title: The burden of psoriatic arthritis: a literature review from a global health systems perspective.
abstract: OBJECTIVE
  We sought to evaluate the clinical, economic, and humanistic burden of illness in patients with psoriatic arthritis (PsA).
  
  
  METHODS
  We performed a literature review.
  
  
  METHODS
  Our literature search, conducted between 1998 and 2009, included published studies that (1) considered the direct and indirect costs of PsA; reported measures of clinical burden, including mortality, physical function, quality of life, and productivity; and (3) reported comorbid conditions in patients with PsA.
  
  
  RESULTS
  We retrieved and reviewed a total of 49 studies. Compared with the general population, patients with PsA had lower health-related quality of life and an increased risk of co-morbid conditions, especially cardiovascular disease. In the U.S., the direct annual health care costs for PsA are estimated to be as high as $1.9 billion. Total indirect costs associated with PsA account for 52% to 72% of total costs. Both direct and indirect costs of PsA increase with worsening physical function and disease activity.
  
  
  CONCLUSIONS
  PsA imposes a considerable economic and quality-of-life burden to patients and society. Clinical features of PsA, including comorbid conditions and disease activity, contribute to reduced physical and psychosocial health-related quality of life. The clinical burden of PsA contributes to direct medical costs attributable to the utilization of health care resources. As a result of the physical functioning limitations imposed by PsA, indirect costs such as disability and lost productivity are substantial drivers of the total costs of care.
authors.forename: Seina
authors.initials: S
authors.lastname: Lee
authors.forename: Alan
authors.initials: A
authors.lastname: Mendelsohn
authors.forename: Evelyn
authors.initials: E
authors.lastname: Sarnes