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Summary of guidance relevant to general practice in October 2012

Psoriasis

GPs should make sure they check the impact psoriasis has on the daily lives of their patients, according to latest guidance from NICE.

NICE's first recommendations on psoriasis say the condition can impact on a person's psychological and social wellbeing. The condition can also have an effect on a person's employment and income.

The recommendations also say people with psoriasis, and particularly those with severe forms of the disease, may additionally be at risk of comorbid conditions such as cardiovascular disease, and diabetes.

GPs and other healthcare professionals should carry out an assessment of the disease before referring for specialist care.

This assessment should cover the severity of disease, assess the impact that psoriasis has on the physical, psychological and social wellbeing of their patients, and should cover the presence of comorbidities.

The guideline also contains recommendations on psoriatic arthritis, a progressive condition that affects one in seven people with arthritis.

GPs and other healthcare professionals should assess whether a person has psoriatic arthritis at first presentation.

Annual assessments for psoriatic arthritis should be offered to people with any type of psoriasis. Assessment is especially important within the first 10 years of onset of psoriasis.

As soon as psoriatic arthritis is suspected, the person should be referred to a rheumatologist for assessment and advice about planning their care.

A range of implementation tools have been produced to help support the use of this guideline.

NICE has produced a range of implementation tools to help support the use of this guideline, including a baseline assessment tool and a clinical audit tools.

New guidance from NICE provides GPs with advice on the use of glucocorticosteroids for the remission and management of people with Crohn's disease.

Typical management options for the condition include drug therapy, smoking cessation, attention to nutrition and surgery in cases of severe or chronic active disease.

In new guidelines on the management of Crohn's disease in adults, children and young people, NICE provides recommendations on a number of new drugs that have been licensed for the condition over the past decade.

These include conventional glucocorticosteroids such as prednisolone, methylprednisolone or intravenous hydrocortisone.

NICE says monotherapy should be offered with a conventional glucocorticosteroid to induce remission in people with a first presentation or a single inflammatory exacerbation of Crohn's disease in a 12-month period.

GPs should consider adding azathioprine or mercaptopurine to a conventional glucocorticosteroid or budesonide to induce remission of Crohn's disease in two cases.

This is either when there are two or more inflammatory exacerbations in a 12-month period, or the glucocorticosteroid dose cannot be tapered.

NICE says that GPs should discuss with people with Crohn's disease, and/or their carer if appropriate, the options for managing disease when in remission include treatment and no treatment.

Such discussions should cover the risk of inflammatory exacerbations (with and without drug treatment) and the potential side effects of drug treatment. The person's views should be recorded.

The guideline also recommends that GPs and other healthcare professionals should provide appropriate additional information on the effects the condition has on a person's lifestyle.

Information should be given on the possible delay of growth and puberty in children, diet and nutrition, fertility and sexual relationships, prognosis, side effects of their treatment, cancer risk, surgery, care of young people in transition between paediatric and adult services, and contact details for support groups.

A range of implementation tools have been produced to help support the use of this guideline.

NICE has produced a baseline assessment tool and a costing statement to help put this guidance into action.

24 October 2012

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Selected, reliable information for health and social care in one place

Accessibility | Cymraeg | Freedom of information | Vision Impaired | Contact Us | Glossary | Data protection | Copyright | Disclaimer | Terms and conditions

Copyright 2014 National Institute for Health and Care Excellence. All rights reserved.