title: A European subset analysis from the population-based Multinational Assessment of Psoriasis and Psoriatic Arthritis shows country-specific features: results from psoriasis patients in Spain.
abstract: BACKGROUND
  The Multinational Assessment of Psoriasis and Psoriatic Arthritis (MAPP) survey data were not analysed to account for cultural and healthcare system differences across European countries (EC).
  
  
  OBJECTIVE
  To utilize MAPP data to characterize psoriasis in Spanish patients, including severity assessment and Dermatology Life Quality Index (DLQI).
  
  
  METHODS
  The MAPP survey was conducted between June and August 2012. This analysis included 1700 patients with self-reported psoriasis (without psoriatic arthritis) from France (n = 349), Germany (n = 311), Italy (n = 359), Spain (n = 354) and the United Kingdom (n = 327).
  
  
  RESULTS
  Patients from Spain vs. other EC self-reported higher mean body mass index (26.9 vs. 25.6, P ≤ 0.001), lower prevalence of depression (6% vs. 12%, P = 0.002) and higher mean self-perceived psoriasis severity at its worst (5.92 vs. 5.33, P < 0.001) despite lower estimated body-surface-area involvement. Overall, patients from Spain vs. other EC had lower mean global DLQI scores (4.70 vs. 6.06, P = 0.001) and lower mean scores for each DLQI dimension [all P < 0.001, except leisure (P = 0.002), treatment (P = 0.002), and work and school (P = 0.005)]. Higher DLQI values were inversely associated with age and directly correlated with perceived severity. Palmoplantar, nail and scalp psoriasis were reported less frequently in Spanish patients (P = 0.026) and were associated with higher DLQI values (P < 0.01). Spanish patients were more likely to have seen multiple healthcare providers (HCPs; P < 0.001) and achieve therapeutic goals (P < 0.001), but current treatments were similar to patients in other EC.
  
  
  CONCLUSIONS
  In the MAPP survey, Spanish patients differed from other EC in several characteristics, including comorbidities, extent and distribution of psoriasis lesions, perception of severity and impact on quality of life. Their perception of psoriasis severity was higher despite a lower estimated extent, and DLQI scores were significantly lower. Spanish patients had more HCP visits and a higher rate of therapeutic goal achievement. These differences might be attributed to cultural factors, phenotypical variation and differences in HCP access.
authors.affiliation: Hospital de la Santa Creu i Sant Pau, Barcelona, Spain.
authors.forename: L
authors.initials: L
authors.lastname: Puig
authors.affiliation: Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands.
authors.forename: P C M
authors.initials: PCM
authors.lastname: van de Kerkhof
authors.affiliation: Sclderm Research Institute and Dermatologikum Hamburg, Hamburg, Germany.
authors.forename: K
authors.initials: K
authors.lastname: Reich
authors.affiliation: Department of Dermatology, APHP Saint-Louis Hospital, Sorbonne Paris Cité Université Paris Diderot, 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: Department of Dermatology, Paul Sabatier University and Larrey Hospital, Toulouse, France.
authors.forename: C
authors.initials: C
authors.lastname: Paul
mesh_terms: D000328:Adult; D015535:Arthritis, Psoriatic / Q000453:epidemiology* / Q000503:physiopathology / Q000523:psychology; D005260:Female; D006801:Humans; D038622:Internationality; D008297:Male; D008875:Middle Aged; D011565:Psoriasis / Q000453:epidemiology* / Q000503:physiopathology / Q000523:psychology; D011788:Quality of Life; D013030:Spain