6/17/2018. Comorbidities in Hidradenitis: Fact or Fiction. What is the best estimate of the rate of arthropathy for people with HS?
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1 Comorbidities in Hidradenitis: Fact or Fiction Joslyn S. Kirby, MD, MS, MEd Department of Dermatology Penn State Milton S. Hershey Medical Center, Hershey PA Conflicts & Financial Disclosures for HS: AbbVie: Speaker Incyte: Consultant HS can contribute to presenteeism and absenteeism. What is the average number of missed days of work? % 16% 36% 56% What is the best estimate of the rate of arthropathy for people with HS? 1
2 The PHQ-2 is a quick way to screen for: Arthropathy Anxiety Depression Hidradenitis HS is not visible in most settings so it doesn t impact relationships with friends or family. True False 2
3 PAIN DRAINAGE ODOR FATIGUE ITCH Health /03/27/rupi-kaur-periodinstagram_n_ html The Whole of HS, The Whole Person Emotional & Spiritual Social Academic, Professional Health & Wellness Academic & Professional Presenteeism: Difficulty concentrating, focusing Absenteeism: 58% have work absence 34 days absent/year Job loss: 10% lost a job Missed Promotion: 23% didn t get a promotion Dufour DN, et al. Postgrad Med J. 2014;90(1062):216. Matusiak L et al. JAAD 2010;62(4):
4 Health & Wellness HS Complications: Anemia Lymphedema Amyloidosis Dauden E, et al. JEADV. 2018;32(1):129. Health & Wellness Constitutional: Fatigue (40%) Cardiovascular: Diabetes (5-30%), Obesity (11-88%) Rheumatologic: Arthropathy (25-50%) Gastrointestinal: Inflammatory bowel disease (1-3%) Psychological: Depression (10-40%) Anxiety (10%, borderline anxiety 20%) Alcohol & tobacco use (40-60%) Dauden E, et al. JEADV. 2018;32(1):129. What You Can Do: ROS Testing Diabetes P/FHx, Polydipsia, Polyuria Fasting Plasma glucose HbA1c Health & Wellness Obesity Height, Weight (BMI >30) IBD Arthropathy Depression Diarrhea (>4w), Urgency, Cramping/pain, Blood (stools or rectum) PHx, Morning stiffness (improves w/ activity), Pain (spinal, periph.) Patient Health Questionnaire-2 (PHQ-2) Dauden E, et al. JEADV. 2018;32(1):129. 4
5 PHQ PHQ-9 Risk Factors Emotional & Spiritual Chronic medical illness Chronic minor daily stress Chronic pain syndrome Family history of depression Female sex Low income/job loss Low self-esteem Low social support Prior depression Single/divorced/widowed Traumatic brain injury Younger age 5
6 Emotional & Spiritual Risk Factors Chronic medical illness Chronic minor daily stress Chronic pain syndrome Family history of depression Female sex Low income/job loss Low self-esteem Low social support Prior depression Single/divorced/widowed Traumatic brain injury Younger age Nonspecific Symptoms of Depression Abdominal pain Back pain Change in weight or appetite Constipation Fatigue Headache Insomnia or hypersomnia Joint pain Neck pain Weakness Social & Emotional Stigma. 6
7 #GetYourSkinOut Social & Emotional But it s hidden: No difference for visible or hidden scars in emotional effects, self-esteem Limited relationships: Perceived & real stigmatization leads to Avoidance, Isolation, & Loneliness Sexual dysfunction: Common in men and women, worsens QOL Lawrence J, et al. J Burn Care Rehab. 2004;25(1):25. Janse IC, et al. BJD. 2017;176(4):1042. Higher resilience is associated with better quality of life, even after controlling for HS severity Kirby JS, et al. JAMA Derm. 2017;153(12):
8 HS can contribute to presenteeism and absenteeism. What is the average number of missed days of work? % 16% 36% 56% What is the best estimate of the rate of arthropathy for people with HS? The PHQ-2 is a quick way to screen for: Arthropathy Anxiety Depression Hidradenitis 8
9 HS is not visible in most settings so it doesn t impact relationships with friends or family. True False Depression Stress Normalize What You Can Do: Patient Health Questionnaire-2 (PHQ-2) Refer to Mental Health Support (CBT, medication) Exercise (as HS allows) Write-out a plan for treating HS Dauden E, et al. JEADV. 2018;32(1): Emotional, Social Feeling frustrated, anxious or depressed is not a sign that you are not coping or are not a strong person. Many people feel this way when they are managing a condition day after day. Naming 1. What emotion are you feeling? 2. What triggered it? Be specific. 3. How did you successfully deal with it before? Managing your Mind Managing your Mind Mindful Breathing Write it all down. Thought Challenging: 1. What was the negative thought? Write it all 2. Why do you think this is true? down. 3. Why could it be untrue? Or, is there another way to look at it? The Whole of HS, The Whole Person Academic, Professional Presenteeism, Absenteeism, Job loss Health, Wellness CV, Rheum, GI ROS, Measures/Labs Emotional, Spiritual, Social Referral, CBT, Naming, Exercise, Mindful Breathing, Thought Challenging 9
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