International Psoriasis Council

Advancing Knowledge. Enhancing Care.

Advancing Knowledge. Enhancing Care.

Common clinical tools to assess psoriasis severity may not capture full impact of disease

The IPC Disease Severity Working Group concluded that the objective measures of two commonly used clinical tools to determine psoriasis severity may not fully capture the impact of the disease on the individual in a new review published in the Journal of The Academy of Dermatology and Venerology (JEADV). 

Clinicians typically determine a patient’s psoriasis severity using quantitative and qualitative measures, including body surface area (BSA) involvement, the Psoriasis Area and Severity Index (PASI), and the Dermatology Life Quality Index (DLQI), a patient-reported questionnaire. Patients with a PASI score of 10 and higher are eligible for systemic and biologic psoriasis treatments. However, these assessment tools lack uniformity: some are not well validated and others are challenging to use in clinical settings.  Moreover, treatment decisions using artificially designated cut-offs based on quantitative measures may leave patients who are significantly affected by their disease undertreated.1

In the new study, IPC researchers re-evaluated the validity of using a PASI score of 10-12 as a threshold to determine eligibility for systemic and biologic treatments when factoring in patient quality of life. The researchers conducted a systematic review of randomized control trial (RCT) data published between 2000-2017 to assess correlations between provider and patient-generated severity at baseline. The RCT data included information from patients with mild and moderate psoriasis. They found with that in subject groups with high impact on quality of life (DLQI >10), the mean weighted BSA was 7.6 (range: 7.1-8.4) and the mean weighted DLQI was 11 (range: 10.2-12.2). Similarly, the mean weighted PASI for patients with DLQI >10 was 8.7 (range: 7.1 – 10.1) and the mean weighted DLQI was 10.9 (range: 10.1 -12.2).

This study showed that the correlation between mean DLQI and mean BSA at baseline was high. However, BSA and DLQI were not well correlated at values of DLQI >10. Importantly, many patients with BSA <10 (range: 7.1-8.4) reported a significant impact on quality of life (DLQI range: 10.2-12.2). Similarly, patients with DLQIs >10 (range: 10.1-12.2) also reported PASI mostly below 10 (range: 7.1-10.1). In general, researchers concluded, the objective measures of BSA and PASI alone, when excluding DLQI, did not fully capture the impact of disease severity.

1. Papp KA, Bissonnette R, Gooderham M, Feldman SR, Iversen L, Soung J et al. Treatment of plaque psoriasis with an ointment formulation of the Janus kinase inhibitor, tofacitinib: Phase 2b randomized clinical trial. BMC Dermatol. 2016;16(1):15. doi:10.1186/s12895-016-0051-4

Leave a Reply

Your email address will not be published.

This site uses Akismet to reduce spam. Learn how your comment data is processed.

Categories

Tags

Recent Posts

PASI 90 blog post with Dr. Maskin

Access to Biologics in Argentina: Rethinking Time to PASI 90

Blog Post - Psoriasis Hub

IPC Partners with Scientific Education Support to Create New Psoriasis and Psoriatic Arthritis Hub

Blog -Expert Insights-Erica-Alba (1)

Monkeypox Symptoms, Treatment, Prevention, and Impact on Psoriasis Patients

Also Read

image of computer with words expert commentary
commentaries

Commentary: Psoriasis treat to target: defining outcomes in psoriasis

In moderate to severe psoriasis, there has been a long-lasting tradition to define outcome as a relative change from baseline PASI, with the classical PASI 75 being more recently replaced by PASI 90 or 100. However, this concept is dated, mainly due to the impressive development of anti-interleukin therapies and an increasing interest in real-world evidence.

Read More

Subscribe to the IPC Newsletter

Stay up-to-date on the latest research, news, and upcoming events right in your inbox.