Integrated Approach to Comorbidity in Patients With Psoriasis
Abordaje integral de la comorbilidad del paciente con psoriasis
E. Daudéna, S. Castañedab, C. Suárezc, J. García-Campayod, A.J. Blascoe,
, M.D. Aguilare, C. Ferrándizf, L. Puigg, J.L. Sánchez-Carazoh, representing the Working Group on Comorbidity in Psoriasis *
Corresponding author
a Dermatology Department, IIS-Princesa, Hospital Universitario La Princesa, Madrid, Spain
b Rheumatology Department, IIS-Princesa, Hospital Universitario La Princesa, Madrid, Spain
c Internal Medicine Department, IIS-Princesa, Hospital Universitario La Princesa, Madrid, Spain
d Department of Psychiatry, Hospital Miguel Servet, Zaragoza, Spain
e Técnicas Avanzadas de Investigación en Servicios de Salud, Madrid, Spain
f Dermatology Department, Hospital Germans Trias i Pujol, Badalona, Spain
g Dermatology Department, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
h Dermatology Department, Hospital General, Valencia, Spain
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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.</p><p id="spar0010" 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. 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.</p><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">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: <span class="elsevierStyleItalic">a)</span> to review the most common diseases associated with psoriasis, including the prevalence of each one and its importance to the dermatologist; <span class="elsevierStyleItalic">b)</span> to provide guidelines for the physical examination, diagnostic tests, and clinical criteria on which to base a preliminary diagnosis; <span class="elsevierStyleItalic">c)</span> to establish criteria for the appropriate referral of patients with suspected comorbidity; <span class="elsevierStyleItalic">d)</span> to provide information on how therapies for psoriasis may modify the course of associated diseases, and <span class="elsevierStyleItalic">e)</span> to provide information concerning treatments prescribed for associated diseases that may have an impact on the course of psoriasis.</p><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">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.</p>" ] "es" => array:2 [ "titulo" => "Resumen" "resumen" => "<p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">En los últimos años, se está prestando especial importancia a la relación de la psoriasis con otras enfermedades concomitantes. 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.</p><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">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.</p><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">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: <span class="elsevierStyleItalic">a)</span> 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; <span class="elsevierStyleItalic">b)</span> orientar en el protocolo de exploración física, pruebas diagnósticas y criterios clínicos que permitan realizar un diagnóstico de sospecha de estas enfermedades; <span class="elsevierStyleItalic">c)</span> establecer los criterios de derivación de los pacientes con sospecha de comorbilidad al especialista correspondiente; <span class="elsevierStyleItalic">d)</span> informar sobre los tratamientos utilizados en el manejo de la psoriasis que modifican el curso de cada una de las enfermedades asociadas, e <span class="elsevierStyleItalic">e)</span> informar sobre los tratamientos utilizados en el manejo de estas enfermedades que pueden influir en el curso de la psoriasis.</p><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">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.</p>" ] ] "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "*" "nota" => "<p class="elsevierStyleNotepara">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, and A. Zulaica</p>" ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:306 [ 0 => array:3 [ "identificador" => "bib1" "etiqueta" => "1." "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ …2] ] "host" => array:1 [ 0 => array:2 [ …2] ] ] ] ] 1 => array:3 [ "identificador" => "bib2" "etiqueta" => "2." "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ …2] ] "host" => array:1 [ 0 => array:1 [ …1] ] ] ] ] 2 => array:3 [ "identificador" => "bib3" "etiqueta" => "3." "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ …2] ] "host" => array:1 [ 0 => array:2 [ …2] ] ] ] ] 3 => array:3 [ "identificador" => "bib4" "etiqueta" => "4." 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| Year/Month | Html | Total | |
|---|---|---|---|
| 2024 November | 4 | 12 | 16 |
| 2024 October | 66 | 68 | 134 |
| 2024 September | 57 | 62 | 119 |
| 2024 August | 67 | 87 | 154 |
| 2024 July | 49 | 46 | 95 |
| 2024 June | 55 | 67 | 122 |
| 2024 May | 47 | 49 | 96 |
| 2024 April | 43 | 33 | 76 |
| 2024 March | 45 | 38 | 83 |
| 2024 February | 41 | 41 | 82 |
| 2024 January | 34 | 52 | 86 |
| 2023 December | 25 | 25 | 50 |
| 2023 November | 36 | 38 | 74 |
| 2023 October | 30 | 32 | 62 |
| 2023 September | 30 | 42 | 72 |
| 2023 August | 20 | 463 | 483 |
| 2023 July | 25 | 43 | 68 |
| 2023 June | 29 | 69 | 98 |
| 2023 May | 27 | 55 | 82 |
| 2023 April | 28 | 39 | 67 |
| 2023 March | 10 | 28 | 38 |
| 2023 February | 24 | 7 | 31 |
| 2023 January | 20 | 51 | 71 |
| 2022 December | 15 | 38 | 53 |
| 2022 November | 39 | 10 | 49 |
| 2022 October | 9 | 13 | 22 |
| 2022 September | 0 | 24 | 24 |
| 2022 August | 0 | 34 | 34 |
| 2022 July | 1 | 43 | 44 |
| 2022 June | 1 | 92 | 93 |
| 2022 May | 14 | 76 | 90 |
| 2022 April | 30 | 76 | 106 |
| 2022 March | 37 | 70 | 107 |
| 2022 February | 35 | 41 | 76 |
| 2022 January | 28 | 48 | 76 |
| 2021 December | 18 | 33 | 51 |
| 2021 November | 26 | 66 | 92 |
| 2021 October | 31 | 82 | 113 |
| 2021 September | 20 | 76 | 96 |
| 2021 August | 33 | 83 | 116 |
| 2021 July | 19 | 51 | 70 |
| 2021 June | 18 | 42 | 60 |
| 2021 May | 19 | 69 | 88 |
| 2021 April | 20 | 62 | 82 |
| 2021 March | 24 | 42 | 66 |
| 2021 February | 14 | 19 | 33 |
| 2021 January | 9 | 25 | 34 |
| 2020 December | 10 | 16 | 26 |
| 2020 November | 14 | 21 | 35 |
| 2020 October | 6 | 15 | 21 |
| 2020 September | 11 | 22 | 33 |
| 2020 August | 8 | 28 | 36 |
| 2020 July | 6 | 27 | 33 |
| 2020 June | 19 | 45 | 64 |
| 2020 May | 10 | 34 | 44 |
| 2020 April | 12 | 22 | 34 |
| 2020 March | 14 | 24 | 38 |
| 2020 February | 2 | 2 | 4 |
| 2018 February | 3 | 8 | 11 |
| 2018 January | 5 | 13 | 18 |
| 2017 December | 6 | 13 | 19 |
| 2017 November | 3 | 2 | 5 |
| 2017 October | 10 | 13 | 23 |
| 2017 September | 3 | 10 | 13 |
| 2017 August | 7 | 6 | 13 |
| 2017 July | 6 | 8 | 14 |
| 2017 June | 12 | 11 | 23 |
| 2017 May | 15 | 7 | 22 |
| 2017 April | 15 | 15 | 30 |
| 2017 March | 6 | 18 | 24 |
| 2017 February | 10 | 7 | 17 |
| 2017 January | 7 | 9 | 16 |
| 2016 December | 12 | 4 | 16 |
| 2016 November | 13 | 7 | 20 |
| 2016 October | 12 | 20 | 32 |
| 2016 September | 15 | 3 | 18 |
| 2016 August | 16 | 4 | 20 |
| 2016 July | 15 | 2 | 17 |
| 2016 January | 1 | 0 | 1 |
| 2015 December | 1 | 0 | 1 |
| 2015 November | 1 | 1 | 2 |
| 2015 October | 8 | 2 | 10 |
| 2015 September | 2 | 0 | 2 |
| 2015 August | 1 | 1 | 2 |
| 2015 July | 20 | 2 | 22 |
| 2015 June | 17 | 21 | 38 |
| 2015 May | 52 | 37 | 89 |
| 2015 April | 36 | 31 | 67 |
| 2015 March | 31 | 31 | 62 |
| 2015 February | 40 | 22 | 62 |
| 2015 January | 32 | 39 | 71 |
| 2014 December | 34 | 24 | 58 |
| 2014 November | 45 | 39 | 84 |
| 2014 October | 35 | 39 | 74 |
| 2014 September | 39 | 43 | 82 |
| 2014 August | 38 | 31 | 69 |
| 2014 July | 48 | 47 | 95 |
| 2014 June | 37 | 35 | 72 |
| 2014 May | 49 | 36 | 85 |
| 2014 April | 38 | 47 | 85 |
| 2014 March | 47 | 34 | 81 |
| 2014 February | 32 | 25 | 57 |
| 2014 January | 36 | 28 | 64 |
| 2013 December | 5 | 18 | 23 |
| 2013 November | 12 | 20 | 32 |
| 2013 October | 8 | 13 | 21 |
| 2013 September | 1 | 13 | 14 |
| 2013 August | 4 | 14 | 18 |
| 2013 July | 2 | 19 | 21 |
| 2013 June | 3 | 18 | 21 |
| 2013 May | 0 | 16 | 16 |
| 2013 April | 1 | 15 | 16 |
| 2013 March | 1 | 22 | 23 |
| 2013 February | 0 | 8 | 8 |
| 2013 January | 0 | 23 | 23 |
| 2012 December | 2 | 23 | 25 |
| 2012 November | 4 | 34 | 38 |
| 2012 October | 2 | 46 | 48 |
| 2012 September | 0 | 1 | 1 |
| 2012 August | 1 | 1 | 2 |
| 2012 July | 1 | 0 | 1 |
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