AAD Notes Knowledge Gap In Psoriasis and Psoriatic Arthritis
The American Academy of Dermatology (AAD) recently updated guidelines for the management of psoriasis and psoriatic arthritis. The academy noted gaps in knowledge of the disease and addressed plausible research options to advance understanding. The top three needs listed were a clarification of genetic factors in the disease, research and definition of natural history and prognosis factors of the disease, and a closer examination of co-morbidities related to the disease.
Genetic research has already greatly advanced the study and understanding of psoriasis, specifically in the naming of genetic susceptibility regions. Genetic research has also shown researchers the nucleotide polymorphisms that are linked to immune pathways, skin barrier, and skin proliferation
However, the AAD also outlines that future genetic research is needed. The AAD would like to see future research address such questions like: Does the genetic factor of psoriasis come primarily from a defect in immunologic function, or keratinocyte function? Could it be the interaction of both? Are psoriasis and psoriatic arthritis genetically distinct diseases? What are the genetic differences between the diseases’ different forms?
Immunologic studies can help define the role of angiogenesis and the vascular bed. Researchers surmise that topical or systemic inhibition of the process can be beneficial to treatments. Moreover, inflammatory cells found in skin and blood should be tested and researched. Immunosuppression is a common adverse side effect, and therefore warrants research to develop immunotherapies that can help the immunologic dysfunction with fewer adverse effects.
Prevalence and Natural History in Populations
The AAD also called for long-term prospective studies at subpopulation level such as pediatrics, the elderly, and pregnant and breastfeeding women. The guidelines stated that children are often affected by psoriasis and are likely to suffer psychosocial effects of the disease, while elderly populations have a higher risk for adverse effects and related co-morbid conditions. Research on treatment plans is needed for this population likely using concomitant medications with age-related reactions to pharmaceutical treatments. The AAD states that further research is needed for the effects of the disease and its treatments on the pregnant and breastfeeding population.
Common comorbidites of psoriasis and psoriatic arthritis include diabetes, obesity, and metabolic syndrome. Additionally, severe psoriasis is being considered a cardiovascular risk factor. There needs to be knowledge-enough to educate these patients on the lifestyle modifications necessary to decrease the risk of heart conditions. Finally, psoriasis patients are also likely to suffer from psychological effects of the disease. Anxiety and depression are often seen among patients with psoriasis and should be treated with meditation, relaxation, counseling or cognitive behavioral therapies.
Image: Pawel Loj