One in 10 people with chronic or multi-chronicity suffers from psoriasis (estimated 1.8 million out of 24 million) which affects approximately 3% of the population in our country. The WHO dealt with it, underlining the significant socioeconomic burden of the pathology due to the impact on professional life, public and private costs for treatments. However, second Tonino Aceti, President Salutequità And Valeria
Armor, president of Apfiaco, Italian psoriasis association, friends of the Corazza Foundationto date “in Italy there is no act of national or regional planning that defines priorities, the appropriate way to deal with them, and health spending on drugs alone increases, but adherence to therapies is generally low”.
It is clear – we read in a note – that people suffering from psoriasis urgently need precise answers in national programming. There is no doubt that the disease fully meets those criteria stated in National Chronic Disease Plan (Pnc) which indicates how to select the chronic pathologies to be included in the second part of the Plan (“…there are no specific planning acts at national level, identified through criteria such as epidemiological relevance, severity, disability, healthcare and economic burden, difficulty of diagnosis and access to treatment”). The request for the inclusion of psoriasis in the PNC, for Aceti and Corazza, would be an “important turning point to also give a new meaning, break the barrier of prejudice and look in a far-sighted way at the sustainability and appropriateness of the NHS”.
Request shared by the regional council of Liguria which in July – continues the note – approved an agenda signed by all the groups, which commits the council to acting as spokesperson for the Government so that the disease is included in the PNC because it falls within the category of pathologies chronic conditions that require an interdisciplinary approach and total patient care. It is in fact one chronic-relapsing immune-mediated disease which develops due to an interaction between genetic and environmental factors, as well as being associated with other pathological situations.
“Today the diagnostic path is still tortuous and not formalised – underlines Corazza – The inclusion of psoriasis in the National Chronicity Plan would represent a greater definition of the extent of the pathology, would help to stratify the population affected by it and would imply systematic development by the different PDTA regions at a specialist level for better management in charge of patients and fairer access to care throughout the national territory. It would mean elevating psoriasis to the same level as all other chronic diseases, with equal rights, because psoriasis is not a disease of just ‘two little spots’ on the skin.”
“The inclusion of psoriasis in the PNC – underlines Aceti – represents a priority, especially at this moment, given that it is under discussion for the update. It would be unacceptable for patients affected by it to have to wait another 7 years to be considered in the next update: it is convenient for everyone, patients, healthcare professionals and the NHS. There are already regions that are realizing this and are asking for a structured and uniform intervention at the national level”
Other pathologies are associated with psoriasis, such as metabolic syndrome (obesity), hypertension, diabetes, depression due to the severity of the pathology and its location (for example face, hands, private parts, sensitive areas), risk of cardiovascular diseases. The good news – the note reports – is that treating psoriasis reduces the risk of heart attack and stroke. One in three people with psoriasis (33%) suffer from one comorbidity, one in five (19%) two, and just under one in ten (8%) three. Since it is inflammatory, if not controlled, it causes cumulative damage such as psoriatic arthritis which appears in 30% of patients who initially present psoriasis only on the skin level.
That’s not all: it is estimated that there are 150 thousand people with severe pathology and that around 50 thousand are being treated with biological drugs and the same number of 50 thousand on the waiting list. However, the rate of therapeutic adherence is generally low: data from a 2016 systematic review – the note reports – showed that only one patient in 5 treated with topical agents maintains the therapy over time (20%); but 4 out of 5 interrupt treatments (80%).
In the Regions – concludes the note – attention is mainly paid to the use of drugs as in the case of Veneto, Emilia Romagna, Piedmont and Sicily; even if there are initiatives that affect the local level such as the financing of the Cross clinic at the Irccs De Bellis approved by Puglia (Dgr 28 March 2022, n. 418). For the rest, the difficulties found by Censis in its 2015 report still remain valid: in 7 out of 10 cases the patients went from one specialist to another to obtain a correct diagnosis and in 5 out of 10 they turned on average to 4 different specialists or Centers before identifying the current interlocutor to rely on for treatment. Access made even more difficult by the pandemic. In 2021, considering only the 3 months monitored, accessing a dermatological visit was more complicated than in 2019 and 2020: the services available to patients for the purposes of diagnosis or checks were 10,827, fewer than in 2 previous years (11,333 and 11,994).
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