膿疱性乾癬（汎発型）

BACKGROUND: Generalized Pustular Psoriasis (GPP) constitutes a rare yet severe variant of psoriasis, characterised by extensive pustule formation on the skin and imposes a significant economic burden. The study aimed to investigate the indirect costs associated with GPP in Malaysia, encompassing patients' work productivity losses and out-of-pocket expenses. METHODS: This primary, multicentre, cross-sectional cost analysis study was conducted among patients diagnosed with GPP attending public hospitals under the Ministry of Health (MOH) in Malaysia. The indirect costs were assessed using the Work Productivity and Activity Impairment (WPAI) tool and standardised data collection form. Data were statistically analysed using descriptive and inferential statistics using IBM SPSS version 28.0. RESULTS: A total of 54 patients with GPP were enrolled in the study, with about one-fourth experiencing flares at the time of the interview. The total annual indirect cost associated with GPP was estimated at MYR 676,081 (MYR 12,520 per patient). The indirect costs of GPP were driven largely by work productivity loss. Both work and activity impairment were significantly higher during GPP flare periods compared to non-flare periods. Additionally, the annual work impairment cost per patient was substantially higher during GPP flare periods, indicating a marked increase in economic burden compared with the non-flare group. CONCLUSION: The study demonstrates a substantial indirect economic burden of GPP, driven primarily by work productivity loss, particularly during acute flares. These findings highlight the broader socioeconomic impact of GPP beyond direct costs. Strategies to enhance patients' presenteeism, reduce absenteeism, and prevent unemployment are likely to have the greatest impact on reducing societal costs.

Psoriasis is a chronic immune-mediated inflammatory disease that affects both the skin and musculoskeletal system. Recent evidence suggests an elevated risk of low bone mineral density (BMD) in patients with psoriasis. However, BMD assessment is rarely performed in routine clinical practice due to limited access to dual-energy X-ray absorptiometry (DXA). To evaluate BMD in patients with psoriasis using an artificial intelligence (AI)-based tool applied to routine chest radiographs, and to investigate associations with disease duration, disease severity (measured by Psoriasis Area and Severity Index [PASI]), and disease subtype. We retrospectively analysed 132 Japanese patients with psoriasis who underwent chest radiographs prior to initiating biologic therapy between 2010 and 2023. BMD was estimated using an original AI model for predicting BMD on chest radiographs. Patients were categorized as having normal BMD, osteopenia, or osteoporosis based on T-scores. Clinical associations were assessed using statistical methods, including ROC curve analysis to determine cut-off values for disease duration and PASI scores. A higher prevalence of AI-estimated osteoporosis was observed among middle-aged male patients compared to the general population. Longer disease duration (≥seven years, as determined by ROC analysis) was significantly associated with lower AI-estimated BMD (p=0.0032). Although patients with PASI scores ≥10.4 and those with the pustular subtype exhibited trends toward lower BMD, these differences did not reach statistical significance. Our findings indicate a substantial reduction in BMD among male psoriasis patients in their 40s and 50s.