Association Between Housing Instability and Severity of Psoriasis and Psoriatic Arthritis: A Cross-Sectional Study

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Jalal Maghfour
Frances Gill
Justin Olson
Andrea Murina


Underserved populations, housing instability, psoriasis, psoriatic arthritis, medical dermatology, patient-centered care


Introduction: Psoriasis and psoriatic arthritis are interrelated chronic inflammatory disorders that can be exacerbated by stress. The impact of housing instability on severity of psoriasis and psoriatic arthritis (PsA) has not been examined.

Methods: An eight-question survey was administered to 59 psoriasis participants, with and without PsA, to assess participants' housing status. The severity of psoriasis and PsA diseases was assessed using Body Surface Area (BSA) and clinical Disease Activity Index of Psoriatic Arthritis (cDAPSA) measurements respectively. A multivariate linear regression model was used to predict BSA and cDAPSA scores differences among participants.

Results: Housing unstable psoriasis participants had a higher average BSA than housing stable psoriasis participants (14% vs 7.1%). Using a regression equation model, housing status and smoking were significant predictors (p<0.04). Housing unstable PsA participants [13 (33%)] were also found to have a higher average cDAPSA than housing-stable psA participants [26 (66%)] (31 vs 16.7).  Housing instability was the only variable to predict differences in cDAPSA scores among PsA participants (p=0.021). Housing unstable participants had a higher BSA even on biologics (21.3% vs 1.65%; P < 0.001), oral therapy (14.6% vs 4 %; P<0.001) and phototherapy (10% vs 4%; P=0.031).

Discussion: This study demonstrated that housing instability might be associated with an increased severity of psoriasis and PsA. Housing instability, as a psychosocial stressor, could be an important element to consider in the management of psoriasis patients.


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