensive psoriasis or those in whom the [[disease]] may appear to vanish. Individuals will often experience flares and remissions throughout their lives.   
* Controlling the signs and symptoms typically requires lifelong therapy.
* Controlling the signs and symptoms typically requires lifelong therapy.
* Psoriasis is linked to 2.5-fold increased risk for non-[[melanoma]] [[skin cancer]] in men and women, with no preponderance of any specific histologic subtype of cancer.<ref>{{cite journal |author=Olsen JH, Frentz G, Møller H |title=[Psoriasis and cancer] |language=Danish |journal=Ugeskr. Laeg. |volume=155 |issue=35 |pages=2687-91 |year=1993 |pmid=8212383 |doi=}}</ref> This, however could be linked to [[Antipsoriatics|antipsoriatic treatment]].
* Psoriasis is linked to 2.5-fold increased risk for non-[[melanoma]] [[skin cancer]] in men and women, with no preponderance of any specific histologic subtype of cancer.<ref>{{cite journal |author=Olsen JH, Frentz G, Møller H |title=[Psoriasis and cancer] |language=Danish |journal=Ugeskr. Laeg. |volume=155 |issue=35 |pages=2687-91 |year=1993 |pmid=8212383 |doi=}}</ref> This, however, could be linked to [[Antipsoriatics|antipsoriatic treatment]].


=== '''Indications for referral to secondary or intermediary care for psoriasis''' ===
=== '''Indications for referral to secondary or intermediary care for psoriasis''' ===
Line 141: Line 141:
* Disability preventing work or excessive time off work
* Disability preventing work or excessive time off work
* Acute unstable psoriasis  
* Acute unstable psoriasis  
* Erythrodermic or generalized pustular psoriasis (emergency referral indicated)
* [[erythroderma|Erythrodermic]] or generalized pustular psoriasis (emergency referral indicated)


==References==
==References==

Revision as of 15:39, 3 August 2017

Psoriasis Microchapters

Home

Patient Information

Overview

Historical Perspective

Classification

Pathophysiology

Causes

Differentiating Psoriasis from other Diseases

Epidemiology and Demographics

Risk Factors

Screening

Natural History, Complications and Prognosis

Diagnosis

History and Symptoms

Physical Examination

Laboratory Findings

X-ray

Ultrasound

CT scan

MRI

Other Imaging Studies

Other Diagnostic Studies

Treatment

Medical Therapy

Surgery

Primary Prevention

Secondary Prevention

Cost-Effectiveness of Therapy

Future or Investigational Therapies

Case Studies

Case #1

Psoriasis natural history, complications and prognosis On the Web

Most recent articles

Most cited articles

Review articles

CME Programs

Powerpoint slides

Images

American Roentgen Ray Society Images of Psoriasis natural history, complications and prognosis

All Images
X-rays
Echo & Ultrasound
CT Images
MRI

Ongoing Trials at Clinical Trials.gov

US National Guidelines Clearinghouse

NICE Guidance

FDA on Psoriasis natural history, complications and prognosis

CDC on Psoriasis natural history, complications and prognosis

Psoriasis natural history, complications and prognosis in the news

Blogs on Psoriasis natural history, complications and prognosis

Directions to Hospitals Treating Psoriasis

Risk calculators and risk factors for Psoriasis natural history, complications and prognosis

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Syed Hassan A. Kazmi BSc, MD [2]

Overview

If left untreated, patients with psoriasis may progress to develop psoriatic arthritis, joint erosions, and conjunctivitis. Common complications of psoriasis include depression, psoriatic arthritis, chronic inflammatory bowel disease, non-alcoholic fatty liver disease, celiac disease, sensorineural hearing loss, osteopenia, and osteoarthritis. Psoriasis is a life-long disease with multiple relapses and remissions. Symptoms can be controlled by medications.

Natural History

Natural history of psoriasis differs according to the clinical sub-type. The symptoms of psoriasis usually develop in the second decade of life, and start with symptoms such as skin lesions characterized by erythema and scales covering the lesions. The chronicity of psoriasis may lead to significant distress for the affected patient and leads to a decrease in quality of life.[1]

Plaque-Type Psoriasis

Guttate Psoriasis

  • Guttate psoriasis presents with spontaneous remissions occurring over the course of weeks to months. In adults, the lesions of guttate psoriasis may become chronic and progress to plaque-type psoriasis.
  • It may be aggravated by extrinsic factors for example, smoking, excessive alcohol, pregnancy, HIV infection and stress.

Pustular Psoriasis

Psoriatic arthritis

Psoriatic arthritis goes through the following stages of progression during its course, defined by the change in clinical damage:[3]

  • Stage 1:
  • Stage 2:
  • Stage 3:
  • Stage 4:

Complications

Individuals with psoriasis may develop the following complications:[4]

Psoriatic arthritis

Subtype Disease pattern[5] Percentage of patients affected Radiological features[6] Histopathological features[7][8][9]
Classical psoriatic arthritis ~5 % X-ray Ultrasonography CT scan MRI
  • Bony proliferation
  • Bone erosion
  • "Pencil-in-cup" deformity (distal head of a bone becomes pointed-like a sharpened pencil, and the neighboring surface becomes rounded due to erosion)
Destructive psoriatic arthritis (arthritis mutilans) < 5 %
Symmetric polyarthritis ~15 %
Asymmetric psoriatic arthritis
  • Does not occur in the same joints on both sides of the body
 ~70 %
Ankylosing spondylitis-like psoriatic arthritis
  • Stiffness of the spine or neck, but can also affect the hands and feet, in a similar fashion to symmetric arthritis
 ~ 5 %

Prognosis

  • Psoriasis is a lifelong condition.[10] There is currently no cure but various treatments can help to control the symptoms.
  • Many of the most effective agents used to treat severe psoriasis carry an increased risk of significant morbidity including skin cancers, lymphoma, and liver disease. However, the majority of people's experience of psoriasis is that of minor localized patches, particularly on the elbows and knees, which can be treated with topical medication.
  • Psoriasis does get worse over time but it is not possible to predict who will go on to develop extensive psoriasis or those in whom the disease may appear to vanish. Individuals will often experience flares and remissions throughout their lives.
  • Controlling the signs and symptoms typically requires lifelong therapy.
  • Psoriasis is linked to 2.5-fold increased risk for non-melanoma skin cancer in men and women, with no preponderance of any specific histologic subtype of cancer.[11] This, however, could be linked to antipsoriatic treatment.

Indications for referral to secondary or intermediary care for psoriasis

The Primary Care Dermatology Society and the British Association of Dermatologists suggests that the following groups of patients may require secondary care:[12]

  • Diagnostic uncertainty
  • Request for further counseling or education, including demonstration of topical treatment
  • Failure to respond to appropriately used topical therapy for three months
  • Psoriasis at sites that are difficult to treat (scalp, face, palms, soles, genitals) if unresponsive to initial therapy
  • Adverse reactions to topical therapies
  • Need for systemic therapy and phototherapy
  • Disability preventing work or excessive time off work
  • Acute unstable psoriasis
  • Erythrodermic or generalized pustular psoriasis (emergency referral indicated)

References

  1. ↑ Rehal B, Modjtahedi BS, Morse LS, Schwab IR, Maibach HI (2011). "Ocular psoriasis". J. Am. Acad. Dermatol. 65 (6): 1202–12. doi:10.1016/j.jaad.2010.10.032. PMID 21550135.
  2. ↑ Hazarika D (2009). "Generalized pustular psoriasis of pregnancy successfully treated with cyclosporine". Indian J Dermatol Venereol Leprol. 75 (6): 638. doi:10.4103/0378-6323.57743. PMID 19915261.
  3. ↑ Gladman DD, Antoni C, Mease P, Clegg DO, Nash P (2005). "Psoriatic arthritis: epidemiology, clinical features, course, and outcome". Ann. Rheum. Dis. 64 Suppl 2: ii14–7. doi:10.1136/ard.2004.032482. PMC 1766874. PMID 15708927.
  4. ↑ Roth PE, Grosshans E, Bergoend H (1991). "[Psoriasis: development and fatal complications]". Ann Dermatol Venereol (in French). 118 (2): 97–105. PMID 2048897.
  5. ↑ Kruithof E, Baeten D, De Rycke L, Vandooren B, Foell D, Roth J, Cañete JD, Boots AM, Veys EM, De Keyser F (2005). "Synovial histopathology of psoriatic arthritis, both oligo- and polyarticular, resembles spondyloarthropathy more than it does rheumatoid arthritis". Arthritis Res. Ther. 7 (3): R569–80. doi:10.1186/ar1698. PMC 1174942. PMID 15899044.
  6. ↑ "Psoriatic Arthritis Mutilans: Clinical and Radiographic Criteria. A Systematic Review | The Journal of Rheumatology".
  7. ↑ Kruithof E, Baeten D, De Rycke L, Vandooren B, Foell D, Roth J, Cañete JD, Boots AM, Veys EM, De Keyser F (2005). "Synovial histopathology of psoriatic arthritis, both oligo- and polyarticular, resembles spondyloarthropathy more than it does rheumatoid arthritis". Arthritis Res. Ther. 7 (3): R569–80. doi:10.1186/ar1698. PMC 1174942. PMID 15899044.
  8. ↑ Fraser A, Fearon U, Reece R, Emery P, Veale DJ (2001). "Matrix metalloproteinase 9, apoptosis, and vascular morphology in early arthritis". Arthritis Rheum. 44 (9): 2024–8. doi:10.1002/1529-0131(200109)44:9<2024::AID-ART351>3.0.CO;2-K. PMID 11592363.
  9. ↑ Fearon U, Griosios K, Fraser A, Reece R, Emery P, Jones PF, Veale DJ (2003). "Angiopoietins, growth factors, and vascular morphology in early arthritis". J. Rheumatol. 30 (2): 260–8. PMID 12563678.
  10. ↑ Jobling R (2007). "A patient's journey:Psoriasis". Br Med J. 334: 953&ndash, 4. doi:10.1136/bmj.39184.615150.802.
  11. ↑ Olsen JH, Frentz G, Møller H (1993). "[Psoriasis and cancer]". Ugeskr. Laeg. (in Danish). 155 (35): 2687–91. PMID 8212383.
  12. ↑ Smith CH, Barker JN (2006). "Psoriasis and its management". BMJ. 333 (7564): 380–4. doi:10.1136/bmj.333.7564.380. PMC 1550454. PMID 16916825.

Template:WH Template:WS

Retrieved from "https://www.wikidoc.org/index.php?title=Psoriasis_natural_history,_complications_and_prognosis&oldid=1334843"