Abordaje integral de la comorbilidad del paciente con psoriasis

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El manejo temprano y adecuado del paciente con psoriasis se ha de contemplar, por tanto, desde un punto de vista integral, tanto para el diagnóstico temprano de la comorbilidad, como para su prevención y tratamiento, así como para evitar que los medicamentos utilizados en las enfermedades asociadas puedan interferir el curso de la psoriasis, o viceversa.Como ayuda a este abordaje integral de la psoriasis, se plantea la elaboración de esta guía de práctica clínica enfocada específicamente hacia el manejo de la comorbilidad, y dirigida especialmente a dermatólogos. Esta guía se centra en las enfermedades más prevalentes en la psoriasis: artritis psoriásica, enfermedad cardiovascular a través del estudio de sus principales factores de riesgo (obesidad, diabetes mellitus, hipertensión arterial, dislipemia y síndrome metabólico), hígado graso no alcohólico, enfermedad inflamatoria intestinal, linfoma y cáncer de piel, ansiedad y depresión. También se consideran otros factores de riesgo cardiovascular relacionados con los hábitos de vida, como el consumo de tabaco y de alcohol.El objetivo principal de esta guía es proporcionar al dermatólogo una herramienta ágil y precisa que protocolice el diagnóstico de la comorbilidad y le facilite la toma de decisiones en relación con la derivación y el tratamiento del paciente con alguna enfermedad asociada. Los objetivos específicos son: a) documentar sobre la comorbilidad más frecuente en psoriasis, aportando datos sobre la prevalencia y la importancia de cada una de estas enfermedades en el ámbito de la consulta de dermatología; b) orientar en el protocolo de exploración física, pruebas diagnósticas y criterios clínicos que permitan realizar un diagnóstico de sospecha de estas enfermedades; c) establecer los criterios de derivación de los pacientes con sospecha de comorbilidad al especialista correspondiente; d) informar sobre los tratamientos utilizados en el manejo de la psoriasis que modifican el curso de cada una de las enfermedades asociadas, e e) informar sobre los tratamientos utilizados en el manejo de estas enfermedades que pueden influir en el curso de la psoriasis.La guía ha sido elaborada por un grupo de trabajo constituido por metodólogos y expertos. La selección y la documentación sobre las enfermedades a incluir y los datos de prevalencia de cada una se han basado en una revisión sistemática de la bibliografía científica y en la síntesis de la evidencia disponible. Las recomendaciones sobre criterios diagnósticos se han basado en las principales guías de práctica clínica de cada una de las enfermedades y en recomendaciones del grupo de expertos. La información sobre las repercusiones terapéuticas de la psoriasis en la comorbilidad se ha obtenido a partir de la ficha técnica de los diferentes fármacos, y de las diferentes enfermedades en la psoriasis a partir de los artículos encontrados en la revisión." ] "en" => array:2 [ "titulo" => "Abstract" "resumen" => "The relationship between psoriasis and associated diseases has drawn particular interest in recent years. To provide appropriate management of psoriasis from an early stage, it is necessary to include prompt diagnosis of concomitant disease and to prevent and treat any comorbidity found. Such an integrated approach also serves to ensure that the drugs used to treat associated diseases do not interfere with the management of psoriasis, and vice versa.This clinical practice guideline on the management of comorbidity in psoriasis has been drawn up to help dermatologists to achieve an integrated approach to this inflammatory disease. The guide focuses primarily on the diseases most often found in patients with psoriasis, which include psoriatic arthritis, cardiovascular disease, nonalcoholic fatty liver disease, inflammatory bowel disease, lymphoma, skin cancer, anxiety, and depression. Cardiovascular disease is approached through the study of its major risk factors (obesity, diabetes mellitus, hypertension, dyslipidemia, and metabolic syndrome). Other cardiovascular risk factors related to lifestyle, such as smoking and alcohol consumption, are also discussed.The overall aim of this guide is to provide the dermatologist with a precise, easyto-use tool for systematizing the diagnosis of comorbidity in these patients and to facilitate decisions regarding referral and treatment once associated diseases have been found. The specific objectives are as follows: a) to review the most common diseases associated with psoriasis, including the prevalence of each one and its importance to the dermatologist; b) to provide guidelines for the physical examination, diagnostic tests, and clinical criteria on which to base a preliminary diagnosis; c) to establish criteria for the appropriate referral of patients with suspected comorbidity; d) to provide information on how therapies for psoriasis may modify the course of associated diseases, and e) to provide information concerning treatments prescribed for associated diseases that may have an impact on the course of psoriasis.This guide has been written by a working group of guideline methodologists and clinical experts. The selection of the diseases included was based on a systematic review of the literature and a summary of available evidence; information on the prevalence of each comorbidity was also taken from the literature. The recommendations on diagnostic criteria are based on the main clinical practice guidelines for each of the diseases discussed and on the recommendations of the expert advisory group. The information regarding the repercussions of psoriasis treatments on comorbid diseases was obtained from the summary of product characteristics of each drug. The statements concerning the impact on psoriasis of the associated diseases and their treatment are based on the review of the literature." ] ] "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "I. Belinchón, X. Bordas, L. Borrego, J.M. Careaga, V. García-Patos, J.M. Hernánz, E. Herrera, J.L. López-Estebaranz, J.C. Moreno, M. Ribera, M.A. Rodríguez-Prieto y A. Zulaica." ] ] "bibliografia" => array:2 [ "titulo" => "Bibliografía" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:306 [ 0 => array:3 [ "identificador" => "bib1" "etiqueta" => "1." 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Integrated approach to comorbidity in patients with psoriasis

E. Daudéna, S. Castañedab, C. Suárezc, J. García-Campayod, A.J. Blascoe,

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ablasco@taiss.com

Autor para correspondencia.

, M.D. Aguilare, C. Ferrándizf, L. Puigg, J.L. Sánchez-Carazoh, en representación del Grupo de Trabajo en Comorbilidades asociadas a la Psoriasis

a Servicio de Dermatología. IIS-Princesa. Hospital Universitario La Princesa. Madrid. España

b Servicio de Reumatología. IIS-Princesa. Hospital Universitario La Princesa. Madrid. España

c Servicio de Medicina Interna. IIS-Princesa. Hospital Universitario La Princesa. Madrid. España

d Servicio de Psiquiatría. Hospital Miguel Servet. Zaragoza. España

e Técnicas Avanzadas de Investigación en Servicios de Salud. Madrid. España

f Servicio de Dermatología. Hospital Germans Trias i Pujol. Badalona. España

g Servicio de Dermatología. Hospital de la Santa Creu i Sant Pau. Barcelona. España

h Servicio de Dermatología. Hospital General. Valencia. España

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        "resumen" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">En los &#250;ltimos a&#241;os&#44; se est&#225; prestando especial importancia a la relaci&#243;n de la psoriasis con otras enfermedades concomitantes&#46; El manejo temprano y adecuado del paciente con psoriasis se ha de contemplar&#44; por tanto&#44; desde un punto de vista integral&#44; tanto para el diagn&#243;stico temprano de la comorbilidad&#44; como para su prevenci&#243;n y tratamiento&#44; as&#237; como para evitar que los medicamentos utilizados en las enfermedades asociadas puedan interferir el curso de la psoriasis&#44; o viceversa&#46;</p><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Como ayuda a este abordaje integral de la psoriasis&#44; se plantea la elaboraci&#243;n de esta gu&#237;a de pr&#225;ctica cl&#237;nica enfocada espec&#237;ficamente hacia el manejo de la comorbilidad&#44; y dirigida especialmente a dermat&#243;logos&#46; Esta gu&#237;a se centra en las enfermedades m&#225;s prevalentes en la psoriasis&#58; artritis psori&#225;sica&#44; enfermedad cardiovascular a trav&#233;s del estudio de sus principales factores de riesgo &#40;obesidad&#44; diabetes mellitus&#44; hipertensi&#243;n arterial&#44; dislipemia y s&#237;ndrome metab&#243;lico&#41;&#44; h&#237;gado graso no alcoh&#243;lico&#44; enfermedad inflamatoria intestinal&#44; linfoma y c&#225;ncer de piel&#44; ansiedad y depresi&#243;n&#46; Tambi&#233;n se consideran otros factores de riesgo cardiovascular relacionados con los h&#225;bitos de vida&#44; como el consumo de tabaco y de alcohol&#46;</p><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">El objetivo principal de esta gu&#237;a es proporcionar al dermat&#243;logo una herramienta &#225;gil y precisa que protocolice el diagn&#243;stico de la comorbilidad y le facilite la toma de decisiones en relaci&#243;n con la derivaci&#243;n y el tratamiento del paciente con alguna enfermedad asociada&#46; Los objetivos espec&#237;ficos son&#58; <span class="elsevierStyleItalic">a&#41;</span> documentar sobre la comorbilidad m&#225;s frecuente en psoriasis&#44; aportando datos sobre la prevalencia y la importancia de cada una de estas enfermedades en el &#225;mbito de la consulta de dermatolog&#237;a&#59; <span class="elsevierStyleItalic">b&#41;</span> orientar en el protocolo de exploraci&#243;n f&#237;sica&#44; pruebas diagn&#243;sticas y criterios cl&#237;nicos que permitan realizar un diagn&#243;stico de sospecha de estas enfermedades&#59; <span class="elsevierStyleItalic">c&#41;</span> establecer los criterios de derivaci&#243;n de los pacientes con sospecha de comorbilidad al especialista correspondiente&#59; <span class="elsevierStyleItalic">d&#41;</span> informar sobre los tratamientos utilizados en el manejo de la psoriasis que modifican el curso de cada una de las enfermedades asociadas&#44; e <span class="elsevierStyleItalic">e&#41;</span> informar sobre los tratamientos utilizados en el manejo de estas enfermedades que pueden influir en el curso de la psoriasis&#46;</p><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">La gu&#237;a ha sido elaborada por un grupo de trabajo constituido por metod&#243;logos y expertos&#46; La selecci&#243;n y la documentaci&#243;n sobre las enfermedades a incluir y los datos de prevalencia de cada una se han basado en una revisi&#243;n sistem&#225;tica de la bibliograf&#237;a cient&#237;fica y en la s&#237;ntesis de la evidencia disponible&#46; Las recomendaciones sobre criterios diagn&#243;sticos se han basado en las principales gu&#237;as de pr&#225;ctica cl&#237;nica de cada una de las enfermedades y en recomendaciones del grupo de expertos&#46; La informaci&#243;n sobre las repercusiones terap&#233;uticas de la psoriasis en la comorbilidad se ha obtenido a partir de la ficha t&#233;cnica de los diferentes f&#225;rmacos&#44; y de las diferentes enfermedades en la psoriasis a partir de los art&#237;culos encontrados en la revisi&#243;n&#46;</p>"
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        "resumen" => "<p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">The relationship between psoriasis and associated diseases has drawn particular interest in recent years&#46; To provide appropriate management of psoriasis from an early stage&#44; it is necessary to include prompt diagnosis of concomitant disease and to prevent and treat any comorbidity found&#46; Such an integrated approach also serves to ensure that the drugs used to treat associated diseases do not interfere with the management of psoriasis&#44; and vice versa&#46;</p><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">This clinical practice guideline on the management of comorbidity in psoriasis has been drawn up to help dermatologists to achieve an integrated approach to this inflammatory disease&#46; The guide focuses primarily on the diseases most often found in patients with psoriasis&#44; which include psoriatic arthritis&#44; cardiovascular disease&#44; nonalcoholic fatty liver disease&#44; inflammatory bowel disease&#44; lymphoma&#44; skin cancer&#44; anxiety&#44; and depression&#46; Cardiovascular disease is approached through the study of its major risk factors &#40;obesity&#44; diabetes mellitus&#44; hypertension&#44; dyslipidemia&#44; and metabolic syndrome&#41;&#46; Other cardiovascular risk factors related to lifestyle&#44; such as smoking and alcohol consumption&#44; are also discussed&#46;</p><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">The overall aim of this guide is to provide the dermatologist with a precise&#44; easyto-use tool for systematizing the diagnosis of comorbidity in these patients and to facilitate decisions regarding referral and treatment once associated diseases have been found&#46; The specific objectives are as follows&#58; <span class="elsevierStyleItalic">a&#41;</span> to review the most common diseases associated with psoriasis&#44; including the prevalence of each one and its importance to the dermatologist&#59; <span class="elsevierStyleItalic">b&#41;</span> to provide guidelines for the physical examination&#44; diagnostic tests&#44; and clinical criteria on which to base a preliminary diagnosis&#59; <span class="elsevierStyleItalic">c&#41;</span> to establish criteria for the appropriate referral of patients with suspected comorbidity&#59; <span class="elsevierStyleItalic">d&#41;</span> to provide information on how therapies for psoriasis may modify the course of associated diseases&#44; and <span class="elsevierStyleItalic">e&#41;</span> to provide information concerning treatments prescribed for associated diseases that may have an impact on the course of psoriasis&#46;</p><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">This guide has been written by a working group of guideline methodologists and clinical experts&#46; The selection of the diseases included was based on a systematic review of the literature and a summary of available evidence&#59; information on the prevalence of each comorbidity was also taken from the literature&#46; The recommendations on diagnostic criteria are based on the main clinical practice guidelines for each of the diseases discussed and on the recommendations of the expert advisory group&#46; The information regarding the repercussions of psoriasis treatments on comorbid diseases was obtained from the summary of product characteristics of each drug&#46; The statements concerning the impact on psoriasis of the associated diseases and their treatment are based on the review of the literature&#46;</p>"
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Article information

ISSN: 00017310
Original language: Spanish

DOI:10.1016/S0001-7310(12)70001-7

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2023 January	66	82	148
2022 December	69	86	155
2022 November	66	114	180
2022 October	76	110	186
2022 September	84	116	200
2022 August	49	106	155
2022 July	58	149	207
2022 June	92	106	198
2022 May	69	88	157
2022 April	52	125	177
2022 March	96	152	248
2022 February	45	134	179
2022 January	47	149	196
2021 December	57	116	173
2021 November	70	130	200
2021 October	69	130	199
2021 September	54	116	170
2021 August	68	86	154
2021 July	73	88	161
2021 June	64	108	172
2021 May	32	96	128
2021 April	115	171	286
2021 March	87	103	190
2021 February	64	67	131
2021 January	36	52	88
2020 December	48	54	102
2020 November	36	47	83
2020 October	26	30	56
2020 September	30	38	68
2020 August	57	52	109
2020 July	32	49	81
2020 June	38	51	89
2020 May	28	67	95
2020 April	50	140	190
2020 March	42	67	109
2020 February	1	34	35
2020 January	0	17	17
2019 December	1	17	18
2019 November	9	15	24
2019 October	0	10	10
2019 September	0	6	6
2019 August	0	7	7
2019 July	0	9	9
2019 June	5	36	41
2019 May	1	62	63
2019 April	6	73	79
2019 March	0	19	19
2019 February	0	11	11
2019 January	1	11	12
2018 December	1	9	10
2018 November	0	15	15
2018 October	0	10	10
2018 September	0	7	7
2018 August	0	29	29
2018 July	0	28	28
2018 June	0	22	22
2018 May	0	28	28
2018 April	1	19	20
2018 March	0	31	31
2018 February	19	33	52
2018 January	36	34	70
2017 December	30	38	68
2017 November	20	33	53
2017 October	22	52	74
2017 September	21	51	72
2017 August	19	65	84
2017 July	23	58	81
2017 June	52	81	133
2017 May	31	66	97
2017 April	41	43	84
2017 March	52	83	135
2017 February	25	72	97
2017 January	31	28	59
2016 December	37	47	84
2016 November	59	84	143
2016 October	50	66	116
2016 September	67	102	169
2016 August	117	57	174
2016 July	94	91	185
2016 June	0	77	77
2016 May	3	88	91
2016 April	2	10	12
2016 March	4	9	13
2016 February	2	15	17
2016 January	4	62	66
2015 December	6	69	75
2015 November	10	56	66
2015 October	12	24	36
2015 September	8	34	42
2015 August	16	28	44
2015 July	120	5	125
2015 June	122	69	191
2015 May	157	92	249
2015 April	144	99	243
2015 March	121	61	182
2015 February	99	69	168
2015 January	103	85	188
2014 December	89	66	155
2014 November	74	93	167
2014 October	107	139	246
2014 September	91	94	185
2014 August	90	86	176
2014 July	95	96	191
2014 June	113	58	171
2014 May	126	67	193
2014 April	173	64	237
2014 March	114	50	164
2014 February	92	26	118
2014 January	101	30	131
2013 December	13	12	25
2013 November	31	13	44
2013 October	35	7	42
2013 September	6	11	17
2013 August	0	5	5
2013 July	3	4	7
2013 June	7	7	14
2013 May	6	7	13
2013 April	2	11	13
2013 March	1	8	9
2013 February	2	5	7
2013 January	3	11	14
2012 December	6	7	13
2012 November	6	29	35
2012 October	3	18	21
2012 September	5	35	40
2012 August	2	1	3

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