New Program for Psoriasis and Psoriatic Arthritis Patients

Researchers from the Perelman School of Medicine at the University of Pennsylvania identified nearly 30% of psoriasis patients in a pilot study as having an undetected, heightened risk for cardiovascular disease. Over the next year, 30 percent of high-risk patients were able to receive more tailored care, although all participants received extra care and advice. Patients received positive feedback on the program, which connected them to a care coordinator with the National Psoriasis Foundation, indicating that dermatologists and rheumatologists may have a blueprint to better prevent cardiovascular disease. The findings of the researchers are outlined in a new study paper published in the Journal of Investigative Dermatology.

“This program has the potential to ensure that we’re empowering patients and clinicians to better identify cardiovascular risk factors in order to prevent heart attacks, stroke, and premature mortality in patients with psoriatic disease who are predisposed to poor cardiovascular health,” said Joel Gelfand, MD, the James J. Leyden, M.D. Endowed Professor in Clinical Investigation in Penn’s Department of Dermatology.

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Psoriasis, a skin, joint, and immune system condition characterized by itchy, dry scales and patches on the skin, develops when skin cells reproduce excessively in response to an overactive immune system. Along with skin irritation, the disease has been related to a number of other conditions, including some malignancies, liver and kidney disease, arthritis, and, most notably, diabetes and atherosclerosis.

The pilot study involved over 80 individuals with psoriasis or psoriatic arthritis (termed psoriatic illness) from four separate dermatological and rheumatology offices across the United States. Participants received blood tests to measure their lipids and hemoglobin A1C, conducted at-home blood pressure recordings, and had virtual meetings with National Psoriasis Foundation care coordinators over the course of a year. All 80 patients got food and exercise suggestions tailored to those with psoriatic illness, who frequently struggle with physical activity due to skin and joint issues.

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Furthermore, at the start of the program, the clinicians identified 23 patients, or roughly 28 percent of the participants, who had previously undiagnosed increased risk for cardiovascular disease, and those patients were then given recommendations based on American Heart Association guidelines and connected to their primary care provider. This includes blood pressure and cholesterol medication recommendations based on national guidelines.

According to Gelfand, few physicians initiate screening for cardiovascular risk factors in adults with psoriatic illness, despite the fact that these patients are at a greater risk for high blood pressure, raised cholesterol, diabetes, and cardiovascular death.

“Our prior work demonstrated that care coordination was a missing link that specialists and patients need to achieve better cardiovascular education, screening, and treatment of risk factors,” Gelfand said in a statement. This pilot study revealed unequivocally that a centralized care coordinator model has the potential to help close the evidence-to-practice gap in avoiding heart attacks, strokes, and premature mortality in our patients.”

While the findings of this pilot program should encourage further collaboration among dermatologists, rheumatologists, and cardiologists, as well as a formal structure for such collaboration, there is also a message for patients.

“People with psoriasis should be aware of the link between psoriasis and their cardiovascular health so they can advocate for themselves and do the daily things that keep their heart healthy and their blood pressure, cholesterol, and weight in check,” Gelfand said in a statement.

Gelfand and his colleagues were motivated by the findings to conduct a larger trial of this program, which will include approximately 500 patients at 10-20 facilities around the United States.

The study also included researchers from New York University, Brigham and Women’s Hospital, SUNY at Buffalo, the University of Washington, the University of California Los Angeles, George Washington University, and Northwestern University.

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