QD 88 - Managing Comorbidities In Psoriatic Patients Save
QD Clinic - Lessons from the clinic
The Rheumatologists Role in Comorbidity Management
Features Dr. Jack Cush
YouTUbe link: https://youtu.be/1R6J_-WM49Q
Transcription
Welcome to QD Clinic. QD Clinic is brought to you by RheumNow Live. I'm Jack Cush from RheumNow. RheumNow Live starts today. You can go online and register and consume it all from home, roomnow.live.
Choose the free online at home registration. Today we're going talk about comorbidity in psoriatic arthritis. Just heard a fabulous lecture by Doctor. Alan Mentor on comorbidity and cardiovascular disease in psoriasis this morning. He's one of our speakers in a Friday afternoon pod entitled, The Management of Psoriatic Disease.
He's going to talk about new therapies and exciting advances in psoriasis at RheumNow Live. But Jose Scherer is going to talk about the curse of comorbidity with psoriatic disease. Anyway, today's lecture, Doctor. Mentor covered a lot of this content, specifically about the links between inflammation, psoriasis inflammation, and cardiovascular inflammation as the driving force behind increased cardiovascular events and poor cardiovascular outcomes in patients with psoriatic disease, both psoriasis and psoriatic arthritis. I think it's important for us to be aware of this.
I think most rheumatologists are aware of the comorbidities. I think the question that I want to cover here is how do we manage comorbidities in the arthritis clinic or in the dermatology clinic? Let's go at them one by one. Number one, cardiovascular morbidity mortality. It's very clear that effective anti inflammatory systemic control of inflammation therapies are going to be effective at lowering cardiovascular risk.
This has been shown with methotrexate in rheumatoid arthritis, it's been shown with TNF inhibitors and other anti inflammatory biologics with rheumatoid arthritis, And there is data suggesting the same can be seen in psoriasis and psoriatic arthritis. Maybe not as much data, but it's still the same message, still the same pathogenesis that's being interrupted by effective therapy. So maybe the best thing you can do is get great control of either psoriatic skin disease or psoriatic arthritis. The second most important thing that you must do is manage the cardiovascular risk factors and either you're going to do that or have the patient seen by their primary care or cardiologist. Again, a psoriatic patient with cardiovascular risk factors and or a history of cardiovascular events needs to be seen by the cardiologist in addition to the dermatologist and rheumatologist.
Of course, the cardiovascular risk is driven by other things like, the metabolic syndrome and obesity and hyperlipidemia. I think that rheumatologists need to be very very clear and very very consistent in the message that reducing weight leads to better disease control. No, that's not a corona cough, it's a kennel cough. That means that patients who undergo dramatic weight loss either by gastric sleeve or other kinds of gastric interruption surgeries or major diets that lead to weight loss repeatedly shown to improve psoriatic skin disease and inflammatory arthritis both in rheumatoid and also in psoriatic arthritis. So, you know, it turns out that we talk to our patients a lot about weight loss and sometimes it seems like we're just talking at a stone, but if you talk if you look at it from the other side, the patients who in fact do lose weight, the number one reason that they lost weight and continue to have successful weight loss is that their doctor was the driving force in them seeking a new solution.
So it is important that we counsel our patients on the strong need for weight loss as a way of managing their inflammatory arthritis, controlling their skin psoriasis. There's a lot of experience again here showing that weight loss leads to better disease control. And then lastly, depression. Depression, as you know, is constitutive for people who have psoriasis. It is sort of a burden that they carry with them, the disfigurement of having psoriasis that bothers them a whole lot more than it bothers other people, but it leads to serious coping issues, if not overt depression.
I think it takes a heightened awareness by the clinician to continually ask the patient how they're coping with their disease. Do they need help? Do they need to see a counselor? Do they need to see a psychologist, psychiatrist? You know, do they need medication for this?
Because if you're not asking this question this problem goes unnoticed and as you know, depression is a serious big time problem including suicidal ideation and frank suicide, all elevating people with active psoriatic disease and our patients with psoriatic arthritis. So you need to be the person that drives that discussion. When we talk about comorbidities and inflammatory arthritis, everyone agrees it's a big issue and I should probably be involved, but I'm going to pass it off to my primary care doctor. Well, the problem is the patients don't often see the primary care doctor because you may be the sharpest knife in the drawer, you may be the person who best tends to their needs, so they think you're going to do everything. That being said, you should take the, the initiative on doing total patient whole disease management and do the screening for A1c serum uric acid, Hep B, Hep C, TFT's lipid levels and then use that either for you to manage the problem or to have another doctor who can be part of the team manage the problem.
And lastly fatty liver is a big issue when there's obesity and psoriasis that also may need to be further assessed and also be managed by the hepatology division. Again, your plate is full when you see patients with psoriatic disease. It's not just skin deep. See you at RheumNow Live.
Choose the free online at home registration. Today we're going talk about comorbidity in psoriatic arthritis. Just heard a fabulous lecture by Doctor. Alan Mentor on comorbidity and cardiovascular disease in psoriasis this morning. He's one of our speakers in a Friday afternoon pod entitled, The Management of Psoriatic Disease.
He's going to talk about new therapies and exciting advances in psoriasis at RheumNow Live. But Jose Scherer is going to talk about the curse of comorbidity with psoriatic disease. Anyway, today's lecture, Doctor. Mentor covered a lot of this content, specifically about the links between inflammation, psoriasis inflammation, and cardiovascular inflammation as the driving force behind increased cardiovascular events and poor cardiovascular outcomes in patients with psoriatic disease, both psoriasis and psoriatic arthritis. I think it's important for us to be aware of this.
I think most rheumatologists are aware of the comorbidities. I think the question that I want to cover here is how do we manage comorbidities in the arthritis clinic or in the dermatology clinic? Let's go at them one by one. Number one, cardiovascular morbidity mortality. It's very clear that effective anti inflammatory systemic control of inflammation therapies are going to be effective at lowering cardiovascular risk.
This has been shown with methotrexate in rheumatoid arthritis, it's been shown with TNF inhibitors and other anti inflammatory biologics with rheumatoid arthritis, And there is data suggesting the same can be seen in psoriasis and psoriatic arthritis. Maybe not as much data, but it's still the same message, still the same pathogenesis that's being interrupted by effective therapy. So maybe the best thing you can do is get great control of either psoriatic skin disease or psoriatic arthritis. The second most important thing that you must do is manage the cardiovascular risk factors and either you're going to do that or have the patient seen by their primary care or cardiologist. Again, a psoriatic patient with cardiovascular risk factors and or a history of cardiovascular events needs to be seen by the cardiologist in addition to the dermatologist and rheumatologist.
Of course, the cardiovascular risk is driven by other things like, the metabolic syndrome and obesity and hyperlipidemia. I think that rheumatologists need to be very very clear and very very consistent in the message that reducing weight leads to better disease control. No, that's not a corona cough, it's a kennel cough. That means that patients who undergo dramatic weight loss either by gastric sleeve or other kinds of gastric interruption surgeries or major diets that lead to weight loss repeatedly shown to improve psoriatic skin disease and inflammatory arthritis both in rheumatoid and also in psoriatic arthritis. So, you know, it turns out that we talk to our patients a lot about weight loss and sometimes it seems like we're just talking at a stone, but if you talk if you look at it from the other side, the patients who in fact do lose weight, the number one reason that they lost weight and continue to have successful weight loss is that their doctor was the driving force in them seeking a new solution.
So it is important that we counsel our patients on the strong need for weight loss as a way of managing their inflammatory arthritis, controlling their skin psoriasis. There's a lot of experience again here showing that weight loss leads to better disease control. And then lastly, depression. Depression, as you know, is constitutive for people who have psoriasis. It is sort of a burden that they carry with them, the disfigurement of having psoriasis that bothers them a whole lot more than it bothers other people, but it leads to serious coping issues, if not overt depression.
I think it takes a heightened awareness by the clinician to continually ask the patient how they're coping with their disease. Do they need help? Do they need to see a counselor? Do they need to see a psychologist, psychiatrist? You know, do they need medication for this?
Because if you're not asking this question this problem goes unnoticed and as you know, depression is a serious big time problem including suicidal ideation and frank suicide, all elevating people with active psoriatic disease and our patients with psoriatic arthritis. So you need to be the person that drives that discussion. When we talk about comorbidities and inflammatory arthritis, everyone agrees it's a big issue and I should probably be involved, but I'm going to pass it off to my primary care doctor. Well, the problem is the patients don't often see the primary care doctor because you may be the sharpest knife in the drawer, you may be the person who best tends to their needs, so they think you're going to do everything. That being said, you should take the, the initiative on doing total patient whole disease management and do the screening for A1c serum uric acid, Hep B, Hep C, TFT's lipid levels and then use that either for you to manage the problem or to have another doctor who can be part of the team manage the problem.
And lastly fatty liver is a big issue when there's obesity and psoriasis that also may need to be further assessed and also be managed by the hepatology division. Again, your plate is full when you see patients with psoriatic disease. It's not just skin deep. See you at RheumNow Live.
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