Psoriatic Arthritis Burden
Psoriatic arthritis (PsA) is a progressive inflammatory condition that predominantly affects the skin, joints, nails, and entheses. Around 1 in 5 patients with psoriasis (PsO) have PsA and for the vast majority of patients, the development of PsA arises either concurrently or following the onset of PsO.
The economic burden of PsA is substantial, where costs for PsA are three times higher in the US than for patients with PsO alone. This highlights a clear unmet clinical need for the treatment and management of these patients. PsA patients also attribute to a significantly greater proportion of healthcare utilization: PsA patients have 42% more visits to the healthcare provider (HCP) in the first year than PsO patients, indicating challenges in reaching a diagnosis and implementing early treatment for PsA.
Optimized diagnosis and treatment of PsA is critical for the preservation of a patient’s mobility, mental health and quality of life, and can be achieved with close monitoring of a patient’s progress following diagnosis of PsO.
Development of Psoriatic Arthritis
Certain risk factors have been associated with the development of PsA in individuals with PsO and these include:
- High cholesterol
- Psoriasis severity, number of sites affected, and location (e.g. nails)
- Musculoskeletal symptoms including pain, fatigue and stiffness, or trauma
- Gut inflammation
- Genetic links (familial history, or presence of the HLA-B27 allele)
Patients with PsA also frequently experience one or more comorbidities and these can include:
- Metabolic syndrome (the combination of hypertension, hyperlipidemia, and Type 2 diabetes)
- Inflammatory bowel disease
- Fatty liver disease
- Mental health conditions such as depression and anxiety
- Cardiovascular disease
It has also been shown that obesity, hypertension and a Charlson Comorbidity Index of ≥1 were prognostic factors for poorer treatment outcome rates in PsA.
The Current Psoriatic Arthritis Journey
Delays in Diagnosis
Patients often experience slow diagnosis of PsA, sometimes delayed for more than 2 years after symptom onset. While patients already experience clinical inertia in the management of their PsO, not reaching a diagnosis for PsA, in addition, can mean patients are faced with a heavy burden of multiple diseases with limited support and only modest satisfaction with the treatment.
Excessive Trial and Error
Patients who become frustrated with the lack of results seen from their current prescription may wane in their treatment adherence. Without the HCP setting realistic expectations in skin clearance timeframes, patients can experience a succession of treatment trials in the hopes that one may be successful. Some may be left using topical treatment alone for cutaneous symptoms, with no treatment for their arthritic symptoms.
PsO patients treated with biologic agents exhibited highest treatment satisfaction over oral therapy, phototherapy, and topical therapy. However, one study shows an apparent lack of confidence in HCPs to prescribe these newer therapeutics, despite up to 15 years of efficacy and safety data in place for some biologics.
A recent roundtable discussion amongst dermatologists cited one of the predominant reasons for reluctance to initiate biologic therapy was the inconvenience of providing patient education on the safety of these agents. This leaves patients in a cycle of undertreatment and progressively worsening disease.
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Lack of Holistic Support
Given the high prevalence of comorbidities in PsA patients, sufficient support for treating these appears to be lacking. PsA patients, for example, have been shown to be associated with a higher cardiovascular disease risk than in PsO patients. As it is known that certain risk factors for cardiovascular disease such as obesity, high cholesterol, high blood pressure and higher waist circumference, are often found in PsA patients, more attention should be given to these when formulating a comprehensive treatment plan.
In a recent study, the ability to perform physical activities and sleep quality were the two most frequently reported impacts of PsA on patients. Sixty percent of the patients reported impacts to their emotional wellbeing stemming from their psoriatic arthritis. Patients are not always receiving adequate support for the less obvious repercussions the disease can have on their quality of life, and this can have a compounding effect on their overall psychological health and subsequent quality of life.
The Psoriatic Arthritis Journey with DTx
Digital therapeutic platforms such as Sidekick’s encourage patients to begin engaging with educational resources on their specific disease and symptoms, allowing patients to streamline their treatment journey.
Supported with in-app stress-management and self-advocacy programs, patients can feel they are taking control of their healthcare from the beginning and have more information at their fingertips to approach their HCP with at the next check-up.
As the patient learns about day-to-day life living with a chronic disease like psoriatic arthritis, they can begin to adjust to a ‘new normal’ with the support of the DTx platform providing a hub of resources to enable lasting lifestyle changes. With features such as advanced medication reminders and tools to help patients set expectations on the course of treatment, patients’ medication adherence is supported which can lead to more successful treatment outcomes.
By understanding the common characteristics of PsA through educational content, and tracking their symptoms within the app, patients have the ability to build their own personal picture of the progression of their disease. By regular logging of Patient Reported Outcomes, this data in turn supports the HCP to direct the care where it is most appropriate, according to the patient’s most pressing needs.
Currently, a variety of biologic agents are available for the treatment of PsA. However, patients often experience anxieties surrounding the safety and efficacy of these newer treatments, particularly in terms of treatment administration or the risks for pregnancy and breastfeeding.
A combination of remote coaching and educational content can provide patients with many of these answers, and help them to have more meaningful discussions with their HCP when treatment escalation is to be considered. HCPs can spend less time on reading the small print with the patient, and more time on initiating an optimized treatment schedule and fewer in-person visits may be needed, freeing up HCP time and reducing healthcare costs.
In addition, through reliable educational content, both HCP and patient can gain a better understanding of biologic characteristics with respect to their effects on specific comorbidities, leading to the right choice for individual patients, especially where unique combinations of comorbidities are present. This can result in a greater confidence in treatment choice, higher persistence with treatment, higher patient satisfaction, whilst minimizing the disease impact of psoriatic arthritis.
Personalization is key for patients, given their heterogeneity. A digital tool can increase treatment adherence by adapting to the patient’s needs – and not vice versa.
Comprehensive and Integrated Support
For many PsA patients, feelings of depression and anxiety arising from their disease challenges can be overwhelming to deal with. Whilst a dermatologist can provide basic counseling on these psychological effects, implementing the use of a DTx platform can ameliorate these distressing feelings through multiple tools designed to promote relaxation, mindfulness, and stress-management.
In addition to this, patients have the opportunity to interact with coaches in real-time, who can offer support and reassurance to the patient throughout their journey. PsA patients also have access to a community feed to re-connect them to people who can share their own experiences, from a place of true empathy. The level of isolation a patient with a chronic disease faces cannot be underestimated.
PsA patients may also have questions surrounding accessing further healthcare support and their associated costs, so easily accessible, tailored educational content on the platform can help direct a patient through navigating the US healthcare system.
The Path Forward
Delivering comprehensive treatment information to the patient will help develop realistic expectations and lead to improved health outcomes. A long-term strategy must be implemented in the form of a multidisciplinary approach that limits the comorbidities associated with psoriatic arthritis.
If psoriatic arthritis disease is left undertreated, it can lead to life-long physical and emotional impacts on those who have a diagnosis, or those who are yet to receive a diagnosis. Undertreatment can also contribute to significant economic burdens. The future of psoriatic disease treatment lies in a holistic approach that addresses health issues beyond the skin and considers all body systems in an integrated way.
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