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01-06-2020 | Obesity | Comorbidities

Delphi-based recommendations for the management of cardiovascular comorbidities in patients with psoriatic arthritis and moderate-to-severe psoriasis

Authors: Pedro Zarco Montejo, Raquel Almodóvar González, Eva De Higes-Martínez, Juan José Gorgojo-Martínez, Carlos Guijarro Herraiz, María Jesús López Navas, David Palacios, Jose Carlos Peláez Álvarez, Diana Ruíz Genao, Blanca Piedrafita, Susana Gómez, Erica Falkenbach, Francisco Jose Rebollo Laserna, Jose Luis López Estebaranz

Published in: Rheumatology International | Issue 6/2020

Abstract

The aim of this study was to generate practical recommendations to assist rheumatologists and dermatologists in the management of cardiovascular (CV) comorbidities in patients with moderate-to-severe psoriasis (MS-PSO) and psoriatic arthritis (PsA). A two-round Delphi study was conducted. A panel of experts rated their agreement with a set of statements (n = 52) on a nine-point Likert scale (1 = totally disagree; 9 = totally agree). Statements were classified as inappropriate (median 1–3), irrelevant (median 4–6) or appropriate (median 7–9). Consensus was established when at least two-thirds of the panel responded with a score within any one range. A total of 25 experts, 60% rheumatologists and 40% dermatologists, participated in two consultation rounds. There was overall unanimity on the appropriateness of an initial assessment for CV risk factors in all patients with MS-PSO and PsA. Most panelists (88.0%) also supported the evaluation of patients’ psychological and physical status. Additionally, most panelists (72.2%) agreed on a novel sequential approach for the management of CV comorbidities. This sequence starts with the assessment of hypertension, diabetes and dyslipidemia along with the identification of depression and anxiety disorders. Once these factors are under control, smoking cessation programs might be initiated. Finally, if patients have not met weight loss goals with lifestyle modifications, they should receive specialized treatment for obesity. This study has drawn up a set of practical recommendations that will facilitate the management of CV comorbidities in patients with MS-PSO and PsA.

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Oliveira Mde F, Rocha Bde O, Duarte GV (2015) Psoriasis: classical and emerging comorbidities. An Bras Dermatol 90(1):9–20. https://doi.org/10.1590/abd1806-4841.20153038 CrossRefPubMed

Jamnitski A, Symmons D, Peters MJ et al (2013) Cardiovascular comorbidities in patients with psoriatic arthritis: a systematic review. Ann Rheum Dis 72(2):211–216. https://doi.org/10.1136/annrheumdis-2011-201194 CrossRefPubMed

McAleer MA, Mason DL, Cunningham S et al (2011) Alcohol misuse in patients with psoriasis: identification and relationship to disease severity and psychological distress. Br J Dermatol 164(6):1256–1261. https://doi.org/10.1111/j.1365-2133.2011.10345.x CrossRefPubMed

Dauden E, Castaneda S, Suarez C et al (2013) Clinical practice guideline for an integrated approach to comorbidity in patients with psoriasis. J Eur Acad Dermatol Venereol 27(11):1387–1404. https://doi.org/10.1111/jdv.12024 CrossRefPubMed

Freire M, Rodriguez J, Moller I et al (2011) Prevalence of symptoms of anxiety and depression in patients with psoriatic arthritis attending rheumatology clinics. Reumatol Clin 7(1):20–26. https://doi.org/10.1016/j.reuma.2010.03.003 CrossRefPubMed

Lamb RC, Matcham F, Turner MA et al (2017) Screening for anxiety and depression in people with psoriasis: a cross-sectional study in a tertiary referral setting. Br J Dermatol 176(4):1028–1034. https://doi.org/10.1111/bjd.14833 CrossRefPubMed

Torre-Alonso JC, Carmona L, Moreno M et al (2017) Identification and management of comorbidity in psoriatic arthritis: evidence- and expert-based recommendations from a multidisciplinary panel from Spain. Rheumatol Int 37(8):1239–1248. https://doi.org/10.1007/s00296-017-3702-9 CrossRefPubMed

Manalo IF, Gilbert KE, Wu JJ (2015) Survey of trends and gaps in dermatologists' cardiovascular screening practices in psoriasis patients: areas still in need of improvement. J Am Acad Dermatol 73(5):872–874. https://doi.org/10.1016/j.jaad.2015.07.029 CrossRefPubMed

John H, Kitas G (2012) Inflammatory arthritis as a novel risk factor for cardiovascular disease. Eur J Intern Med 23(7):575–579. https://doi.org/10.1016/j.ejim.2012.06.016 CrossRefPubMed

10.

Coates LC, Kavanaugh A, Mease PJ et al (2016) Group for research and assessment of psoriasis and psoriatic arthritis 2015 treatment recommendations for psoriatic arthritis. Arthritis Rheumatol 68(5):1060–1071. https://doi.org/10.1002/art.39573 CrossRefPubMed

11.

Roubille C, Richer V, Starnino T et al (2015) Evidence-based recommendations for the management of comorbidities in rheumatoid arthritis, psoriasis, and psoriatic arthritis: expert opinion of the canadian dermatology-rheumatology comorbidity initiative. J Rheumatol 42(10):1767–1780. https://doi.org/10.3899/jrheum.141112 CrossRefPubMed

12.

Fitch K, Bernstein SJ, Aguilar MD et al (2001) The Rand/UCLA appropriateness method user’s manual. https://www.rand.org/content/dam/rand/pubs/monograph_reports/2011/MR1269.pdf. Accessed Feb 2020

13.

Cuende JI (2016) Vascular age versus cardiovascular risk: clarifying concepts. Rev Esp Cardiol (Engl Ed) 69(3):243–246. https://doi.org/10.1016/j.rec.2015.10.019 CrossRef

14.

Estruch R, Ros E, Salas-Salvado J et al (2018) Primary prevention of cardiovascular disease with a mediterranean diet supplemented with extra-virgin olive oil or nuts. N Engl J Med 378(25):e34. https://doi.org/10.1056/NEJMoa1800389 CrossRefPubMed

15.

Salas-Salvado J, Diaz-Lopez A, Ruiz-Canela M et al (2019) Effect of a lifestyle intervention program with energy-restricted mediterranean diet and exercise on weight loss and cardiovascular risk factors: one-year results of the PREDIMED-plus trial. Diabetes Care 42(5):777–788. https://doi.org/10.2337/dc18-0836 CrossRefPubMed

16.

Dauden E, Castaneda S, Suarez C et al (2012) Integrated approach to comorbidity in patients with psoriasis. Working Group on Psoriasis-associated Comorbidities. Actas Dermosifiliogr 103(Suppl 1):1–64. https://doi.org/10.1016/S0001-7310(12)70001-7 CrossRefPubMed

17.

Strohal R, Kirby B, Puig L et al (2014) Psoriasis beyond the skin: an expert group consensus on the management of psoriatic arthritis and common co-morbidities in patients with moderate-to-severe psoriasis. J Eur Acad Dermatol Venereol 28(12):1661–1669. https://doi.org/10.1111/jdv.12350 CrossRefPubMed

18.

Dauden E, Blasco AJ, Bonanad C et al (2018) Position statement for the management of comorbidities in psoriasis. J Eur Acad Dermatol Venereol 32(12):2058–2073. https://doi.org/10.1111/jdv.15177 CrossRefPubMed

19.

Adler BL, Krausz AE, Tian J et al (2014) Modifiable lifestyle factors in psoriasis: screening and counseling practices among dermatologists and dermatology residents in academic institutions. J Am Acad Dermatol 71(5):1028–1029. https://doi.org/10.1016/j.jaad.2014.06.043 CrossRefPubMed

20.

Casals-Sanchez JL, De Yebenes G, Prous MJ, Descalzo Gallego MA et al (2012) Characteristics of patients with spondyloarthritis followed in rheumatology units in Spain. emAR II study. Reumatol Clin 8(3):107–113. https://doi.org/10.1016/j.reuma.2012.01.006 CrossRefPubMed

21.

Molto A, Etcheto A, van der Heijde D et al (2016) Prevalence of comorbidities and evaluation of their screening in spondyloarthritis: results of the international cross-sectional ASAS-COMOSPA study. Ann Rheum Dis 75(6):1016–1023. https://doi.org/10.1136/annrheumdis-2015-208174 CrossRefPubMed

22.

Truong B, Rich-Garg N, Ehst BD et al (2015) Demographics, clinical disease characteristics, and quality of life in a large cohort of psoriasis patients with and without psoriatic arthritis. Clin Cosmet Investig Dermatol 8:563–569. https://doi.org/10.2147/CCID.S90270 CrossRefPubMedPubMedCentral

23.

McDonough E, Ayearst R, Eder L et al (2014) Depression and anxiety in psoriatic disease: prevalence and associated factors. J Rheumatol 41(5):887–896. https://doi.org/10.3899/jrheum.130797 CrossRefPubMed

24.

Emdin CA, Odutayo A, Wong CX et al (2016) Meta-analysis of anxiety as a risk factor for cardiovascular disease. Am J Cardiol 118(4):511–519. https://doi.org/10.1016/j.amjcard.2016.05.041 CrossRefPubMed

25.

Hare DL, Toukhsati SR, Johansson P et al (2014) Depression and cardiovascular disease: a clinical review. Eur Heart J 35(21):1365–1372. https://doi.org/10.1093/eurheartj/eht462 CrossRefPubMed

26.

Warburton DE, Nicol CW, Bredin SS (2006) Health benefits of physical activity: the evidence. CMAJ 174(6):801–809. https://doi.org/10.1503/cmaj.051351 CrossRefPubMedPubMedCentral

27.

Kavanaugh AF, Ritchlin CT, Committee GTG (2006) Systematic review of treatments for psoriatic arthritis: an evidence based approach and basis for treatment guidelines. J Rheumatol 33(7):1417–1421PubMed

28.

Lubrano E, Spadaro A, Parsons WJ et al (2009) Rehabilitation in psoriatic arthritis. J Rheumatol Suppl 83:81–82. https://doi.org/10.3899/jrheum.09235 CrossRefPubMed

29.

Agca R, Heslinga SC, Rollefstad S et al (2017) EULAR recommendations for cardiovascular disease risk management in patients with rheumatoid arthritis and other forms of inflammatory joint disorders: 2015/2016 update. Ann Rheum Dis 76(1):17–28. https://doi.org/10.1136/annrheumdis-2016-209775 CrossRefPubMed

30.

Matthews DR, Hosker JP, Rudenski AS et al (1985) Homeostasis model assessment: insulin resistance and beta-cell function from fasting plasma glucose and insulin concentrations in man. Diabetologia 28(7):412–419. https://doi.org/10.1007/bf00280883 CrossRefPubMed

31.

Tilg H, Moschen AR (2008) Inflammatory mechanisms in the regulation of insulin resistance. Mol Med 14(3–4):222–231. https://doi.org/10.2119/2007-00119.Tilg CrossRefPubMedPubMedCentral

32.

Polic MV, Miskulin M, Smolic M et al (2018) Psoriasis severity—a risk factor of insulin resistance independent of metabolic syndrome. Int J Environ Res Public Health 15:7. https://doi.org/10.3390/ijerph15071486 CrossRef

33.

Zhu TY, Li EK, Tam LS (2012) Cardiovascular risk in patients with psoriatic arthritis. Int J Rheumatol 2012:714321. https://doi.org/10.1155/2012/714321 CrossRefPubMedPubMedCentral

34.

Davies MJ, D'Alessio DA, Fradkin J (2018) Management of hyperglycaemia in type 2 diabetes, 2018. A consensus report by the American Diabetes Association (ADA) and the European Association for the Study of Diabetes (EASD). Diabetologia 61(12):2461–2498. https://doi.org/10.1007/s00125-018-4729-5 CrossRefPubMed

35.

Das SR, Everett BM, Birtcher KK et al (2018) 2018 ACC expert consensus decision pathway on novel therapies for cardiovascular risk reduction in patients with type 2 diabetes and atherosclerotic cardiovascular disease: a report of the american college of cardiology task force on expert consensus decision pathways. J Am Coll Cardiol 72(24):3200–3223. https://doi.org/10.1016/j.jacc.2018.09.020 CrossRefPubMed

36.

Piepoli MF, Hoes AW, Agewall S et al (2016) 2016 European guidelines on cardiovascular disease prevention in clinical practice: the Sixth Joint Task Force of the European Society of Cardiology and Other Societies on Cardiovascular Disease Prevention in Clinical Practice (constituted by representatives of 10 societies and by invited experts). Developed with the special contribution of the European Association for Cardiovascular Prevention and Rehabilitation (EACPR). Eur Heart J 37(29):2315–2381. https://doi.org/10.1093/eurheartj/ehw106 CrossRefPubMedPubMedCentral

37.

Mach F, Baigent C, Catapano AL et al (2019) 2019 ESC/EAS guidelines for the management of dyslipidaemias: lipid modification to reduce cardiovascular risk. Eur Heart J 41(1):111–188. https://doi.org/10.1093/eurheartj/ehz455 CrossRef

38.

Gafoor R, Booth HP, Gulliford MC (2018) Antidepressant utilisation and incidence of weight gain during 10 years' follow-up: population based cohort study. BMJ 361:k1951. https://doi.org/10.1136/bmj.k1951 CrossRefPubMedPubMedCentral

39.

Vilarrasa E, Notario J, Bordas X et al (2016) ORBIT (outcome and retention rate of biologic treatments for psoriasis): a retrospective observational study on biologic drug survival in daily practice. J Am Acad Dermatol 74(6):1066–1072. https://doi.org/10.1016/j.jaad.2016.01.037 CrossRefPubMed

40.

Eder L, Thavaneswaran A, Chandran V et al (2015) Obesity is associated with a lower probability of achieving sustained minimal disease activity state among patients with psoriatic arthritis. Ann Rheum Dis 74(5):813–817. https://doi.org/10.1136/annrheumdis-2013-204448 CrossRefPubMed

41.

Di Lernia V, Ricci C, Lallas A et al (2014) Clinical predictors of non-response to any tumor necrosis factor (TNF) blockers: a retrospective study. J Dermatol Treat 25(1):73–74. https://doi.org/10.3109/09546634.2013.800184 CrossRef

42.

Kalb RE, Fiorentino DF, Lebwohl MG et al (2015) Risk of serious infection with biologic and systemic treatment of psoriasis: results from the psoriasis longitudinal assessment and registry (PSOLAR). JAMA Dermatol 151(9):961–969. https://doi.org/10.1001/jamadermatol.2015.0718 CrossRefPubMed

43.

Proffesional Education Materials. https://www.niaaa.nih.gov/publications/clinical-guides-and-manuals Accessed Feb 2020

44.

Nast A, Gisondi P, Ormerod AD et al (2015) European S3-guidelines on the systemic treatment of psoriasis vulgaris—update 2015—short version—EDF in cooperation with EADV and IPC. J Eur Acad Dermatol Venereol 29(12):2277–2294. https://doi.org/10.1111/jdv.13354 CrossRefPubMed

45.

Catapano AL, Graham I, De Backer G et al (2016) 2016 ESC/EAS guidelines for the management of dyslipidaemias. Eur Heart J 37(39):2999–3058. https://doi.org/10.1093/eurheartj/ehw272 CrossRefPubMed

46.

American Diabetes Association (2017) 2. Classification and diagnosis of diabetes. Diabetes Care 40(Supplement 1):S11–S24. https://doi.org/10.2337/dc17-S005 CrossRef

47.

National Institute for Health and Care Excellence (NICE) (2014) Obesity: identification, assessment and management. NICE clinical guideline 189. https://www.nice.org.uk/guidance/cg189. Accessed Feb 2020

48.

National Institute of Health (NIH) (2020) National institute on alcohol abuse and alcoholism. Professional Education Materials. www.niaaa.nih.gov/publications/clinical-guides-and-manuals Accessed Mar 2020

49.

Ramos Pinedo A, Mayayo Ulibarri ML (2007) Abordaje del tabaquismo. Manual SEPAR de procedimientos. https://issuu.com/separ/docs/procedimientos13?mode=window&backgroundColor=%23222222. Accessed Mar 2020

50.

Swift DL, Johannsen NM, Lavie CJ et al (2014) The role of exercise and physical activity in weight loss and maintenance. Prog Cardiovasc Dis 56(4):441–447. https://doi.org/10.1016/j.pcad.2013.09.012 CrossRefPubMed

Title: Delphi-based recommendations for the management of cardiovascular comorbidities in patients with psoriatic arthritis and moderate-to-severe psoriasis
Authors: Pedro Zarco Montejo
Raquel Almodóvar González
Eva De Higes-Martínez
Juan José Gorgojo-Martínez
Carlos Guijarro Herraiz
María Jesús López Navas
David Palacios
Jose Carlos Peláez Álvarez
Diana Ruíz Genao
Blanca Piedrafita
Susana Gómez
Erica Falkenbach
Francisco Jose Rebollo Laserna
Jose Luis López Estebaranz
Publication date: 01-06-2020
Publisher: Springer Berlin Heidelberg
Keywords: Obesity
Obesity
Vulgar Psoriasis
Psoriatic Arthritis
Published in: Rheumatology International / Issue 6/2020
Print ISSN: 0172-8172
Electronic ISSN: 1437-160X
DOI: https://doi.org/10.1007/s00296-020-04573-w

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