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The multidimensional health status measures discussed in the systematic review by de Korte et al1 aim to measure all aspects of the effect of psoriasis on patients' lives. Such an understanding of the impact of disease is vital for clinical practice and research.
One major associated condition having a considerable impact on the quality of life of people with psoriasis is inflammatory arthritis. This is a relatively common condition in people with psoriasis, with a rate between 7% and 42%,2 - 3 depending on the definition and ascertainment methods used, and considerably higher than the rate of inflammatory arthritis in the general population.4 Inflammatory arthritis is equally distributed among the sexes, and occurs at all ages, although in children there may only be a family history of psoriasis. Factors predictive of an associated inflammatory arthritis include psoriatic nail dystrophy5 and more severe cutaneous psoriasis.6
The effects of inflammatory arthritis on an individual may also be recorded using the health status measures described by Korte et al,7 particularly where generic health status measures are used. While this is important, as these effects also reflect the altered experience of these patients, it is important to be aware that not all impact measured on quality-of-life questionnaires is due to cutaneous disease and so results need to be interpreted carefully. For example, one of the studies quoted in the review by de Korte et al describes the impact of psoriasis using the Medical Outcomes Study 36-Item Short Form Health Survey (SF-36) in a primary care population of people with psoriasis. There was no described attempt to ascertain the prevalence of inflammatory arthritis in this population, and so it cannot be stated with confidence that the impaired health status measured was attributable to the psoriasis alone. More psoriasis-specific tools can also pick up symptoms such as fatigue, stigmatization, and poor self-image, which may be related to the arthritis rather than the psoriasis.
Inflammatory arthritis is an important confounder in the study of patients with psoriasis. Awareness of the association between psoriasis and inflammatory arthritis appears to be low, for example, only 42% of referral letters to our service from general practitioners and dermatologists concerning patients subsequently diagnosed with psoriatic arthritis mentioned the preexisting psoriasis. Studies using health status measures to quantify the impact of psoriasis should control for the effects of psoriatic arthritis.
The authors have no relevant financial interest in this letter.
Country-Specific Mortality and Growth Failure in Infancy and Yound Children and Association With Material Stature
Use interactive graphics and maps to view and sort country-specific infant and early dhildhood mortality and growth failure data and their association with maternal
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