Psoriasis and Advancing Doctor-Patient Dialogue
Dr. Paul Yamauchi and Novartis Pharmaceuticals shared information on the pathophysiology of psoriasis and advancing doctor-patient dialogue at a lecture for the SDPA 2014 Fall Conference in San Diego.
Dr. Yamauchi began by broadening audience understanding of the Th1 and Th17 cells and their associated cytokines that play a role in psoriasis.
Types of Cytokines:
TNF-a is a broadly acting inflammatory cytokine
Acts at multiple points in the inflammatory cascade
Produced by T cells, macrophages, mast cells, and keratinocytes
Induces cytokine production and immune cell recruitment
Synergistic effects with IL-17A and IFN-y3
Key role in psoriasis
Driver of Th1 Cells
Differentiation and activation of Th1 cells
Primarily produced by myeloid dendritic cells and macrophages
Is important for cell-mediated immunity and contributes to inflammation in psoriasis
IFN-y is produced by th1 cells
An important indirect driver of pathology in psoriasis
Produced at sites of skin inflammation by dendritic cells and possibly by keratinocytes
Essential for maintenance and expansion of Th17 cells
Stimulates secretion of IL-17 by Th-17 cells and by innate immune cells.
IL-23 and its receptor linked to psoriasis susceptibility
Contributes to Inflammation and Keratinocyte Hyperproliferation in Psoriasis
IL-22 has both proinflammatory and tissue-protective properties
Induces cell proliferation
Stimulates the production of antimicrobial molcules
Can prevent tissue damage and aid in repair
Highly expressed in chronic inflammatory conditions, such as psoriasis, inflammatory bowel disease, and rheumatoid arthritis
Confers protection against extracellular infection and can cause chronic inflammation
It is a bi product of the Th17 cells
IL-17 has 6 different types, but IL-A is most common
Never forget that inflammation is the hallmark feature of Psoriasis.
Increased numbers of immune cell in the skin
T cells in the epidermis and dermic
Dendritic cells in the dermis
Neutriphils in the epidermis
Macrophages in the dermis
Advancing Doctor-Patient Dialogue
Novartis Pharmaceutical and the Patient Listening Project
After teaching on the pathophysiology of psoriasis, Dr. Yamauchi discussed how we can best dialogue with and serve our psoriasis patients. He noted that though understanding the science of psoriasis has evolved over the years, many patient issues remain a challenge. It is therefore important to get an idea on how the psoriasis is impacting their lives as many patients face physical and emotional challenges with psoriasis.
A significant proportion of patients still remain untreated or undertreated. A 2011 survey found that many patients with moderate to severe disease still receive no treatment or are treated with topical medications alone. Those who are treated often feel dissatisfied with “treatment effectiveness” and seem to want more info on disease, treatment options and other associated conditions.
Novartis Pharmaceuticals was involved in the Patient Listening Project which provided insights into the patient’s mind and heard their stories through art and surveys.
One survey asked: What is the one question you want your physician to ask you about your condition? They answered:
How is your psoriasis affecting you beyond your skin? 23.6%
How are you coping with your psoriasis on a daily basis? 19.5%
Are you comfortable with the level of improvement your medication is providing? 13.8%
How do you want to treat your psoriasis? 10.6%
Clinical Pearls: Three simple steps to enhance patient care and satisfaction
1. Thoroughly examine the skin and physical impact
Psoriasis has a significant impact on the physical well-being of patients: itchiness, physical irritation, physical pain
2. Evaluate the emotional impact on the patient’s everyday life
Limitations due to physical impact of psoriasis: feeling unattractive, movement-limiting lesions, restricting activities due to embarrassment
3. Build rapport through small talk and include the patient in management decisions
Take time to talk with your psoriasis patients, give patients access to a physician for discussions, allow for shared decision making