Psoriasis a challenge for young GPs

Australian GP registrars see relatively few psoriasis patients during their vocational training but seek assistance to manage patients appropriately.

A cross-sectional analysis of data from the Registrar Clinical Encounters in Training (ReCEnT) study found psoriasis represented just 0.15% of clinical problems managed during 241,888 consultations.

Registrars used electronic sources (64%), their supervisor (33%), hard copy sources (6%) and specialists (4%) to inform their management.

The study found 79% of psoriasis was managed with prescribed medications particularly betamethasone, mometasone, calcipotriol and combinations.

“This (together with the strong association of psoriasis problems/diagnoses with in-consultation assistance-seeking) suggests that, despite their lack of experience in this area, consultation with information sources and the GP registrars’ supervisor may facilitate appropriate treatment,” the study said.

Follow-up appointments were organised in 36% of cases suggesting continuity of care may be an issue.

Referrals to a dermatologist occurred in 13% of cases – more often in those patients with previously diagnosed psoriasis rather than a new diagnosis.

Dermatology Practical & Conceptual

Zoster risk for JAK inhibitor patients

Shingles vaccination should be considered for older patients taking JAK inhibitor therapy, according to German researchers who showed it is associated with an almost four-fold higher risk of herpes zoster compared to conventional synthetic DMARDs.

Investigators reviewed the risk of herpes zoster in almost 14,000 patients with RA receiving DMARD treatment between 2007 and 2020. After adjusting for factors such as age and glucocorticoid therapy (>10mg), their analysis showed that the risk of herpes zoster was significantly increased with targeted synthetic DMARDs (Hazard Ratio 3.66), monoclonal anti-TNF antibodies (HR 1.63) and rituximab (HR 1.57) compared with csDMARDs.

Based on 559 cases of herpes zoster that developed in 533 patients the exposure-adjusted event rates (EAER) per 1000 patient years were 21.5 for JAK inhibitors such as tofacitinib, baricitinib and upadacitinib; 10.3 for B cell targeted therapy (rituximab) and 9.3 for monoclonal anti-TNF antibodies (adalimumab, certolizumab, golimumab and infliximab).

The EAER for IL-6 inhibitors (tocilizumab, sarilumab) was 8.8, while the rates for soluble TNF receptor fusion protein (etanercept) and T cell costimulation modulator (abatacept) were 8.6 and 8.1 respectively. The reference group, csDMARDs had herpes zoster rates of 7.1.

The findings are published in Annals of Rheumatic Diseases.

Physicians not active social media

While most physicians (70%) have some kind of social media presence the vast majority are not active, a study of 650 randomly selected doctors at the top 10 US hospitals has found.

Physicians were most likely to have a social media profile on LinkedIn (45%), followed by Facebook (23%) and Twitter 19%) and 7% had a blog or personal webpage.

However, almost 90% had no engagement on social media in recent months in terms of posts or interactions with other users, the survey found.

Physicians had a median of 99 followers on Twitter, 301 on Facebook and 161 followers on LinkedIn. Female physicians were more likely than males to have a social media presence, according to the findings published in JAMA Network Open..

The survey also showed that surgeons had higher number of followers than physicians and were also three times more likely to be active on social media.