title: Physician perspectives in the management of psoriasis and psoriatic arthritis: results from the population-based Multinational Assessment of Psoriasis and Psoriatic Arthritis survey.
abstract: BACKGROUND
  Available literature on psoriasis and psoriatic arthritis (PsA) demonstrates a tremendous burden of disease and suggests underdiagnosis and undertreatment.
  
  
  OBJECTIVE
  To obtain real-world physician perspectives on the impact of psoriasis and PsA and its treatment on patients' daily lives, including perceptions of, and satisfaction with, current therapies.
  
  
  METHODS
  The Multinational Assessment of Psoriasis and Psoriatic Arthritis (MAPP) surveyed dermatologists (n = 391) and rheumatologists (n = 390) in North America (Canada and the United States) and Europe (France, Germany, Italy, Spain and United Kingdom).
  
  
  RESULTS
  Dermatologists classified 20.3% and 25.7% of their patients as having severe psoriasis and severe PsA respectively; rheumatologists indicated that 48.4% of their PsA patients had active disease. Of the psoriasis patients complaining of joint pain, only 33.0% had a diagnosis of PsA. An impact on daily activities or social/emotional well-being was recognized by 57.2% to 79.3% of physicians. In patients with moderate-to-severe psoriasis, dermatologists reported 74.9% were receiving topical therapy, 19.5% conventional oral therapy and 19.6% biologics. Dermatologists and rheumatologists reported similar rates of topical (≈45%) and biologic (≈30%) therapy utilization for their PsA patients; conventional oral therapy was more often prescribed by rheumatologists (63.4%) vs. dermatologists (35.2%). Reasons for not initiating or maintaining systemic therapies were related to concerns about long-term safety, tolerability, efficacy and costs (biologics).
  
  
  CONCLUSIONS
  Physicians in North America and Europe caring for patients with psoriasis and PsA acknowledge unmet treatment needs, largely concerning long-term safety/tolerability and efficacy of currently available therapies; evidence suggests underdiagnosis of PsA and undertreatment of psoriasis among dermatologists.
authors.affiliation: Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands.
authors.forename: P C M
authors.initials: PC
authors.lastname: van de Kerkhof
authors.affiliation: Dermatologikum Hamburg, Hamburg, Germany.
authors.forename: K
authors.initials: K
authors.lastname: Reich
authors.affiliation: University of California, San Diego, School of Medicine, La Jolla, CA, USA.
authors.forename: A
authors.initials: A
authors.lastname: Kavanaugh
authors.affiliation: Sorbonne Paris Cité Univerité Paris Diderot, Saint-Louis Hospital, Paris, France.
authors.forename: H
authors.initials: H
authors.lastname: Bachelez
authors.affiliation: Division of Genetics and Molecular Medicine, St. John's Institute of Dermatology, King's College, London, UK.
authors.forename: J
authors.initials: J
authors.lastname: Barker
authors.affiliation: University of Verona, Verona, Italy.
authors.forename: G
authors.initials: G
authors.lastname: Girolomoni
authors.affiliation: Dalhousie University, Halifax, NS, Canada.
authors.forename: R G
authors.initials: RG
authors.lastname: Langley
authors.affiliation: Hôpital Larrey, Toulouse University, Toulouse, France.
authors.forename: C F
authors.initials: CF
authors.lastname: Paul
authors.affiliation: Hospital de la Santa Creu i Sant Pau, Barcelona, Spain.
authors.forename: L
authors.identifier: http://orcid.org/0000-0001-6083-0952
authors.initials: L
authors.lastname: Puig
authors.affiliation: Icahn School of Medicine at Mount Sinai, New York, NY, USA.
authors.forename: M G
authors.initials: MG
authors.lastname: Lebwohl
mesh_terms: D000203:Activities of Daily Living; D000279:Administration, Cutaneous; D000284:Administration, Oral; D018501:Antirheumatic Agents / Q000627:therapeutic use; D015535:Arthritis, Psoriatic / Q000188:drug therapy / Q000523:psychology; D001291:Attitude of Health Personnel; D001688:Biological Products / Q000627:therapeutic use; D002170:Canada; D003879:Dermatologic Agents / Q000627:therapeutic use; D003880:Dermatology / Q000706:statistics & numerical data*; D004644:Emotions; D005060:Europe; D006801:Humans; D033183:Interdisciplinary Communication; D010347:Patient Care Planning / Q000706:statistics & numerical data; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D011565:Psoriasis / Q000188:drug therapy* / Q000523:psychology; D012219:Rheumatology / Q000706:statistics & numerical data*; D012720:Severity of Illness Index; D058992:Social Participation; D014481:United States
chemical_list: D018501:Antirheumatic Agents; D001688:Biological Products; D003879:Dermatologic Agents