RESUMEN
Managing moderate to severe psoriasis in older adults is complex due to factors characteristic of the later years of life, such as associated comorbidity, polypharmacy, and immunosenescence. This consensus statement discusses 17 recommendations for managing treatment for moderate to severe psoriasis in patients older than 65 years. The recommendations were proposed by a committee of 6 dermatologists who reviewed the literature. Fifty-one members of the Psoriasis Working Group of the Spanish Academy of Dermatology and Venereology (AEDV) then applied the Delphi process in 2 rounds to reach consensus on which principles to adopt. The recommendations can help to improve management, outcomes, and prognosis for older adults with moderate to severe psoriasis.
Asunto(s)
Dermatología , Psoriasis , Venereología , Humanos , Anciano , Psoriasis/tratamiento farmacológicoRESUMEN
BACKGROUND AND OBJECTIVE: Anti-tumor necrosis factor therapy for moderate to severe psoriasis can increase the risk of active tuberculosis in patients who have latent tuberculosis infection (LTBI). The main objective of this study was to estimate the prevalence of LTBI in patients with moderate to severe plaque psoriasis being treated in dermatology clinics in Spain. MATERIAL AND METHOD: Non-interventional, cross-sectional, national epidemiological study conducted in Spain in 2011-2012. Patients with moderate to severe plaque psoriasis were included if they had undergone at least one tuberculin skin test (TST) and/or been evaluated with an interferon-γ release assay (IGRA) based on enzyme-linked immunosorbent assay (QuantiFERON(®) TB Gold In-Tube) in the 2 years preceding the study. RESULTS: Data for 440 patients were valid for analysis. In total, 97.7% of the patients had undergone a TST, with a positive result in 23%. Of the 238 patients in whom the initial result was negative, 5% converted to positive on re-testing for a booster effect. IGRA results were available for 16.8%, 20.5% of them positive. Two of the patients with positive IGRA results had a negative TST. The prevalence of LTBI in the whole sample was 26.6%. The degree of concordance between the TST and the IGRA was moderate (κ=0.516; P<.001). CONCLUSIONS: The prevalence of LTBI in this study was similar to previous estimates for Spain.
Asunto(s)
Tuberculosis Latente/epidemiología , Psoriasis/epidemiología , Adulto , Antirreumáticos/uso terapéutico , Vacuna BCG , Contraindicaciones , Estudios Transversales , Emigrantes e Inmigrantes , Femenino , Humanos , Ensayos de Liberación de Interferón gamma , Tuberculosis Latente/diagnóstico , Masculino , Persona de Mediana Edad , Prevalencia , Psoriasis/tratamiento farmacológico , Psoriasis/genética , España/epidemiología , Prueba de Tuberculina , Vacunación/estadística & datos numéricosRESUMEN
El abordaje terapéutico de pacientes de edad avanzada con psoriasis en placas moderada-grave es complejo debido, entre otros factores, a las comorbilidades asociadas, la polimedicación y la inmunosenescencia propias de este grupo de edad. En el presente documento se recogen 17 recomendaciones para el manejo de la psoriasis moderada-grave en pacientes de edad avanzada (>65 años). Estas recomendaciones han sido propuestas por un comité científico de 6 dermatólogos a partir de una revisión de la literatura científica y consensuadas entre 51 miembros del Grupo de Psoriasis de la Academia Española de Dermatología y Venereología mediante dos rondas de consulta Delphi. En los pacientes con psoriasis moderada-grave de edad avanzada, estas recomendaciones pueden mejorar su manejo, resultados y pronóstico. (AU)
Managing moderate to severe psoriasis in older adults is complex due to factors characteristic of the later years of life, such as associated comorbidity, polypharmacy, and immunosenescence. This consensus statement discusses 17 recommendations for managing treatment for moderate to severe psoriasis in patients older than 65 years. The recommendations were proposed by a committee of 6 dermatologists who reviewed the literature. Fifty-one members of the Psoriasis Working Group of the Spanish Academy of Dermatology and Venereology (AEDV) then applied the Delphi process in 2 rounds to reach consensus on which principles to adopt. The recommendations can help to improve management, outcomes, and prognosis for older adults with moderate to severe psoriasis. (AU)
Asunto(s)
Humanos , Psoriasis/diagnóstico , Psoriasis/terapia , Índice de Severidad de la Enfermedad , Academias e Institutos , EspañaRESUMEN
El abordaje terapéutico de pacientes de edad avanzada con psoriasis en placas moderada-grave es complejo debido, entre otros factores, a las comorbilidades asociadas, la polimedicación y la inmunosenescencia propias de este grupo de edad. En el presente documento se recogen 17 recomendaciones para el manejo de la psoriasis moderada-grave en pacientes de edad avanzada (>65 años). Estas recomendaciones han sido propuestas por un comité científico de 6 dermatólogos a partir de una revisión de la literatura científica y consensuadas entre 51 miembros del Grupo de Psoriasis de la Academia Española de Dermatología y Venereología mediante dos rondas de consulta Delphi. En los pacientes con psoriasis moderada-grave de edad avanzada, estas recomendaciones pueden mejorar su manejo, resultados y pronóstico. (AU)
Managing moderate to severe psoriasis in older adults is complex due to factors characteristic of the later years of life, such as associated comorbidity, polypharmacy, and immunosenescence. This consensus statement discusses 17 recommendations for managing treatment for moderate to severe psoriasis in patients older than 65 years. The recommendations were proposed by a committee of 6 dermatologists who reviewed the literature. Fifty-one members of the Psoriasis Working Group of the Spanish Academy of Dermatology and Venereology (AEDV) then applied the Delphi process in 2 rounds to reach consensus on which principles to adopt. The recommendations can help to improve management, outcomes, and prognosis for older adults with moderate to severe psoriasis. (AU)