Cross-sectional study to assess the clinical profile of psoriatic patients in Korea

Background: Psoriasis is associated with serious physical, psychological and sociofunctional disorders, as well as increased medical cost and reduced productivity, having a major impact on health-related quality of life (HRQoL). The United States and several countries in Europe recently conducted HRQoL survey among psoriatic patients, but national large-scale study on clinical profiles of psoriatic patients, including their HRQoL, has not been studied in Korea. Objectives: This nationwide cross-sectional study was aimed at determining epidemiologic characteristics of psoriasis, disease severity and HRQoL among psoriatic patients in Korea. In addition, we also investigated demographic, disease-specific, socio-economic, therapeutic and clinical factors that may affect disease severity and HRQoL of psoriatic patients in Korea. Methods: This study was conducted from February 2013 to June 2013 in psoriatic patients, aged 20 or older, recruited from 25 centers across the country. Data were collected on demographic factors, such as age, sex, height, body weight, and waist circumference; disease-specific factors, such as PASI score, BSA, onset age, clinical types, area of lesion, family history, and past and present medical history; drinking and smoking histories; presence of comorbidity (blood pressure, CRP, LFT, BUN, creatinine, fasting glucose, TG, total cholesterol, HDL-C, LDL-C); and the rate of patients suggesting psoriatic arthritis (PASE questionnaire). SF-36, DLQI, WPAI:PSO, and MSQ were used to determine HRQoL of psoriatic patients. Statistical significance was analyzed by ANOVA, Kruskal-Wallis test, student`s t-test, chi-square test, and Fisher`s exact test. Results: 1,278 psoriatic patients were enrolled and 1,260 of them completed the study. 749 (59.4%) were male and 511 (40.6%) were female patients (sex ratio, 1.47:1). Mean age was 47.1±14.5 years (range, 20-89 years); 24.9% were in their 50s, 22.3% were 40s, 20.1% were 30s, 12.6% were 20s, 12.1% were 60s, and 7.9% were 70s. Onset age was below 30 in 33.8%, 30 and older in 66.2%; the percentage was greatest among 20s (22.4%), followed by 30s (19.8%), 40s (18.7%), 50s (14.7%), teens (11.4%), 60s (7.1%), 70s (3.3%), and below teens (2.6%). Mean duration of psoriasis was 109.2±122.0 months (range, 1.0-825). Mean BMI was 23.9±3.5 kg/m2. 602 (47.8%) were current drinkers; 389 (30.9%) were current smokers and their mean duration of smoking was 19.9±10.7 years. Mean PASI score was 7.5±7.1; 75.6% were less than 10 points, 18.4% were between 10 and 20 points, and 6.0% were 20 points or beyond. Mean BSA was 13.1±14.6%; 21.2% were below 3%, 41.4% were 3-10%, and 37.4% were 10% or beyond. Mean DLQI score was 12.0±7.2; 21.2% were 5 points or below, 24.7% were between 6 and 10 points, and 54.1% were 11 points or higher, indicating that more than half of the psoriasis patients had their quality of life severely affected by psoriasis. Mean SF-36 score was 48.8±8.0 for PCS and 42.6±11.2 for MCS. WPAI:PSO results were 6.4±15.1% for absenteeism, 28.9±27.5% for presenteeism, 31.6±28.3% for TWPI and 37.2±30.0% for TAI. Mean PASE score was 33.7±13.1; symptom subscale was 16.1±6.1 points and function subscale was 17.6±7.7 points. 301 (24.0%) out of 1,255 patients had PASE score 44 points or higher, suggesting active psoriatic arthritis. Patients were not satisfied with treatments in 16.1%, neutral in 25.3%, and satisfied in 58.6%. Clinical type of psoriasis was plaque type in 1,081 patients (85.8%), guttate in 106 (8.4%), pustular in 66 (5.2%), erythrodermic in 44 (3.5%), and others in 28 patients (2.2%). Systolic BP was 140mmHg or higher in 12.9% and diastolic BP was 90mmHg or higher in 15.2% of patients. Waist circumference was 90cm or beyond in 38.5% of male patients and 85cm or beyond in 29.1% of female patients. The rate of patients with greater-than-normal fasting glucose, TG, total cholesterol, LDL-C, creatinine, and CRP level was 27.6%, 23.4%, 27.5%, 27.0%, 10.5%, and 18.6%, respectively. When patients were categorized to mild ( 20) groups according to their PASI score, the more severe, the higher their mean DLQI was, with significant difference among each group (p<0.001). PCS and MSC of SF-36 were both significantly lower in the severe group compared to the other groups (p<0.001). The duration of psoriasis was also significantly different among the three groups (p=0.0175); the mild group had significantly shorter duration than the other two groups. Onset age was significantly different between mild group and moderate- severe group, and psoriasis was more severe among the patients with onset age of below 30 than those with onset age of 30 or older (p=0.0196). Medical cost was significantly higher in the severe group than in the mild group (p=0.0398). According to WPAI:PSO test, the severe group had significantly higher absenteeism than the other two groups (p=0.0066). Presenteeism and TWPI were significantly different among the three groups, with increasing tendency toward the severe group (p<0.0001 for all comparison). TAI was significantly lower in the mild group compared to the other two groups (p<0.0001). As for PASE, total score, symptom score, function score and the number of patients with 44 points or higher were all significantly higher in the severe group than in the other two groups (p=0.0001, p=0.0005, p=0.0001, and p<0.0001, respectively). The severe group had significantly higher systolic and diastolic BPs than the mild group (p=0.0007 and p=0.0006, respectively), significantly greater waist circumference than the mild group among female patients (p=0.0172), and significantly higher glucose and TG than the mild and moderate groups (p=0.0008 and p=0.0411, respectively). Conclusion: This is the first nationwide survey of psoriatic patients in Korea and shows epidemiologic characteristics and clinical profiles of Korean psoriatic patients. Psoriasis also has a profound impact on quality of life including physical and psychological well-being in Korean patients. *Support: This study was conducted with support from Janssen Korea Ltd.