P103 Analysis of cumulative life course impairment in tertiary psoriasis care: insights from the initial delivery of the DermCLCI-r questionnaire in an English cohort

Abstract Chronic diseases such as psoriasis place an ongoing and aggregate burden on patients throughout their life, leading to a negative life-changing impact on decisions and opportunities in patients’ lives. This phenomenon is known as Cumulative Life Course Impairment (CLCI), yet no tools which measure CLCI in a standardized way in patients exist. The DermCLCI-r questionnaire is a novel 25-item questionnaire assessing the impact of psoriasis over the whole course of a patients’ disease journey. This questionnaire is undergoing simultaneous validation in German and English language between centres in Germany and England in a 1-year longitudinal study against existing quality of life tools. This study explores CLCI measured in psoriasis patients from a large tertiary psoriasis clinic in England at the initial assessment with the DermCLCI-r questionnaire and correlates it with clinical and quality of life data. The English data (n = 98) showed 60.2% male; mean age, 51.37 years; mean, 27.98 years since psoriasis diagnosis; mean age of diagnosis, 23.0; mean psoriasis area and severity index (PASI), 3.3; 94% on systemic therapy; 44% PASI > 2; mean DLQI 5.1. 55.1% of patients reported experiencing at least one life-changing experience due to their disease, with a mean number of 4.35 life-changing experiences per patient. The most common life-changing experiences were ‘feeling stressed by the disease’ (31.6%), ‘nervousness, anxiety or tenseness’ (27.6%), ‘impairments regarding choice of clothing’ (26.5%), ‘effort with the treatment of the disease’ (26.5%) and ‘limitations in physical performance’ (25.5%). Ongoing cumulative life stress was experienced by 65.3% of patients, with a mean of 5.53 separate items contributing to their current disease burden. Relevant items in the DermCLCIr tool correlated significantly with total DLQI score, e.g. ‘impairments in quality of life’ (0.568), ‘feeling stressed by the disease’ (0.519), and ‘limitations in physical performance’ (0.492), P < 0.001 respectively. CLCI significantly impacts the majority of patients in tertiary psoriasis care and has contributed to multiple ongoing and life-changing experiences in this patient group; the DermCLCI-r questionnaire is able to identify these. The ability to detect CLCI could allow earlier conservative or therapeutic management of life-changing elements of the psoriasis disease experience, and could potentially reduce the negative personal and social impact of psoriasis. Completion of the longitudinal validation study will further assess the accuracy of the DermCLCI-r questionnaire in aiding clinical decision-making on the holistic management of psoriasis patients.