PHILADELPHIA – Researchers from the Perelman School of Medicine at the University of Pennsylvania and 16 other research institutions from the United States and Canada in collaboration with the National Psoriasis Foundation have created guidelines for caring for patients with Psoriasis during the coronavirus pandemic. The guidelines list 22 recommendations for management of psoriatic disease based on the most current research, including that psoriasis and psoriatic arthritis and treatment for those conditions alone likely do not meaningfully increase one's risk of COVID-19. The report – which published online in the Journal of the American Academy of Dermatology—is meant to be a living document, one that evolves as the scientific community learns more about COVID-19.
After combing through dermatology, rheumatology, gastroenterology, and infectious diseases research regarding COVID-19, the National Psoriasis Foundation COVID-19 Task Force, co-chaired by Joel Gelfand, MD, MSCE, the director of the Psoriasis and Phototherapy Treatment Center at Penn Medicine, developed the guidelines to advise how specialists and clinicians should care for psoriasis patients in light of the threat of COVID-19. While the coronavirus may worsen one's psoriasis or psoriatic arthritis symptoms, the group of dermatologists, rheumatologists, infectious diseases doctors, critical care doctors, epidemiologists, and immunologists did not find scientific evidence that medical interventions to treat psoriasis and psoriatic arthritis should be interrupted or altered to minimize COVID-19 risks, with exception of chronic systemic corticosteroids for psoriatic arthritis, which should be avoided when possible in normal circumstances.
The researchers caution that existing data are limited in quality and note that as more patients are studied, future consideration of these guidelines is warranted. Their report also calls for, among other things, making telemedicine available to patients with psoriatic disease, implementing masks, physical distancing, and hand washing especially at work or school, and being vaccinated against the flu when the shot is available.
"The pandemic has caused devastating personal, economic, and societal repercussions worldwide and clinicians and patients urgently need science-based guidance to help navigate these difficult times safely," Gelfand said.
"We sought to identify the signals most helpful and impactful for patients with psoriatic disease and their care teams and to weed out the noise," said George L. Anesi, MD, MSCE, MBE, an instructor of Medicine and a specialist in Pulmonary and Critical Care Medicine at Penn.
Due to the relationship psoriasis and psoriatic arthritis have to patients' immune systems, many feared the diseases or helpful interventions, which often weaken patients' immune responses to other viruses, could exacerbate coronavirus risks.
"Patients and clinicians have to balance proven benefits of treatment with theoretical safety concerns related to the novel coronavirus. Not treating psoriatic disease can have terrible consequences on patients' well-being, and in the case of psoriatic arthritis, can result in permanent joint damage and disability," Gelfand said. "The initial publications of hundreds of patients who developed COVID-19 while on treatments used for psoriatic disease have been largely reassuring and therefore we recommend that patients who are not infected with SARS-CoV-2 continue their biologic or oral therapies for psoriasis and/or psoriatic arthritis in most cases."
While the report is meant to promote optimal management of psoriatic disease during the pandemic, the researchers advise patients not to adjust or change any aspect of their care without careful consultation with their physician.
"Shared decision making between patient and clinician that considers potential benefits of treatment, the activity of skin and/or joint disease and response to previous therapies, as well as the patient's underlying risk for poor COVID19 outcomes, ability to maintain measures to prevent infection with SARS-CoV-2 and individual circumstances and preferences is critical to navigating these uncertain times," Gelfand.
The authors of the report will stay in close contact and keep their eyes on new research to ensure their direction stays up to date.
"In addition to the study findings, this initiative led us to come together and form a group from diverse medical specialties," said co-author Vincent Lo Re, MD, MSCE, an associate professor of Medicine and of Epidemiology in Biostatistics and Epidemiology. "We will continue to come together to review and synthesize data in real time to provide valuable guidance as new information emerges in order to continue providing patients and care teams with information necessary to their disease treatment."
Other Penn co-authors are George L. Anesi, Christoph Ellebrecht, Maha N Syed, and Erica Weinstein.
