Retrospective Analysis Of Patients With Psoriasis:Real-World Data

ObjectiveThe study is aim to deepen the understanding of psoriasis and nail psoriasis and provide theoretical basis for standardized diagnosis and treatment of psoriasis and nail psoriasis by analyzing epidemiology and disease burden of psoriasis and nail psoriasis in the real world.MethodsThis is a retrospective observational study based on the data obtained from the Psoriasis Center of National Clinical Research Center for Skin and Immune Diseases.The data were collected from 79 hospitals from June 2020 to September 2021.The total sample size was 1738 after excluding missing data.The study analyzed the demographic characteristics of psoriasis(gender,age,BMI,smoking,family history),disease duration,life quality,comorbidities,disease severity(Psoriasis area and severity index,(PASI),Body surface area(BSA),Investigator’s Global Assessment 2011 modified version(IGA mod 2011)),arthritis(Psoriatic arthritis,Psoriasis Epidemiology Screening Tool(PEST))and treatment regimens.The patients with psoriasis were divided into nail psoriasis group(N=574)and psoriasis without nail involvement group(N=1164),and the clinical characteristics of the two groups were compared and analyzed.ResultsPart One:Retrospective analysis of patients with psoriasis:Real-world data(1)Demographic characteristic:The prevalence of patients with psoriasis is higher in men than in women(67.72%vs.32.27%).The mean age of patients with psoriasis was49.18 years.The age of overall age,male and female showed bimodal distribution,with the first peak around 30-39 years old and the second peak around 50-59 years old.The body mass index(BMI)and age were higher in men than in women.There was a correlation between BMI and PASI scores(r=0.06,P<0.05),and BMI was higher in patients with comorbidities.Patients who smoked had a higher proportion of comorbidities and involvement of special sites than patients who did not smoke,and PASI scores were higher in smokers than in nonsmokers,the differences between the groups were statistically significant(P<0.05).(2)Disease duration:It was estimated that the disease duration of the patients was49.18±16.08 years in this study,and there were differences in the disease duration between patients of different ages,but no differences in the disease duration between patients of different genders.Psoriasis had a longer disease duration in patients with comorbidities,higher disease severity and special sites involvement than in those without,the differences were statistically significant.(3)Quality of life:The mean DLQI scores in psoriasis patients was 8.87±6.60.The patients with long duration,involvement of special areas and higher disease severity significantly had lower individuals’quality of life than those without,the differences were statistically significant.(4)Disease severity:The severity of patients with psoriasis was associated with increasing age(r=0.186,P<0.01),and the patients with males,comorbidities and involvement of special sites had higher levels of disease severity.(5)Treatment:Among patients with disease duration of<5 years,5≤and<10 years and≥10 years,84%,83%,62%were respectively receiving topical,with the largest proportion having more than 10 years of disease duration.Patients with disease duration of≥10 years had higher proportion of receiving systemic therapy than patients with a disease duration of 5≤and<10 years,<5 years(59%vs.53%vs.35%).The most common topical and systemic treatments were glucocorticoids(49.08%)and oral traditional Chinese medicine(21%),respectively.A lower proportion of patients with psoriasis receive biologics than those not receiving biologics(9.84%vs.90.16%).Patients with disease duration of≥10 years had higher proportion of receiving biologics than patients with a disease duration of 5≤and<10 years,<5 years(11.90%vs.9.79%vs.6.7%).Compared with conventional treatment,biologics had a greater improvement in quality of life,the difference was statistically significant(P<0.01).Part Two:Retrospective analysis of patients with nail psoriasis:Real-world data(1)Demographic characteristics:Nail psoriasis accounts for 33.3%of psoriasis.The age of patients with nail psoriasis showed a unimodal pattern,most of the patients were 50-59 years old.The proportion of males with psoriasis was higher than that of females(63.57%vs.36.43%).The proportion of family history with nail psoriasis was higher than that of no nail involvement(20.91%vs.13.14%).The proportion of psoriasis patients with a smoking history was higher than those who no nail involvement(52.45%vs.34.98%).This study revealed that the average BMI of nail psoriasis was 24.60±3.54kg/m~2.There was no difference in BMI between psoriasis with nail involvement and non-nail psoriasis,and nail psoriasis between different genders.(2)Characteristics of the disease:The average duration of nail psoriasis was 14.57±11.27years.Nail psoriasis had a longer disease duration in total and different age groups,more intensely,poorer quality of life,higher prevalence of comorbidities,arthritis and involvement of other special sites compared with psoriasis without nail involvement.(3)Therapy:A higher proportion of nail psoriasis received topical therapy,systemic therapy and biologics compared with psoriasis without nail involvement(84.32%vs.73.20%;62.37%vs.43.21%;13.76%vs.7.90%).We performed a logistic regression analysis to identify BSA,DLQI and previous use of biologic agentsin creased the probability of receiving biological therapy,the being older and smoking decreased the likelihood of receiving biologics.ConclusionsPart One:Retrospective analysis of patients with psoriasis:Real-world data(1)Psoriasis tended to occur in middle-aged men and had a chronic disease duration.The age of overall age,male and female showed bimodal distribution,and the age and BMI of males were higher than those of females.Patients with comorbidities had higher BMI.(2)Higher disease severity,smoking and longer disease duration were all associated with comorbidities and special site involvement.Secondly,the disease severity of psoriasis patients was also related to gender,age,BMI,smoking,and prolonged disease duration.(3)Patients with psoriasis had a stronger impairment of life quality,and the patients with involvement of special sites,higher disease severity and longer illness duration significantly reduced quality of life.(4)Treatment options for patients with psoriasis were influenced by the disease characteristics.The biological agents could improve the quality of life of patients more than traditional methods.However,low utilization of biological agents among patients with psoriasis had found in this study.Part Two:Retrospective analysis of patients with nail psoriasis:Real-world data(1)Nail psoriasis which occured in middle-aged and elderly men and had a chronic disease duration:a common presentation of psoriasis.(2)Psoriasis with nail involvement were associated with smoking,longer disease duration,higher disease severity,involvement of special sites,coexisting comorbidities,arthritis and poorer quality of life.(3)Most patients with nail psoriasis were willing to receive treatment.Age,smoking,DLQI score,BSA scores and previous treatment regimens were related factors for the acceptance of biological agents in patients with nail psoriasis.