But both the PSA and Pharmacy Guild believe the RACGP is provoking a turf war that is putting patients at risk. Recent sexual activity. Patients with psoriasis are more likely to have cardiovascular mortality than patients without psoriasis,6 so it is important that risk factors are screened for and treated. He says the RACGP’s stance is out of step with what’s happening on the ground and in his experience, GPs welcome pharmacist health checks, as long as they are evidence-based, delivered to PSA standards and there is a clear referral pathway. doi: 10.1111/bjd.18245. Mr Tassone says there was similar push-back when pharmacy-based flu vaccinations — now an “accepted and beneficial” part of the health system — were introduced. Malassezia spp., a common yeast, is associated with scalp psoriasis, seborrheic dermatitis and sebopsoriasis. doi: 10.1080/09546634.2017.1395800. 18 A proportion of men with BCR will progress to metastases and death; others will have … doi: 10.1111/jdv.14460. An enlarged prostate gland. Prostate cancer resource Prostate cancer accounted for the second highest number of male cancer deaths in Australia. GPs are in a prime position to screen, diagnose and manage comorbidities in a patient with psoriasis. A biopsy is a procedure in which samples of prostatic tissue are removed. PSA president Shane Jackson says recent findings by a Victorian coroner highlighted the importance of pharmacists and GPs working together. For this test, a blood sample is sent to a laboratory for analysis. Hohenberger M, Cardwell LA, Oussedik E, Feldman SR. Interleukin-17 inhibition: Role in psoriasis and inflammatory bowel disease. Depression and suicidality in psoriasis: Review of the literature including the cytokine theory of depression. High prevalence of alcohol use disorders in patients with inflammatory skin diseases. General The aim of this article is to outline the well-recognised comorbidities associated with psoriasis to facilitate a discussion for general practitioners (GPs) to have with their patients about lifestyle changes, the need to screen for other diseases and management of comorbidities. Dermatol Clin 2015;33(1):41–55. The PSA test measures the level of PSA in a man’s blood. doi: 10.1097/HJH.0b013e32835bcce1. Journal of The RACP will close from Thursday 24 December 2020 and re-open Monday 4 January 2021 (Australia) and Tuesday 5 January 2021 (Aotearoa New Zealand). RACGP is the latest medical college to endorse the guidelines, which provide health professionals with evidence-based recommendations for using the prostate specific antigen (PSA) blood test to assess prostate cancer risk and manage test-detected patients. doi: 10.1007/s40257-018-00420-8. It is common for older men to have some cancer cells in their prostate glands. The risk of lymphoma in patients with psoriasis. It is characterised by salmon pink plaques with adherent scale, and the most common locations include the elbows, knees, intergluteal cleft, nails and scalp. Guild Victoria president Anthony Tassone says pharmacies work closely with local GPs and health checks are an important way to identify at-risk patients. Therefore, it is important to screen for conditions such as tuberculosis, hepatitis B and C, HIV, syphilis and strongyloidiasis before commencing and, if at high risk, during such therapies. The guideline recommendations must be referenced and graded to help guide clinical management, in the context of the patient’s setting. The RACGP (2012) advise: GPs need not raise this issue, but if men ask about prostate screening they need to be fully informed of the potential benefits, risks and uncertainties of prostate cancer testing. Joint damage starts early in the disease, manifesting in dactylitis, enthesitis and spondylitis.3 Tendons, ligaments, joints, synovium and bone can all be inflamed in PsA.3. doi: 10.1111/bjd.15497. A recent, long bike ride.Up to 25% of men with high PSAs may have prostate cancer, depending on age and PSA level. PsA questionnaires include but are not limited to Psoriatic Arthritis Quality of Life (PsAQoL) and Psoriatic Arthritis Impact of Disease (PsAID). Serum rheumatoid factor is elevated in 13% of patients with PsA, compared with 80% of those with rheumatoid arthritis.2 Radiographic changes include pencil-in-cup deformity, with digit shortening and bone lysis.2 These changes can occur within two years of disease onset. Patients with human immunodeficiency virus (HIV) tend to have more severe psoriasis. Inflamm Bowel Dis 2017;23(10):1783–89. J Dermatolog Treat 2018;29(1):13–18. Despite treatment-attributable risk, there seems to be a moderately increased risk of NMSCs but not melanomas,22,23 so regular skin checks and vigilance are prudent, especially for patients who have had immunosuppressive  therapy or phototherapy. Clin Dermatol 2019;37(2):160–66. But both the PSA and Pharmacy Guild believe the RACGP is provoking a turf war that is putting patients at risk. Psoriasis: Classical and emerging comorbidities. In addition to treating the skin, it is important to assess patients for psoriasis-related comorbidities by taking a simple history (eg asking about arthralgia and arthritis, alcohol and drug intake/abuse, sexual dysfunction), performing clinical examinations (eg measuring waist circumference, weight, body mass index), performing QoL scales (eg depression and anxiety scales) and ordering laboratory investigations (eg lipid profile, blood sugar levels, liver and renal function).6 A multidisciplinary team approach to patients with psoriasis may include non-GP specialists such as dermatologists, rheumatologists, cardiologists, endocrinologists, gastroenterologists and psychiatrists as well as allied health practitioners (eg psychologists and dietitians). Prostate-specific antigen, or PSA, is a protein produced by normal, as well as malignant, cells of the prostate gland. The guidelines have also received formal endorsement from the Urological Society of Australia 4. The economic burden of psoriasis is accentuated by the presence of psychiatric disorders when taking into account emergency department and outpatient visits, time off work and prescription costs.15. There are several reasons for this. J Eur Acad Dermatol Venereol 2017;31(12):1999–2009. The RACGP information for GPs and patients Pharmaceutical Society of Australia Dedicated Electronic Prescriptions Support Line for pharmacies: 1300 955 162. PsA is considered a spondyloarthropathy because of the extra-articular features and spondylitis that occur in up to 40% of patients.2 It is also associated with HLA-B27.2 Nail involvement affects approximately 87% of patients with PsA.3 Typical changes include pitting, crumbling, onycholysis, leukonychia, subungual hyperkeratosis and splinter haemorrhages. www.racgp.org.au Healthy Profession. Egeberg A, Thyssen JP, Gislason GH, Skov L. Skin cancer in patients with psoriasis. Br J Dermatol 2014;170(2):304–14. doi: 10.1111/jdv.13619. Welcome to AusDoc.Plus, the new home of Australian Doctor, Medical Observer, 6minutes and How to Treat. Do you know the symptoms of spinal muscular atrophy? It is a criterion for the initiation and continuation of biological therapy. The pathogenesis occurs via a dysfunction of the skin microbiome and impaired tolerance, resulting in abnormal immune activation.25. doi: 10.1097/MIB.0000000000001169. doi: 10.3109/00016350903583678. Dactylitis, which is inflammation of the entire digit, can present as a ‘sausage finger’ because of inflammation of the joints and tendons.2,4 Both enthesitis  and dactylitis are common in PsA. doi: 10.1111/bjd.12670. Chelsea Felkai MPS usually balances a busy life of university teaching, PhD study and community pharmacy locum shifts in Newcastle, NSW. J Eur Acad Dermatol Venereol 2016;30(8):1349–53. “The average pharmacist and the average GP out there treating patients get along very well. Cai Q, Teeple A, Wu B, Muser E. Prevalence and economic burden of comorbid anxiety and depression among patients with moderate-to-severe psoriasis. Of the 80 people screened, five were ultimately referred and started treatment for diabetes. Because psoriasis precedes PsA by approximately 12 years,3 there is ample time to ask patients about symptoms of PsA and investigate and treat early in the disease process before permanent joint destruction occurs.3 This primary prevention is not undertaken in almost 60% of patients with PsA, who do not have their joints treated.3 When assessing a patient with psoriasis, no matter how severe, it is important to examine their nails and joints, ask about symptoms of PsA and provide analgesia and early referral to a rheumatologist. Acta Odontol Scand 2010;68(3):165–70. The management of the comorbidities is not discussed as it is beyond the scope of this article. Wellona Pharma is a leading supplier, exporter & dropshipper of Pharma finished formulation & generic Wellona Pharma is a reputed and fast growing Manufacturing Company in Pharmaceutical. Rademaker M, Agnew K, Anagnostou N, et al. Five of the best AusDoc stories of the year, Long COVID: 'I wouldn't wish it on my worst enemy', Doctors split over compulsory COVID-19 vaccination for health workers. Australian doi: 10.1016/S0140-6736(18)30830-4. The development of hypertension is 1.3 times more likely in patients with mild psoriasis than in patients without psoriasis. Higher incidence rates of comorbidities in patients with psoriatic arthritis compared with the general population using US administrative claims data. AMH is jointly owned by the Royal Australian College of General Practitioners (RACGP), the Pharmaceutical Society of Australia (PSA) and the Australasian Society of Clinical and Experimental Pharmacologists and Toxicologists (ASCEPT). P oststreptococcal arthritis (psa) is a poorly understood clinical syndrome that has generated much controversy and for which clear diagnostic criteria and therapeutic recommendations are lacking. Although these QoL tools are time consuming to complete and analyse, they provide important current and evolving information about the impact that psoriasis has on a patient. This includes comorbidities and preferences. GPs are in a prime position to screen and diagnose these common comorbidities and have the experience and knowledge to manage them accordingly. It is speculated that reducing the amount of circulating cytokines will improve the systemic manifestations and complications associated with psoriasis.27. It calculates a score between 0 and 72 on the basis of the erythema (redness), induration (thickness) and desquamation (scaling) on the various locations of the body. J Am Acad Dermatol 2017;77(2):287–92.e4. doi: 10.1016/j.det.2014.09.010. “So we’d like to see this kind of rivalry put aside so we can all be making the best possible contribution to our health system.”. Int J Dermatol 2016;55(2):e72–78. The prevalence of psoriasis in patients with IBD can be up to 10%.10 IBD occurs in 0.4% of the general population, compared with 1.6% of patients with psoriasis.10 The risk of developing psoriasis in patients with Crohn’s disease has been reported to be five times greater than the risk for controls.11 Crohn’s disease and psoriasis have similar peak ages of onset, findings of intestinal permeability, immunopathogenesis and responses to therapies. The association between psoriasis and hypertension: A systematic review and meta-analysis of observational studies. Ann Rheum Dis 2005;64(Suppl 2):ii14–17. Treating a patient with psoriasis should encompass education about lifestyle changes and evaluating their risk of other comorbidities. 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