Arthritis possibly induced and exacerbated by a tumour necrosis factor antagonist in a patient with psoriasis vulgaris

ences and to explain the reasons for their choice. Psoriasis Area Severity Index (PASI) and Dermatology Life Quality Index (DLQI) were completed for all patients. Of the whole group, 54/99 (55%) expressed a preference for bath PUVA. Among female patients, 31/51 (61%) preferred bath PUVA. Among male patients, 23/48 (48%) preferred bath PUVA. Thus, 61% of women, 13% more [95% confidence limits 7%, 32%] than the 48% of men, favoured bath PUVA, P = 0 10). The mean DLQI for male patients who preferred bath PUVA was 6 8 vs. 10 for those who preferred systemic PUVA and this difference was statistically significant (P = 0 047). For female patients, DLQI score was the same for both modes of PUVA. Additionally, PASI score did not influence patients’ preferences in either sex. Stated reasons for female patients’ preferences for bath PUVA were as follows: 55% did not like taking tablets; 19% did not like the prospect of possible side-effects of systemic therapy; 13% considered bath PUVA to be more convenient; 6% did not like wearing protective glasses with systemic PUVA; only 3% preferred bath PUVA due to the lower frequency of treatment (once every 5 days in our unit, compared with twice weekly for systemic PUVA). Stated reasons for male patients were as follows: 48% did not like taking tablets; 22% considered bath PUVA more convenient; 17% preferred the idea of bath PUVA due to absence of side-effects from systemic medication; 9% stated that they disliked wearing sunglasses after treatment; 4% preferred bath PUVA due to their previous good experience with this modality. In the group of female patients who preferred systemic PUVA, 50% stated that they preferred the shorter course duration compared with bath PUVA (e.g. treatment given twice weekly takes 8–12 weeks, whereas treatment given every 5 days takes 12–16 weeks); 35% considered systemic PUVA as more convenient as it avoids the need for a bath; 5% preferred systemic due to their previous experience. In the group of male patients who preferred systemic PUVA, 60% considered it more convenient; 20% selected this modality due to the shorter course duration; 12% believed that systemic PUVA was more effective (despite the fact that they had been informed that there was no evidence to support this view); 4% preferred systemic PUVA due to their previous experience. We assessed the influence of previous experience on patient’s preferences. Seventeen of the 99 patients had previously received PUVA (12 bath, 4 systemic and 1 both): 9/12 (75%) who had previously received bath PUVA preferred bath PUVA; 4/4(100%) who had previously received systemic PUVA preferred the same treatment. The one patient who had both modes of PUVA preferred bath PUVA. There was no influence of comorbidities on patient preferences. The results of this questionnaire demonstrate several findings. Firstly, female patients with psoriasis preferred bath PUVA to systemic PUVA while there was no preference either way amongst male patients. Secondly, higher DLQI scores in male patients may influence their preference toward systemic PUVA. Thirdly, previous experience with PUVA may influence patient preferences and this issue could be explored in subsequent studies. Finally, there is no influence of PASI score or comorbidities on patient preference for mode of PUVA in either sex. We recommend the inclusion of patients in the decision-making process when prescribing PUVA, for units that offer both bath and systemic PUVA.