Unequal Treatment for Psoriasis?

Psoriasis patients said they do not always get adequate care

(RxWiki News) The type of medical care patients get depends on several factors. Some patients with psoriasis, or the arthritis that can accompany psoriasis, don't believe they get enough quality care.

Roughly half of psoriasis and psoriatic arthritis patients responding to a nationwide survey described their illness as untreated or under-treated.

Lack of effective treatment and lack of insurance coverage for treatment were among the causes for their dissatisfaction, according to a new study based on that patient survey.

"Ask your doctor about safe, effective psoriasis care."

April Armstrong, MD, PhD, the University of California at Davis Medical Center's director of teledermatology and clinical research, was lead author of this study.

The study was based on a January 2003 through December 2011 survey that got responses from 5,604 patients with psoriasis or psoriatic arthritis. The National Psoriasis Foundation (NPF) compiled and collected the surveys. NPF has about 76,000 members.

In reviewing the responses, the researchers found that over the years, 36.6 percent to 49.2 percent of patients with mild psoriasis were untreated. Also untreated were 23.6 percent to 35.5 percent of patients with moderate psoriasis and 9.4 percent to 29.7 percent of patients with severe psoriasis.

Also, 29.5 percent of patients with moderate psoriasis and 21.5 percent of patients with severe psoriasis were treated only with ointments that are applied to the skin.

Overall, 52.3 percent of patients with psoriasis and 45.5 percent of patients with psoriatic arthritis were dissatisfied with their treatment, the researchers found.

Glenn Kolansky, MD, a dermatologist and director of the Advanced Dermatology Surgery and Laset Center in Tinton Falls, New Jersey, told dailyRx News that the study did not fully capture the complexity of this health issue. For example, it failed to note that some medical insurers help cover medication costs for psoriasis patients who cannot afford it.

According to Dr. Kolansky, a big part of the problem is that psoriasis is incurable.

"If you have mild psoriasis, the topical ointments can be beneficial but they don’t help people permanently. And most people are not happy to apply a cream twice of day,” Dr. Kolansky said.

“If you have severe arthritis, a lot of the medications for that suppress the body’s immune system, they do have side effects...So, you have people who are very frustrated by this debilitating disease that has no cure. I agree with the study, in that most people are disappointed by all this,” he said.

Nevertheless, the researchers said they believe the dissatisfaction is even greater than the survey shows.

"These estimates are likely more conservative than those among the general US population with psoriasis because the respondents, who are members of the NPF, are probably more engaged with their health care," the researchers wrote.

"Collaborative efforts from the various stakeholders, including patients, physicians, [insurance] payers, regulatory agencies, and advocacy organizations, are necessary to improve the lives of those affected by psoriasis and psoriatic arthritis," they wrote.

Ointments, therapy under artificial lights and prescription medications — including one that US Food and Drug Administration (FDA) later determined was too dangerous and banned — are among treatments that have been available to some patients in recent years, the researchers wrote.

While some patients discontinued certain treatments that proved ineffective for them, researchers also wrote in a press release announcing the study that "...the inability to obtain adequate insurance coverage was among the top reasons for discontinuation."

This study was published online August 14 in JAMA Dermatology.

Dr. Armstrong reported that she had received research grants and been paid other fees by pharmaceutical companies.

Review Date: 
August 13, 2013