Pediatric Consensus on Comorbidity Assessments Save

Comorbidity is a serious consequence or confounder in patients with inflammatory diseases. This has been well described in both psoriatic and rheumatoid disease.  JAMA Dermatology has published the recommendations of a pediatric multispecialty group regarding the screening for comorbid disease. (Citation source https://buff.ly/2u4pi3J)

A panel of experts specializing in psoriasis, pediatric dermatology, pediatric rheumatology, pediatric gastroenterology, pediatric endocrinology, and adult and pediatric cardiology was convened to  review the literaturem grade the quality of evidence abd develop guidelines for comorbidity screening for patients with pediatric psoriasis..

Owing to a limited number of studies focused on this issue, many of the panel’s recommendations were given a SORT level C recommendations. Also, the majority of recommendations coincide with those endorsed by the American Academy of Pediatrics with added attention to arthritis, depression, and anxiety.  Specific recommendations addressed: 

Obesity

• Clinicians should screen for overweight and obesity every year using body mass index (BMI) percentile, starting at 2 years of age.

Type 2 diabetes

• Clinicians should screen every 3 years starting at 10 years of age, or at the onset of puberty if the patient is overweight and has at least 2 risk factors for type 2 diabetes.
• Screen patients with obesity every 3 years starting at 10 years of age or at the onset of puberty regardless of risk factors.
• Screenings should be performed by measuring fasting glucose serum.

Dyslipidemia

• Patients between 9 and 11 years of age and between 17 and 21 years of age should receive universal lipid screenings.
• Screenings are also recommended in patients with any additional cardiovascular risk factors.
• The recommended lipid screening is a fasting lipid panel.

Hypertension 

• Clinicians should screen for hypertension every year starting at 3 years of age, using age, sex, and height reference charts.

Nonalcoholic fatty liver disease

• Children with obesity or who are overweight with additional risk factors (central adiposity, insulin resistance, prediabetes or diabetes, dyslipidemia, obstructive sleep apnea, or a family history of nonalcoholic fatty liver disease) should be screened with alanine aminotransferase measurements at 9 to 11 years of age.
• Screening before 9 years of age can be considered in patients with risk factors such as severe obesity, family history, or hypopituitarism.

Arthritis 

• Patients with pediatric psoriasis should be screened for the development of arthritis by a directed review of systems and physical examination.

Mood disorders and substance abuse

• Screen every year for depression and anxiety regardless of age.
• Screen every year for substance abuse starting at 11 years of age.

Thus, pediatric psoriasis should receive routine screening and identification of risk factors for the above noted comorbidities. These guidelines have the intent of early recognition so as to limit morbid risks to the inflammatory patient. 

While screening and management of comorbidity is not often addressed in adults  (https://buff.ly/2wa7s0V), consideration of these pediatric guidelines may be important for all practitioners.