Page 72 - JCTR-11-4

Journal of Clinical and
Translational Research Adherence and psoriasis severity in Brazil

December 9, 2022, with participants receiving treatment medication?; (3) When you feel better, do you sometimes
at the Santa Casa de Curitiba Hospital (Dermatology stop taking your medication?; (4) If you feel worse while
Department), the Dermatology Service of Mackenzie taking the medication, do you sometimes stop taking it?
Evangelical University Hospital, and the Specialty Adherence was classified as follows: High adherence
Outpatient Clinic of the State University of Londrina for no positive responses, moderate adherence for 1 or 2
University Hospital (AEHU).
positive responses, and low adherence for 3 or 4 positive
The study included 133 participants, recruited randomly responses.
and indirectly through posters advertising the research, in The questionnaire also inquired whether the patient
accordance with ethical guidelines. The inclusion criteria had interrupted or discontinued treatment. If so, the
for the study required patients with psoriasis at any level of patient was further questioned about the reasons for the
activity, diagnosed either clinically or confirmed through interruption or discontinuation.
pathological laboratory reports. Individuals under 18 years
of age and those of indigenous descent were excluded from The dermatology life quality index (DLQI) was used to
the study. Data were collected by dermatology residents assess the impact of psoriasis on patient quality of life. The
through interviews after routine consultations, using a DLQI consists of 10 questions, with total scores ranging
pre-tested and validated form, at the participating study from 0 to 30. Based on the sum of the points, the impact
18
centers. on quality of life was categorized as follows: 0 – 1 for no
impact, 2 – 5 for a small impact, 6 – 10 for a moderate
The project was approved by the Human Research
Ethics Committee of the Health Sciences Sector at the impact, 11 – 20 for a very large impact, and 21 – 30 for an
extremely large impact.
20
Federal University of Paraná (SCS/UFPR) under approval
number 4.294.864, issued in 2021. Initially, a descriptive statistical analysis was performed.
This was followed by the Shapiro-Wilk and Shapiro-Francia
Authorization for data collection at the participating tests to assess the distribution of the dependent variable
centers—Santa Casa de Curitiba Hospital, Mackenzie (psoriasis severity). Spearman’s correlation analysis was
Evangelical University Hospital, and the University then conducted to evaluate the correlations between
Hospital of the State University of Londrina—was granted variables, presented as rs values.
2
following a preliminary project review assessing both
methodological and ethical aspects. Approval was obtained 3. Results
from the respective hospital superintendents and ethics
committees. Table 1 presents the sociodemographic profile of
the participants. The mean age of participants was
To assess participant profiles, sociodemographic 55.09 ± 12.54 years, ranging from 25 to 83 years. Table 2
information was collected, including sex, age, race or shows the psoriasis classification results. Based on the
ethnicity, current marital status, education level, and PASI assessment, 65.41% (87/133) of participants had mild
household income. psoriasis, 24.06% (32/133) had moderate psoriasis, and
Psoriasis severity was assessed through both clinical 10.53% (14/133) had severe psoriasis. The average self-
evaluation and patient self-assessment using a 0 – 10 scale. assessed psoriasis severity on a 0 – 10 scale was 4.06 ± 3.09.
Clinically, severity was measured using the PASI, which Notably, 62.41% (83/133) of participants had never
considers three criteria: Erythema, infiltration, and scaling. experienced an asymptomatic period, while only 37.59%
Each criterion is rated on a 0 – 4 intensity scale across (50/133) reported periods without lesions.
four body regions: Head, upper limbs, trunk, and lower Most patients were using topical treatment with
limbs. In addition to these criteria, the total affected area is corticosteroids (60.90%), while 30.82% used calcipotriol
graded on a 0 – 6 scale. The final PASI score is calculated by (Table A1). Among systemic medications, methotrexate
summing the intensity ratings for erythema, infiltration, (21.05%) and acitretin (10.52%) were the most commonly
and scaling, multiplied by the area grade for each body used (Table A2), while 17.29% of participants were
region. The score ranges from 0 to 72, with higher scores treated with secukinumab, and 16.54% with adalimumab
indicating more severe psoriasis. 15 (Table A3). Table 3 presents the results related to treatment
Treatment adherence was assessed using the adherence among participants. The majority, 75.94%
Morisky-Green questionnaire, which includes the (101/133), reported never interrupting their psoriasis
19
following questions to evaluate adherence: (1) Do you treatment, while 23.31% (31/133) had started and later
sometimes have trouble remembering to take your discontinued treatment. One participant could not recall
medication?; (2) Do you sometimes neglect to take your whether they had ever discontinued treatment. The main

Volume 11 Issue 4 (2025) 66 doi: 10.36922/jctr.24.00057