Regular Comorbidity Screening Needed for Children With Psoriasis
Patients with pediatric psoriasis should receive routine screening and identification of risk factors for associated comorbidities, according to a consensus statement published online in JAMA Dermatology.
These guidelines are relevant for all health care providers caring for patients with pediatric psoriasis, including primary care clinicians, dermatologists, and pediatric specialists. Because these are the first pediatric guidelines, re-review and refinement will be necessary as studies further detail, and possibly stratify, risk in affected children, noted the researchers.
Psoriasis is associated with serious medical comorbidities in adults, including obesity, hypertension, dyslipidemia, type 2 diabetes mellitus, psoriatic arthritis, nonalcoholic fatty liver disease, depression, anxiety, and decreased quality of life. Because psoriasis begins in childhood in almost one-third of patients, early identification of risk may be critical to minimizing effects on future health.
The panel, comprised of experts in psoriasis, pediatric dermatology, pediatric rheumatology, pediatric gastroenterology, pediatric endocrinology, and adult and pediatric cardiology, developed the first set of guidelines for comorbidity screening for patients with pediatric psoriasis based on current evidence. A literature review was performed using PubMed from January 1999 through December 2015. Limiting the search to human studies published in English and eliminating reviews and editorials produced 153 relevant manuscripts.
The panel used the patient-centered Strength of Recommendation Taxonomy (SORT) method to evaluate and grade the quality of evidence.
Many recommendations are similar to those endorsed by the American Academy of Pediatrics for the general pediatric patient. They include annual screening for overweight and obesity beginning at age 2 years; screening of overweight patients every 3 years for type 2 diabetes beginning at age 10 years; lipid screening between ages 9 to 11 years and between ages 17 to 21 years; annual screening for hypertension beginning at age 3 years; and screening for nonalcoholic fatty liver disease for children with risk factors. The panel also recommended screening for signs and symptoms of arthritis, depression, and anxiety.
Due to the limited number of pediatric studies published on these topics, the strength of the panel’s recommendations is classified as SORT level C expert consensus recommendations. The panel also identified key areas for further investigation.
Osier E, Wang AS, Tollefson MM, et al. Pediatric psoriasis comorbidity screening guidelines [published online May 17, 2017]. JAMA Dermatol. doi:10.1001/jamadermatol.2017.0499
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Osteoporosis Risk in Patients With Psoriasis
Psoriasis and psoriatic arthritis (PsA) are likely associated with osteoporosis, along with osteopenia, ankylosingspondylitis (AS), and pathological fractures, according to a new study.
The researchers conducted a cross-sectional study of nearly 200 million children and adults, using data from the 2006-2012 Nationwide Emergency Department Sample, including 20% of hospital-based emergency care visits across the United States. A total of 183,725 participants had psoriasis, and 28,765 had PsA.
Participants with psoriasis tended to be older, male, and more likely to have Medicare as a primary payment method.
Those with PsA also tended to be older and have Medicare, but sex distribution was similar between males and females.
A pooled analysis across all 7 years indicated that patients with psoriasis faced a much greater risk of developing osteoporosis, osteopenia, osteomalacia, AS, and pathological fractures. Analysis of patients with PsA demonstrated similar results.
Additionally, the researchers linked psoriasis to vertebral, pelvic, femoral, and tibial/fibular fractures, and PsA was associated with stress and vertebral, pelvic, femoral, and tibial/fibular fractures.
The results indicated that women with psoriasis or PsA faced a greater risk of developing osteopenia, osteoporosis, and osteomalacia, while the risk of developing AS was greater in men. Additionally, patients with psoriasis and PsA who experienced fractures tended to show higher rates of hospitalization, prolonged hospitalization, and increased care costs.
“In conclusion, both [psoriasis] and PsA are associated with osteopenia, osteoporosis, osteomalacia, AS, and multiple types of fractures, particularly pathological femoral, vertebral, pelvic, tibia, and fibula fractures,” the researchers concluded. “Further studies are needed to confirm these findings and determine the ideal approaches to prevent and treat these comorbidities.”
Kathuria P, Gordon KB, Silverberg JI. Association of psoriasis and psoriatic arthritis with osteoporosis and pathological fractures.