Photo Credit: Kiwis
Itch and pain are important symptoms of psoriatic disease impacting patients’ QOL. During the IFPA 2024, Adam Reich, PhD, from Medical College of Rzeszów University, Poland, reviewed itch in psoriasis, and Anushka Irani, B.M.B.Ch., PhD, from University of Oxford, UK, presented the link between pain and psoriatic disease.
“Historically, psoriasis was considered not to present with itch and this can even be found in textbooks,” said Prof. Reich1. However, recent data have shown that “more than 80% of patients who suffer from psoriasis also suffer from itch.”
The question of whether psoriatic itch intensity is related to disease severity was addressed in a cross-sectional in participants with large-plaque psoriasis, nummular psoriasis, guttate psoriasis, scalp psoriasis, inverse psoriasis, erythrodermic psoriasis, palmoplantar psoriasis vulgaris, palmoplantar pustular psoriasis, and generalized pustular psoriasis2. Itch intensity and psoriasis severity are significantly correlated in subtypes such as palmoplantar psoriasis, scalp psoriasis, and generalized pustular psoriasis.
Itch has a very detrimental effect on people living with psoriasis. Patients consider pruritus as the most bothersome symptom of psoriasis, and itch intensity is significantly associated with increased suicidal ideation3,4. Furthermore, improvement in itch is significantly associated with QOL measures even after statistical adjustment for psoriasis objective severity measures5.
“There is no single therapy licensed for itch,” said Prof. Reich1. “I do believe all biologics are highly effective in decreasing itch. Definitively, histamine is not a major player in the pathogenesis of psoriasis, but I don’t want to say that antihistamines are completely ineffective.”
Managing Pain in Psoriatic Disease
Reducing pain is an important treatment goal for psoriasis, with up to 60% of patients considering it key and 70% of patients considering a reduction in burning as a treatment goal6. “As rheumatologists, we have traditionally assumed that the pain comes from inflammation in the joints and potentially from structural changes,” said Dr. Irani1. “While there is some truth in that, it is not always the only cause of the pain.” An analysis of the large DANBIO cohort of patients with inflammatory arthritis showed that pain visual analogue scale scores were higher than 30 out of 100 in patients treated with biologics or disease-modifying antirheumatic drugs confirming that pain might be due to other causes7.
Diagnosis of chronic pain can be based on widespread pain of a long duration that is unresponsive to treatment8. Other indirect indicators of chronic pain include heightened fatigue, unrefreshing sleep, poor memory and concentration, as well as hypersensitivity to visual, auditory, and tactile stimuli. Pain can also be measured with several tools including the Widespread Pain Index in case of fibromyalgia, the Pain Questionnaire, the DN4 questionnaire, and the Centria Sensitization Inventory (CSI)1.
No specific guidelines are available for pain management in psoriatic disease. However, the EULAR recommendations for pain management in osteoarthritis and inflammatory arthritis can be used9. “The emphasis is thinking about the patients holistically and worrying about what’s happening in the joints but zooming out and thinking about the biopsychosocial elements as well and trying to tailor treatment utilizing pharmacological elements but also other treatment options”1.
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