11 Background There is a growing interest in policy making 12 for using utility measures and identifying algorithms to 13 convert disease-specific measures into utilities. 14 Objectives To analyse the relationship between EQ-5D, 15 Dermatology Life Quality Index (DLQI) and Psoriasis 16 Area and Severity Index (PASI) in psoriasis. To transform 17 DLQI scores, and key clinical, demographic and health 18 service utilisation variables into utilities. 19 Methods A cross-sectional questionnaire survey of 200 20 consecutive adult patients with moderate to severe psoria-21 sis was carried out in two Hungarian university clinics. The 22 relationship between the outcome measures were analysed 23 with correlations and with the known-groups method. 24 Bivariate and multivariate regression algorithms on EQ-5D 25 scores were formulated. 26Results The mean age of respondents was 51 years 27 (SD = 12.9), 68.5 % were male, and 51.5 % received 28 biological therapy. Median EQ-5D, DLQI, and PASI scores 29 were 0.73, 3.0, and 3.45, respectively. EQ-5D showed a 30 moderate correlation with the DLQI and with the PASI 31 (r s = -0.48 and -0.43, p \ 0.05). Strong correlation was 32 found between DLQI and PASI (r s = 0.81, p \ 0.05). 33 DLQI and PASI discriminated better among groups cate-34 gorised by the localisation of the lesions than EQ-5D.

10 Background Despite the widespread availability of bio-11 logical drugs in psoriasis, there is a shortage of disease 12 burden studies. 13 Objectives To assess the cost-of-illness and quality of 14 life of patients with moderate to severe psoriasis in 15 Hungary. 16 Methods Consecutive patients with Psoriasis Area and 17 Severity Index (PASI) [ 10 and Dermatology Life Quality 18 Index (DLQI) [ 10, or treated with traditional systemic 19 (TST) or biological systemic treatment (BST) were inclu-20 ded. Demographic data, clinical characteristics, psoriasis 21 related medication, health care utilizations and employ-22 ment status in the previous 12 months were recorded. 23 Costing was performed from the societal perspective 24 applying the human capital approach. Quality of life was 25 assessed using DLQI and EQ-5D measures. 26 Results Two-hundred patients were involved (females 27 32 %) with a mean age of 51 (SD 13) years, 103 (52 %) 28 patients were on BST. Mean PASI, DLQI and EQ-5D 29 scores were 8 (SD 10), 6 (SD 7) and 0.69 (SD 0.3), 30 respectively. The mean total cost was €9,254/patient/year 31 (SD 8,502) with direct costs accounting for 86 %. The 32 main cost driver was BST (mean €7,339/patient/year).

Limited data are available on the vitamin D 3 status and bone mineral density (BMD) of patients with psoriasis or with psoriatic arthritis. Our study intended to explore possible correlations between vitamin D status and BMD, as well as among these parameters and the features of the underlying disorder. Seventy-two patients with psoriasis/ or psoriatic arthritis (female : male ratio, 40:32; mean age, 58.5 AE 11.6 years; mean duration of follow up, 142.7 AE 147.7 months) participated in the study. We evaluated the characteristic clinical features of the underlying disease, performed bone densitometry of the lumbar spine and the hip region, measured the serum vitamin 25 (OH)D 3 levels of the patients, and undertook the statistical analysis of the relationships between the clinical and the laboratory parameters. The proportion of patients with a low BMD value did not exceed that seen in the general population. We found an inverse correlation between the serum level of vitamin 25(OH)D 3 and body mass index, as well as between the former and the severity of skin involvement. Furthermore, the activity of psoriatic arthritis was significantly higher in patients with inadequate vitamin D 3 status. In patients with psoriatic arthritis, BMD significantly exceeded the values measured in patients suffering from psoriatic skin lesions only. Our findings suggest the importance of evaluating the vitamin D 3 status and screening for comorbid conditions in patients with psoriasis or psoriatic arthritis. This appears justified, in particular, due to the possible role of hypovitaminosis D 3 in provoking the development of skin lesions and joint symptoms.

No abstract

Our findings highlight the importance of exploring expectations that might help to increase patients' compliance.

Background: The aetiology of chronic urticaria is heterogeneous. Physical urticaria (PU) is estimated at around 35%, autoimmune urticaria (AIU) at 25% and chronic idiopathic urticaria (CIU) at 35% of all chronic urticaria cases. Methods: Differences in clinical and laboratory parameters among AIU, PU and CIU groups were examined. AIU was diagnosed if the basophil CD63 assay was positive. Demographic data, severity of symptoms and association with allergic and autoimmune diseases were analysed by the aid of a questionnaire. Immunoassays were carried out and the effectiveness of therapy was also investigated. Results: Concerning the urticaria score, AIU patients had significantly higher total urticaria scores than patients with CIU (p = 0.013), dermatographic urticaria (p = 0.05) or cholinergic urticaria (p = 0.038). Between CIU and dermatographic urticaria and between CIU and cholinergic urticaria patients, we found insignificant differences in the urticaria score (p = 0.707 and p = 0.336, respectively). AIU was more frequently associated with autoimmune diseases in the personal history (p < 0.001) and with other types of urticaria in the family history (p < 0.001). Also, anti-thyroid antibodies were more frequently detected in the AIU group. Antihistamine therapy was less effective in the AIU group (12.8%) than in the PU (70.3%) and CIU groups (68.6%), but there were no significant differences between the CIU and PU groups regarding the effectiveness of antihistamine therapy. Conclusion: The autoimmune subgroup represents the most severe form of chronic urticaria. On the other hand, there were no significant differences between the CIU and PU groups neither in urticaria scores nor in response to antihistamine therapy.

Patients with severe psoriasis exhibit signs of subclinical cardiovascular disease compared to control, and prolonged anti-TNF-α therapy has a potentially beneficial effect on these signs.

Bevezetés: A psoriasis a leggyakoribb krónikus, szisztémás, immunmediált gyulladásos kórkép, amely elsősorban a bőrt és az ízületeket érintheti. Célkitűzés: Arthritis psoriaticával társuló középsúlyos és súlyos psoriasisos betegek életmi-nőségének és betegségköltségeinek vizsgálata. Módszer: Két egyetemi bőrgyógyászati klinikán keresztmetszeti kérdő-íves felmérést végeztek. Eredmények: A vizsgált 57 beteg (65% férfi ) átlagéletkora 54,3±11,6 év, életminősége az EQ-5D indexszel mérve 0,48±0,4 volt. Az egy betegre jutó éves átlagköltség 2,56 millió Ft, amelyből 71% a bioló-giai terápiához kapcsolódó költség és 21% az indirekt költség. Az indirekt költség 95%-a, 506 ezer Ft/beteg/év a psoriasis miatti munkából való kiesés miatt jelentkezik. A szisztémás kezelésben nem részesülő (21%), a tradicionális szisztémás (32%) és a biológiai szisztémás terápiában részesülő (47%) betegek egy betegre jutó éves átlagköltsége sorrendben 493 ezer Ft, 513 ezer Ft és 4,84 millió Ft. Következtetések: A biológiai terápia szignifi káns életminőség-javulást eredményez. Mivel az arthritis psoriaticával társuló psoriasis-betegcsoportban a szisztémás kezelések mindkét kórképben hatásosak, ezért a terápiával elérhető egészségnyereség mérése egészség-gazdaságtani szempontból a két kórkép esetén együttesen is célszerű, mert a valós egészséghaszon nagyobb lehet, mintha csak az egyik kórképet vizsgáljuk. Orv. Hetil., 2014, 155(48), 1913-1921 Kulcsszavak: psoriasis, arthritis psoriatica, biológiai terápia, életminőség, költség, Magyarország Disease burden of psoriasis associated with psoriatic arthritis in HungaryIntroduction: Psoriasis is a frequent, chronic, systemic immune-mediated disease mainly affecting the skin and joints. Aim: To assess health related quality of life and cost-of-illness in moderate to severe psoriasis associated with psoriatic arthritis. Method: A cross-sectional questionnaire survey was conducted at two academic dermatology clinics in Hungary. Results: Fifty-seven patients (65% males) completed the survey with a mean age of 54.3±11.6 years and mean EQ-5D score of 0.48±0.4. Mean annual total cost was €8,977 per patient, of which 71% occurred due to biological therapy and 21% were indirect costs, respectively. Permanent work disability due to psoriasis accounted for €1,775 (95% of the indirect costs). Per patient costs of subgroups not receiving systemic therapy (21%), traditional systemic therapy (32%), and biological systemic therapy (47%) amounted to the sum of €1,729, €1,799, and €16,983, respectively. Conclusions: Patients on biological therapy showed signifi cantly better health related quality of life. As for health economics, the effi cacy of systemic treatments is appropriate to be assessed together in patients with moderate to severe psoriasis associated with psoriatic arthritis, since actual health gain might exceed that reported in psoriasis or psoriatic arthritis separately.