Alexis Ogdie, MD, on Depression Among Patients with PsA and Active PsO

In this podcast, Dr Ogdie discusses her research into the relationship between depression and active psoriasis and psoriatic arthritis, presented at the recent ACR Convergence meeting.

Alexis Ogdie, MD, is a rheumatologist and an associate professor of medicine and of epidemiology at the Hospital of the University of Pennsylvania.

TRANSCRIPT:

Rheumatology and Arthritis Learning Network:  Hello, and welcome to another podcast from the Rheumatology and Arthritis Learning Network. I'm your moderator, Rebecca Mashaw. Today, I'm very pleased to say we're joined by Dr. Alexis Ogdie, who is a rheumatologist and associate professor of medicine at the hospital of the University of Pennsylvania. Thank you for joining us today.

Dr. Alexis Ogdie:  Thanks so much for having me.

RALN:  Let's start out talking about your abstract on the impact of skin involvement in depression on what you term an acceptable symptoms state among patients with psoriatic arthritis and psoriasis. First of all, how significant is depression among patients with psoriatic disease?

Dr. Ogdie:  Depression is quite common in psoriatic arthritis, and it was common even before the pandemic. Before the pandemic, the estimates were that approximately 25 to 30 percent of patients with psoriatic arthritis had depression. Now, after the pandemic, from clinical practice, we can say it's likely a lot more, and we don't yet have estimates about that.

RALN:  Can you give us an overview of this UPLIFT program? What were your objectives with this study?

Dr. Ogdie:  This study is a survey study across the United States and Europe, and also Japan. One of the goals of the study was to just get the pulse of how psoriasis and psoriatic arthritis is being cared for in the community, both in terms of what kinds of medications are people actually using, but then also how satisfied are people with their therapies.

Then, along with that, we wanted to know more about some of the other comorbidities, for example, depression and how common that was, and how it was impacting patient's outcomes.

RALN:  You looked at responses from patients with PSA alone and those with PSA and active psoriasis. Is that correct?

Dr. Ogdie:  That's correct.

RALN::  How did those responses differ?

Dr. Ogdie:  In patients who had psoriatic arthritis, who did not currently have skin disease, the prevalence of depression was 27%. In patients with psoriatic arthritis and active skin disease, the prevalence of depression was 43%. Pretty significantly higher in those patients with skin disease as well.

RALN:  What does that tell you? How do you interpret those differences?

Dr. Ogdie:  There could be a couple of things. One is that patients who don't have any skin disease could we just have general better control of their disease and then be feeling overall better. Maybe that patients who have more skin disease have less control of the disease thus have maybe more depression.

Also, sometimes for some individuals, the skin disease can be more impactful in terms of depression because it's an outward sign of the disease. People can see your skin disease, can see your hands or your scalp with the disease, and then it makes people feel very uncomfortable and can be associated with depression.

RALN:  What advice do you have for clinicians who are caring for patients with PSA and active psoriasis in regard to monitoring for depression, helping them find treatment, and any other advice that you might give them?

Dr. Ogdie:  One thing is that skin disease is important. As rheumatologists, we often think about the joints. We're focused on how much joint swelling there is or how many entheses are tender. Sometimes we don't think as much about the psoriasis. If I can impart one specific message, it is that the skin disease is important. It's important to the patient and important to their well-being.

Then, in terms of depression, it's important to screen for depression in all patients regardless of the skin disease, so maybe even separately. I ask it every single visit about depression. We use a screening questionnaire. In this case, the PHQ2 was one of the questioners that we use. We use that in clinical practice, as well.

Those are easy questions just to screen for any signs of depression. Then, to ask about what they are doing or refer them back to primary care, or even to get on a list to get a therapist because it's unfortunate what you have to do right now.

RALN:  What about working in an interdisciplinary fashion with dermatologists to bring them in and help address, particularly, the skin issues since that seems to be such a driver of depression?

Dr. Ogdie:  Absolutely. We work a lot with dermatologists. We have a virtual combined clinic, we call it. We're literally across the hall from each other. We don't necessarily see patients on the same day at the same time, but we find an opportunity to discuss patients, especially when we're making treatment decisions.

That's incredibly helpful, and in general, leads to better patient care when you can point to a dermatologist, call that dermatologist and say, "This is what's going on. What can we do to make this patient's skin get better? The disease as a whole get better?"

RALN:  Thanks very much for talking to us about this.

Dr. Ogdie:  Thank you. Thanks for the opportunity.