In JAMA Dermatology, Finola Bruins et al showed that greatest improvement in quality of life was achieved with 90% improvement of the Psoriasis Area and Severity Index (PASI) and 90% decrease of affected body surface area in a large cohort of children with psoriasis. These findings support personalization of treatment in order to help pediatric psoriasis patients reach optimal quality of life.
Treatment of psoriasis is associated with improved quality of life (QOL) in those with the disease. However, in daily clinical practice, the association between the degree of psoriasis clearance and QOL has not been studied to date, especially in the pediatric population.
To identify the association between the degree of psoriasis improvement (as measured by the Psoriasis Area Severity Index [PASI] and body surface area [BSA] response) and QOL (as measured by the Children's Dermatology Life Quality Index [CDLQI]) in pediatric psoriasis, and to assess the association of treatment type with QOL, independent of psoriasis improvement.
Design, Setting, and Participants
Data used in this single-center cohort study were extracted from the Child-CAPTURE (Continuous Assessment of Psoriasis Treatment Use Registry), a prospective, observational, daily clinical practice cohort of all children (aged <18 years) with a psoriasis diagnosis who attended the outpatient clinic of the Department of Dermatology at the Radboud University Medical Center in Nijmegen, the Netherlands, between September 3, 2008, and May 4, 2018. All records of treatment episodes with CDLQI, PASI, and BSA scores were included in the analysis.
Patients were treated according to daily clinical care. Treatments were clustered into topical, dithranol, conventional systemic, and biological treatments. Because of low numbers of UV-B phototherapy, this treatment was not assessed.
Main Outcomes and Measures
Primary outcomes were mean change of CDLQI scores per PASI and BSA response categories (0 to <50, 50 to <75, 75 to <90, and ≥90) and mean CDLQI change per treatment categories.
In total, 319 patients (median [interquartile range] age, 10.0 [7.0] years; 183 female [57.4%]) were analyzed for PASI score improvement (399 treatment episodes) and improvement in BSA involvement (366 treatment episodes). The greatest improvements in CDLQI scores were seen in the PASI ≥90 response category, with an estimated marginal mean change in CDLQI score of -6.6 (95% CI, -7.5 to -5.7). The greatest improvements in CDLQI scores were also observed in the BSA ≥90 response category, with an estimated marginal mean change in CDLQI score of -6.8 (95% CI, -7.5 to -6.1). Systemic treatment demonstrated a greater degree of improvement of CDLQI compared with topical treatment, independent of PASI response categories.
Conclusions and Relevance
This cohort study in a real-world setting found that the greatest improvements in QOL were associated with PASI 90 or greater, a decrease in BSA involvement of 90% or greater, and systemic treatments. These findings suggest that reaching PASI 90 or greater and decreasing BSA involvement by at least 90% may be clinically meaningful treatment goals that will help pediatric patients with psoriasis reach optimal QOL.
Association Between Quality of Life and Improvement in Psoriasis Severity and Extent in Pediatric Patients.
Bruins FM, Bronckers IMGJ, Groenewoud HMM, van de Kerkhof PCM, de Jong EMGJ, Seyger MMB.
Related news items
RIMLS award ceremony proudly presenting the winners16 January 2020
Several RIMLS researchers received an award and bonus during the New Year's drinks. See all photo's and the ENABLE aftermovie.read more
The PRIDE Study Evaluation of online methods of data collection16 January 2020
In Paediatric and Perinatal Epidemiology RIHS researchers Marleen van Gelder and Nel Roeleveld described the recruitment methods and online data collection within the PRIDE Study, the largest Dutch birth cohort study.read more
Laparoscopy reduces the number of adhesions but it is still too high14 January 2020
Adhesions after abdominal surgery cause too many re-admissions. Although keyhole surgery reduces the number of adhesions and the complications associated with them, the total disease burden remains high, as reported in The Lancet by RIHS researcher Richard ten Broek and colleagues.read more
Rubicon Grant for Marieke Klein14 January 2020
DCMN researcher Marieke Klein, theme Neurodevelopmental disorders, received a Rubicon Grant from the Dutch Organisation for Scientific Research (NWO). The Rubicon program gives young, highly promising researchers the opportunity to gain international research experience.read more
Radboud Talks 2020 scientific pitch competition14 January 2020
The next edition of Radboud Talks will take place in the spring. During this academic pitch competition, young researchers will be given the opportunity to share their stories with a large audience. In a three-minute presentation, you will talk about your research in a fun and accessible manner.read more