Quality of Life and Psychosocial Factors Associated With Severe Psoriasis Following Treatment With Adalimumab (Body Image)

Psoriasis affects around 1.5% of the UK population with 20- 30% of these patients having severe psoriasis managed by National Health Service's secondary and tertiary care centres. Secondary care initiated therapies include light therapy, systemic agents such as ciclosporin and methotrexate and ultimately if no response is seen with these agents a biologic therapy may be initiated. Aside from the management of dermatological symptoms of the disease, the disorder is also associated with significant emotional and social dysfunction. It has been shown that patients with psoriasis have a greater prevalence of depressive symptoms, mood disturbances, anxiety and even suicidal tendencies. The aim of this study is to assess the impact that treatment of psoriasis with adalimumab (a biologic agent) has on quality of life, body image and psychosocial factors. The main outcome measure will be the proportion of 'responders' (having a 5 or more point drop in their score on the Dermatology Life Quality Index DLQI) after 16 weeks of adalimumab treatment.

The study will involve collecting some information from clinical records and administering a series of patient reported questionnaires on 4 occasions (once just before and 3 times after initiation of adalimumab). The decision to prescribe adalimumab will be outside the study and will be made by the consultant according to his / her own clinical judgment, together with the patient. Any consenting adult patient being initiated on adalimumab as their first biologic for psoriasis will be eligible to participate in the study. There will be no change to the patient's management for the study. The patient will be asked to complete the questionnaires at the time of initiation of therapy and then after approximately 4 weeks, 16 weeks and 6 months of treatment as and when the patient attends the clinic for routine appointments.