Thai Patients with Psoriasis : a questionnaire-based research on demographic data, disease manifestation, comorbidities, related health care system, health education on psoriasis and quality of life

Abstract

Background: The current study of epidemiology, clinical data and quality of life of Thai patients with psoriasis is limited . There are many problems that arise from patient’s misunderstanding about the disease nature and system of continual care.

Objectives:  To study epidemiology, clinical data, quality of life and to overview the care system of psoriasis patients in Thailand.

Methods:  Researcher interviewed 100 patients with psoriasis in out-patient setting at King Chulalongkorn Memorial Hospital  in three months.

Results: 56 male and 44 female patients with psoriasis were interviewed. Almost half of them (40%) have income less than 10,000 baht per month . The common comorbidities include dyslipidemia (32%) and hypertension (28%). The average BMI is 24.08 and 25.31 kg/m2  and the average waist circumference is 91.5 and 88.8  cm. for male and female patients respectively, all of which are higher than the standard of Thai people .  66% of patients have early age of onset (less than 40 years of age ,by Henseler and Christopher classification) . Female patients tend to present earlier than male (p=0.01), and patients with family history of psoriasis tend to present earlier than without family history (p=0.04). More than half of patients (55%) have mild diseases. The most common type is chronic plaque (92%) and the most common area involvement are scalp (92%), upper extremities (92%) and lower extremities (90%). The associated symptoms are pruritus (81%), nail change (72%), arthritis (22%) , fever (3%). Psoriasis tends  to be more severe in patients with nail and joint involvement than patient without (p=0.03,0.01 respectively) . Both psoriatic nail and psoriatic arthritis are more common in male than female patients. There are many reasons why patients change their hospitals and/or doctors , such as for disease improvement (17%) and cure (14%). The treatment options other than topical agents are oral medication (56%), phototherapy (32%) and biologic drugs (7%). Adverse reaction is found in about 20% of patients. By average, cost of treatment is 1,465 baht per month (200-6000 baht/month) and travelling expense is 320 baht per month(0-6000baht/month). Almost one-fifth of patients used to try herbal remedies containing steroid. 11% of patients reported absent from their work due to disease exacerbation. The sick leave-duration ranges from 2 to 30 days and two patients have to quit their job. Most patients never attended group therapy because they aren’t aware of the activities.  77% of patients were informed about aggravating factors and routine care by their doctors. Other teaching media includes posters (67%), brochures (66%). There is still misbelief about the disease. Some patients think that it is contagious (3%), non genetic (32%) and curable (10%). The most common aggravating factors that patients are aware of include skin injury (86%),  stress (85%)   and  more than half of the patients think that food can aggravate the rash, especially preserve and

seafood. The average DLQI score for patients with psoriasis is 8.5 (0-24) and Pearson’s correlation between PASI and DLQI score is 0.41

Conclusion: Most Thai patients with psoriasis have low socioeconomic status, while the disease brings about both direct and indirect costs. Female patients and patients with family history tend to have earlier age of onset. Most patients have mild disease. The lesion is usually on scalp and extremities. Metabolic syndrome risk factors are common in patients with psoriasis. Nail and joint involvement wane found more frequently in male than female patients and correlates well with disease severity. Patients misunderstanding about the disease can lead to many problems, such as changing hospitals, seeking for cure, herbal remedies containing steroid and frequent disease exacerbation due to unaware of aggravating factors.