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21-07-2011 | Article

Dermatomyositis has a major impact on patients’ quality of life

Abstract

Free abstract

MedWire News: The quality of life (QoL) of patients with dermatomyositis (DM) should be a major concern for doctors, say researchers, who found that such patients had poorer quality of life scores than those with other skins diseases.

Vitality score, which represents energy levels, and mental health scores were particularly badly affected in DM patients.

"It is important to realize that patients with DM may be an underserved population in terms of being evaluated by clinicians for psychological well-being,' say study co-author Victoria Werth (University of Pennsylvania School of Medicine, Philadelphia, USA) and colleagues.

Dermatomyositis belongs to a group of diseases called idiopathic inflammatory myopathies. Recently, a clinical tool called the Cutaneous Dermatomyositis Area and Severity Index (CDASI) was introduced as a useful means to measure skin symptoms in DM in a numerical fashion.

"Now that new skin evaluation instruments and comparable data between DM and other diseases are available, studies on QoL in DM can be introduced into the literature," say Werth and colleagues.

This could help "demonstrate the need for more effective therapies that may include the use of off-label medications when standard less expensive options are ineffective," they add.

The researchers therefore invited all patients with clinical or pathologic evidence of DM seen at the Hospital of the University of Pennsylvania and Stanford University Dermatology Clinics to participate in a study examining QoL.

The DM patients' QoL was also compared with QoL in other dermatologic and nondermatologic diseases because, say the researchers, it "is important to evaluate more completely [DM's] impact on QoL."

In the DM patients, QoL score was significantly correlated with CDASI scores, thereby providing confirmation that increased cutaneous severity has a direct impact on QoL.

Looking at other skin conditions, DM patients had some of the worse QoL subscores, including function, symptoms, and emotional subscores. Of particular note, the emotional subscore in DM patients was significantly higher than in patients with epidermolysis bullosa, pemphigus, cutaneous T-cell lymphoma, rosacea, actinic keratoses, vitiligo - but roughly equal to those with vulvodynia.

Similarly, when looking at patients with other diseases, DM patients also showed some of the worst QoL subscores. In the social/emotional realm, DM patients had significantly worse scores than those with congestive heart failure, recent heart attacks, Type 2 diabetes mellitus, or hypertension, although a significantly better score than those with clinical depression.

Discussing the findings, Werth and colleagues speculate that poor emotional health in DM patients might actually make symptoms worse through the production of stress chemicals called proinflammatory cytokines, which also could affect the skin.

The research is published in the Journal of the American Academy of Dermatology.

MedWire (www.medwire-news.md) is an independent clinical news service provided by Springer Healthcare Limited. © Springer Healthcare Ltd; 2011

By Andrew Czyzewski