[ad_1]
. 2 July 2018
For psoriasis, the situation has improved considerably since there are biological products. At least theoretically. In the case of patient counseling and the desire to prescribe organic products, an expert sees a need for action. Will psoriasis patients get the therapy they need?
There are people who want to talk about their serious illness, others do not want it and then there are those who have no choice: patients with psoriasis. Many of them look at the previously incurable disease. In psoriasis, clearly defined red spots appear on the skin, causing dandruff and often itching or pain. Affected are often the extensor sides of the arms and legs, the scalp and the visible areas of the head and back. About two million Germans (2.5% of the population) suffer from this disease, of which about 400,000 of a moderate to severe form. Visible changes in the skin often make people feel marginalized and discriminated against – even if the disease is not contagious.
A large-scale study conducted by Novartis among 8,338 patients from 31 countries shows that 84% of patients report discrimination and humiliation in daily life. Many withdraw from others for fear of rejection and shame, feel stressed at work and in everyday life, and suffer from mental illnesses such as depression and anxiety.
In 2014, WHO added psoriasis as the fifth non-infectious disease. Diseases on. It is a chronic benign skin disorder, often bumpy. The symptoms occur in 60 to 70% of patients before the fortieth year of life (type 1 psoriasis), in the remaining 30 to 40% after the age of 40 (type 2 psoriasis).
The purpose of therapy is to relieve symptoms and heal inflammation. On the other hand, a recurrence of symptoms should be avoided as long as possible. "Overall, the care provided to patients with psoriasis in Germany has improved considerably over the past ten years," says Marc Alexander Radtke, a physician at the Institute for Health Services Research in Germany. dermatology and nursing of the University Medical Center Hamburg-Eppendorf. "This can be seen in the severity of symptoms as well as the quality of life of patients and other quality of care indicators."
The WHO World Report on Psoriasis also describes Germany as a pioneer in health care. However, this does not mean that an ideal state is achieved: "It is true that the treatment options for patients with psoriasis in Germany have improved – and this applies only to severely affected patients" says Claudia Liebram of the Psoriasis Network, a self – help organization. Network for people with psoriasis
There are now a number of treatment options available, which even in moderate to severe psoriasis in most cases lead to significant improvement, according to the book " Care of Psoriasis in Germany – Facts 2014 "Regional Psoriasis Networks in Germany (PsoNet). It states that widely uniform international treatment standards apply: for mild forms of psoriasis, external drugs should be used, for moderate to severe psoriasis or for non-response to external systemic therapy or to UV light. In addition, psychological counseling, rehabilitation or physical therapy may be helpful in some patients.
For external treatment, cortisone and vitamin D3 supplements are most commonly used as creams, ointments, lotions or shampoos on the skin. to be applied. Both agents are anti-inflammatory and can also be combined with each other. "However, little has changed in recent years for the vast majority of patients requiring external treatment," says Liebram. "There were newer forms of administration of known concoctions of vitamin D3 from cortisone, for example in the form of a gel or foam, but new drugs were not available. have not been suggested. "
Moderate to Severe Forms: Systemic Therapy
Systemic therapy involves a variety of immunosuppressive drugs – drugs that suppress the immune system – and biological drugs – that are similar to those found in the body. question. Among the immunosuppressants, methotrexate and fumaric acid esters, which are also suitable for long-term therapy, are recommended.
Biologics can inhibit the cells involved in inflammation and thus suppress the symptoms of psoriasis. In Germany, among others, the biological adalimumab, ustekinumab, infliximab, etanercept and the interleukin-17 antagonist, secukinumab z and treatment of psoriasis are licensed
Also a UV light Therapy, ie radiation with certain wavelengths, can relieve the symptoms of many patients. However, it can increase the risk of skin cancer in the long run – and it has no effect on comorbid diseases.
Immunosuppressants or Biologics
But how should the doctor decide which treatment is best for moderate-to-severe psoriasis? In a recent article of the "PsoNet Magazine" regional psoriasis networks in Germany, a team of experts discusses the best way to make a therapeutic decision. It was important to find a treatment as effective as possible for each patient, but at the same time as cost-effective, taking into account the individual wishes of the patient. It should also take into account the severity of the disease, the quality of life of the patient and the side effects as well as the possible risks of the drugs.
The question of when conventional therapy with immunosuppressants and when the use of biological products – usually effective but expensive – is preferable is particularly important. "Organic products cause a significant proportion of patients to have a high rate of improvement, sometimes even for healing.They have revolutionized the treatment of psoriasis," says dermatologist Radtke. "In addition, the treatment is safe long term and well tolerated. "In particular the group of interleukin-17 antagonists have shown good efficacy with a high safety profile, says Radtke." At the same time, it is also important to consider the & t & & & & avec,,,,,,,,,,,. aspect of profitability take into account ", emphasizes Radtke." If we can expect that other cheaper drugs are just as effective as biological drugs, they should be used in "It also depends in particular on the severity of the disease." Biological agents may be considered if the symptoms of immunosuppressive or immunomodulatory therapy do not improve, if they provoke side effects or if contraindications exist.
What is the quality of the supply of organic products?
"Organic products are a blessing for seriously ill patients, and with side effects or compatibility, there are few complaints," says the Liebram psoriasis network. But what is the quality of the supply of organic products? Do psoriasis patients know that this option exists and do family physicians and dermatologists know enough? "We hear very different numbers of how many patients are severely affected, so need internal treatment.The bandwidth ranges from 20 to 40%," says Liebram. "Plus, I do not think psoriasis is aware that there are any biologic drugs now." There are patients who have discontinued their psoriasis treatments years ago and who have not had it. never seen a doctor. "
On the other hand, there are pharmaceutical projects on psoriasis: elaborate websites, pamphlets, and primetime TV commercials try to address as many patients as possible "One consequence is that drug-related information providers, such as self-help, are finding it increasingly difficult to reach patients," says Liebram.
To obtain biologic drugs, patients should contact their doctor directly. "But not everyone dares to do that. In addition, the prescribing practice differs according to the state. The worst is probably in Baden-Wuerttemberg. There, the Kbadenärztliche Vereinigung puts great pressure on the dermatologists, which allows to prescribe only some biological products. From there, the psoriasis network receives the most complaints. Even with severe psoriasis, a patient has a low chance of getting a biologic drug, "says journalist and co-founder of Psoriasis Network
From Family Physician to Specialist
Another Important Aspect of Care What is the doctor? Patients treated. About 40% of adult patients with psoriasis are treated by dermatologists, 50% by their family doctor, according to figures from "Facts 2014" already mentioned. Here, there are marked differences in the choice of drugs and the quality of care between the two groups of physicians
For example, GPs and pediatricians prescribe more products containing cortisone, while dermatologists prescribe more vitamin D3 supplements. Several studies have also shown that the treatment of psoriasis by specialists leads to better therapeutic results. Regional networks of psoriasis play an important role, with dermatologists and disease centers joining forces.
"Patients with psoriasis should be referred to a specialist dermatologist for appropriate treatment," says Radtke. It is important that the attending physician make a careful diagnosis, recognize the triggers of the disease, and clarifies comorbidities
What's Missing: Guidelines and Training
It would also be helpful to introduce a measurement culture in which the severity of symptoms and quality of life patients were recorded at regular intervals, it says in "Psoriasis Care in Germany – Facts 2014". This could help evaluate the effectiveness of the treatment and adjust it if necessary. For example, the severity of symptoms can be determined using the psoriasis zone severity index (PASI). "An important part of the therapy is also to educate the patient about his illness and the various treatment measures and to involve him in the therapeutic decisions," says Radtke. "At the same time, good compliance with the treatment can be achieved."
Providing family physicians and other physicians should be informed about appropriate diagnoses and treatment of psoriasis – for example by appropriate training. "Physicians who treat a patient with psoriasis should take into account that other systemic diseases may occur in people with this condition and that they have an increased cardiovascular risk," says Radtke. "The family doctor should therefore regularly perform appropriate screening procedures, such as blood pressure, blood glucose, and blood lipid levels."
From Liebram's perspective, closer interdisciplinary cooperation between dermatologists and rheumatologists would be desirable. "An accompanying psoriasis disease is known to be psoriatic arthritis.It is often diagnosed too late.In the process, according to the patient's representative, the main problem concerns the patients: they also have to talk to their dermatologist's joint problems and psoriasis to the doctor they suffer because of their joint pain.Because rheumatologists are rare, many dermatologists have now come to know about psoriatic arthritis. " Existing rheumatoid arthritis is even more likely to be recognized by the rheumatologist than by the dermatologist, "says Liebram
What can patients do?
Overall, it is desirable and helpful for patients to heal know their disease and the triggers to understand the benefits and risks of different therapeutic measures. It is important for patients to learn how to manage their disease, "says Radtke. "For example, they should see the doctor regularly to see if the current therapy is still appropriate or if it needs to be changed."
It is also helpful for many patients to determine the causes of symptoms and how to avoid these factors. risk. or at least reduce it. In addition, they should try to live a healthy life: this includes a healthy and balanced diet, regular exercise, little or no alcohol to drink and refrain from smoking. On the one hand, it can help strengthen the immune system, so that new episodes of the disease occur less frequently. On the other hand, a healthy lifestyle is important to reduce the risk of possible comorbidities.
An essential aspect of treatment is also a good basic skin care. "It is in our opinion in total and also extremely important between outbreaks," says Liebram. "However, patients with psoriasis are not well supported, in our opinion, urea creams, for example, were withdrawn from reimbursement years ago, and all patients can not afford Buy urea creams or other bad creams at the pharmacy – not to mention medical shampoos. "
Source link
