Psoriasis Survey Reveals Devastating Impact on Quality of Life

Introduction

Main Item

Published in Journal of Cutaneous Medicine and Surgery, SKIN survey contributes to a growing body of data around the world about the debilitating effects of psoriasis.

Many of the approximately one million Canadians(i) living with psoriasis may be faced with physical or emotional challenges as they struggle with public mis-perceptions and stigmas of this painful, chronic immune disorder that affects the skin. Now, a Leger Marketing survey of Canadians with psoriasis, pSoriasis Knowledge IN Canada (SKIN), reveals that the debilitating skin condition presents a substantial problem for them in their daily lives. The SKIN survey, which included questions about burden of illness, revealed that two-thirds (66 percent) of SKIN respondents agreed with the statement that psoriasis ranks among the top two illnesses in terms of its impact on quality of life (QoL) out of ten of the worst diseases, including cancer, heart disease, diabetes and arthritis.(1)

Of those SKIN respondents who stated that their psoriasis "sometimes" or "very often" caused them problems in their personal or social relationships, and difficulties with normal daily activities when it was not in control, almost 60 percent indicated that their disease was a substantial problem.(2),(ii) Previous studies show that patients with psoriasis reported a reduction in physical and mental functioning comparable to that seen in cancer, arthritis, hypertension, heart disease, diabetes and depression.(iii)

Recently published online in the Journal of Cutaneous Medicine and Surgery (JCMS), SKIN is the largest survey of its kind in Canada and contributes to a growing body of data regarding the burden of psoriasis in countries around the world.

Psoriasis is a chronic and debilitating skin disorder. Not only does it affect a person physically, but it can contribute to low self esteem and other emotional problems," says Dr. Harvey Lui, Professor and Chairman, Department of Dermatology and Skin Science, University of British Columbia. "The SKIN data helps tell the story of how psoriasis affects quality of life. It reinforces the need for better understanding of the burden of illness of psoriasis, as well as the importance of more effective treatment and management."

The SKIN survey was conducted in partnership with the Canadian Skin Patient Alliance (CSPA), a coalition that provides psoriasis education and information to physicians, patients and researchers. Before SKIN, published evidence about the effects of psoriasis was lacking in Canada and these results provide a Canadian benchmark and offer important insight into treatment patterns.

"The goal of the CSPA is to raise awareness about psoriasis and other skin diseases and to ensure patients and physicians are well-informed about the effects and optimal treatment. The results of SKIN add a new dimension to the information available to us and we look forward to using the data to continue to educate Canadians," says Christine Jackson, Executive Director, Canadian Skin Patient Alliance and co-author of the SKIN publication.

Gender Differences: Female Vs. Male Psoriasis Sufferers

The SKIN study population was predominantly female (66 percent). Female respondents ranked their disease as a more serious problem than did males and they were significantly more likely than males to say that their psoriasis had been a substantial problem in their everyday life (41 percent versus 24 percent).(iv)

Female respondents also reported significantly greater sleep loss in general and greater disability when psoriasis was under poor control.

Under-Diagnosis of Psoriatic Arthritis in Psoriasis Patients

The SKIN survey reveals that half of all respondents reported that they had developed joint pain or stiffness, but only 18 percent of these respondents had ever received a diagnosis of psoriatic arthritis.

Psoriatic arthritis, a condition linked to psoriasis,(v) causes swelling and pain in and around the joints,(vi) can affect a number of joints including the fingers, wrists, toes, knees, ankles, elbows and shoulder joints, the spine and joints in the lower back and can also affect tissues surrounding the joints including tendons and ligaments.(vii) Up to one-third of people with psoriasis develop psoriatic arthritis.(viii)

Respondents reporting no psoriatic arthritis diagnosis indicated that they experienced stiffness in the knees, shoulders and hips (48 percent)(ix), followed by pain or stiffness in the finger joints (38 percent)( x ) and toe joints (23 percent)(xi).

About Psoriasis

Psoriasis is a noncontagious, lifelong chronic skin disease, which affects approximately one million Canadians.(xii) It can strike at any age and, in severe cases, have enormous physical and psychological effects on patients.

"People sometimes ask me what it's like to have psoriasis and my answer is always the same - you can't know what it's like until you've experienced it," says Christine Clarke, a psoriasis sufferer since the age of 16. "You know things are not OK when a gas attendant asks you if you need help because the plaques on your hands look like you've been in a fistfight, or when your child asks you to come to the class swim party and you have to say no because you don't want to embarrass him."

The most common form of psoriasis, plaque psoriasis, results when skin cells called keratinocytes start overproducing and accumulating on the surface to create plaques, or red patches on the skin, covered with dry, silvery scales. It can affect the head, body, arms, legs, elbows, knees, groin and genitals, palms and the bottoms of feet.(xiii)

Diagnosis and Treatment of Psoriasis

It is important for patients with psoriasis symptoms to consult a dermatologist for a definitive diagnosis. Doctors generally treat psoriasis based on the severity of the disease, type of psoriasis, and the patient's attitude toward and response to initial treatments.

Treatments for psoriasis include: topical therapies (ointments and creams containing corticosteroids or coal tar); phototherapy (ultraviolet radiation); and systemic therapies (methotrexate or cyclosporine) taken by pill or injection.

Newer biological therapies (Enbrel, Remicade, Amevive, Humira and Stelara) work on the body's immune system, treating psoriasis symptoms differently than other medications, and are available to treat moderate to severe forms of the disease. As with any medication, there is the potential for side effects with any of these treatments, including increased risk of infection.

About the SKIN Survey

The pSoriasis Knowledge IN Canada (SKIN) survey was conducted to provide insight into the current state of psoriasis in Canada, including number of people affected by psoriasis, quality of life and burden of illness. The objective of SKIN was to characterize the natural history of disease in a sample of Canadians with a history of moderate to severe psoriasis and to identify factors that influenced their perception of psoriasis as a problem in their daily lives.

Between April 30 and June 2, 2007, Canadian households were contacted by telephone by an independent market research group, Leger Marketing. Target telephone numbers were identified from a database of contact information built from consumers requesting information about psoriasis management.

In all, a total of 5,093(xiv) Canadian households were contacted. Individuals who indicated that they had been diagnosed with psoriasis or psoriatic arthritis were asked first if they considered themselves informed about psoriasis and second if, at the height of their condition, the affected areas of their skin would have been covered by at least 3-10 palms of their hands. Those who answered in the affirmative were considered to have a history of moderate to severe psoriasis and were eligible to answer the survey.

Five hundred eligible adult Canadians were administered the SKIN survey. Given an assumed Canadian psoriatic population of approximately one million, it is anticipated that this sample size allows for sound and statistically significant results with a 95 percent confidence interval of +/-4 percent. SKIN was conducted in partnership with the Canadian Skin Patient Alliance (CSPA) and supported by an unrestricted educational grant from Amgen Canada Inc. and Wyeth Pharmaceuticals.

About the Canadian Skin Patient Alliance

Founded in 2007, the Canadian Skin Patient Alliance (CSPA) provides education, information, an online supportive community, and opportunities to create and join local support groups for all Canadian skin patients. CSPA is a patient-centered organization serving patient needs to enhance care, to promote skin health and to find cures for Canadian skin patients. CSPA also provides physicians and researchers access to patients and their concerns regarding skin disease. For more information, visit www.skinpatientalliance.ca.

About Amgen Canada

Amgen discovers, develops and delivers innovative human therapeutics. A biotechnology pioneer since 1980, Amgen was one of the first companies to realize the new science's promise by bringing novel medicines from lab, to manufacturing plant, to patient. Amgen therapeutics have changed the practice of medicine, helping millions of people around the world in the fight against cancer, kidney disease, rheumatoid arthritis, and other serious illnesses. With a broad and deep pipeline of potential new medicines, Amgen is committed to advancing science to dramatically improve people's lives. To learn more about Amgen's pioneering science and our vital medicines, visit www.amgen.com.

About Wyeth Canada

Wyeth (NYSE:WYE) is one of the world's largest research-driven pharmaceutical and health care products companies. It is a leader in the discovery, development, manufacturing and marketing of pharmaceuticals,vaccines, biotechnology products and non-prescription medicines that improve the quality of life for people worldwide. Wyeth Canada (www.wyeth.ca), an affiliate of Wyeth, employs over 1,700 people across the country with a commercial head office in Markham, Ontario and manufacturing and R&D facilities in Montreal, Quebec. It markets leading products in the areas of women's health care, neuroscience, musculoskeletal therapy, transplantation and immunology, hemophilia and vaccines.

(1) This data is not included in the published manuscript and is a survey result.

(2) Answering 8, 9 or 10 on a 10-point Likert scale.

References:

(i) Canadian Dermatology Association. Psoriasis. www.dermatology.ca/patients_public/info_patients/psoriasis/index.html. Last Accessed June 17, 2008.

(ii) Journal of Cutaneous Medicine and Surgery. Online issue - June 2009. Page 21.Table 3.

(iii) Rapp SR et al. Psoriasis Causes as Much Disability as other Major Medical Diseases J Am Acad Dermatol. 199 Sep;41 (3 pt 1):401-7.

(iv) Leger Gender Data.

(v) Arthritis Society of Canada, www.arthritis.ca/types%20of%20arthritis/psoriatic%20arthritis/default.asps=1.

(vi) Arthritis Society of Canada, www.arthritis.ca/types%20of%20arthritis/psoriatic%20arthritis/default.asps=1.

(vii) Arthritis Society of Canada, www.arthritis.ca/types%20of%20arthritis/psoriatic%20arthritis/default.asps=1.

(viii) Canadian Skin Patient Alliance. www.skinpatientalliance.ca/en/skin-conditions-diseases/psoriasis. Last accessed August 29, 2008.

(ix) Journal of Cutaneous Medicine and Surgery. Online issue - June 2009. Page 10.

( x ) Ibid.

(xi) Ibid.

(xii) Canadian Dermatology Association. Psoriasis. www.dermatology.ca/patients_public/info_patients/psoriasis/index.html. Last Accessed June 17, 2008.

(xiii) Ibid.

(xiv) Journal of Cutaneous Medicine and Surgery, Online issue - June 2009.