Dr. Ivan Bogdanov: Psoriasis patients live worse than diabetics

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Dr. Ivan Bogdanov: Psoriasis patients live worse than diabetics
Dr. Ivan Bogdanov: Psoriasis patients live worse than diabetics

In 2013, he defended the educational and scientific degree "Doctor" in the scientific speci alty "Dermatology and venereology" on the topic: "Combined climatherapeutic method in the therapy of psoriasis". In the period 2009-2010, he specialized in "Saint Louis" University Hospital - Paris, France, and in 2014 in "London Clinic", London.

Why is the quality of life of psoriasis patients in Bulgaria worse than that of patients with many other serious diseases? Why is the Bulgarian patient with this disease the most discriminated against in terms of treatment with biological preparations?

Why are the criteria for starting this type of treatment so severe? When will the relevant institutions undertake concrete commitments on these serious cases? See the answer to these and other questions in the interview with Dr. Ivan Bogdanov.

Dr. Bogdanov, in one publication you state that psoriasis damages life more than cancer and heart attack. Is it really so and why?

- Yes, in many ways the quality of life of patients with psoriasis is just as impaired as with these diseases. And compared to other diseases, it is even worse. For example, the quality of life of patients with psoriasis is worse than that of diabetics.

The reason is that everything that psoriasis affects on the skin is exposed to a certain extent. In the sense that when psoriasis lesions are on exposed parts of the body or affect the genitals, or the face, or the scalp - in these cases, the patient's social contact suffers greatly.

Imagine how it feels to have a person who, for example, has a severe scalp or hand lesion that makes people afraid to shake hands with them or avoid close contact. When the genitals are affected, it accordingly affects the sex life of the patients extremely severely.

Psoriatic arthritis patients suffer no less when the disease affects the small joints of the fingers. The motor function of the hands is very seriously impaired, contractures and deformation of the fingers occur.

Which means that at some point, what makes us human - the ability to use our hands - is seriously impaired. In general, a patient with psoriasis, especially in the severe forms of the disease, can have many problems.

Maybe that is why the WHO recognizes this disease as extremely important and socially significant?

- Yes, it is one of the five diseases in the world that the World He alth Organization recognizes as extremely important to humanity. Our colleague from Germany, Prof. Sven M alte Jon, who works at the WHO, managed to convince colleagues that psoriasis is an extremely serious problem. At least because it affects a significant part of humanity - between 1.5 and 3.5%.

What other diseases can accompany psoriasis?

- Psoriasis is often accompanied by many different accompanying diseases such as hypertension, dyslipidemia, diabetes, obesity, gout, depression. Suicidal thoughts are much more common in these patients.


Why is the Bulgarian patient with psoriasis the most discriminated compared to the European? Doesn't he also get state of the art treatment?

- In truth, the Bulgarian patient receives state-of-the-art treatment. For several years, our patients have had access to this modern treatment, which we talk about at almost all of our meetings. It is about the so-called biological preparations. But this "but" is very important, because Bulgaria is the only country that has such severe criteria for starting biological treatment of psoriasis.

I don't know of any other European country, even among the former socialist republics, with such severe criteria. In our country, the criteria for starting such treatment are twice as serious as in most European countries.

This means that the Bulgarian patient must be in twice as serious a condition as a patient in France, for example, in order to receive biological treatment.

It is about time these conditions and criteria were corrected. We have taken several steps in this regard. We have discussed the problems at several meetings with the He alth Insurance Fund, and at most of the meetings we organize with the Psoriasis Foundation. This is a problem that affects a large number of our patients and we cannot remain silent.

And do the relevant institutions promise to adjust these criteria, do they show intention and any indications of change?

- Unfortunately, there is no indication, not even intention, of this happening. Even on the contrary. Additional restrictions appear for the prescription of this type of medication, such as the so-called cost effectiveness, which divided the preparations into groups, depending on what their price is.

And in reality, Bulgarian dermatologists who prescribe this type of medication do not have the right to use all medications when they have to start biological treatment. They should choose the ones that are cheaper, or at least the ones that the Treasury has judged to be cheaper.

But there is something else to consider in this regard: the decision about which detergent is cheaper in the long run is not determined only by how much it costs. It is also determined by how this medication affects the patient; whether he needs more or fewer hospitalizations; whether the drug has a good and positive effect on the other accompanying diseases; whether it reduces the need for treatment for these diseases. Does it reduce the patient's stay in hospital due to the other accompanying diseases.

And last but not least, of course - whether the respective medicine or medicines improve the quality of life of this patient, so that he can work actively, continue to make he alth contributions, etc. In addition, each such biological preparation has its own indications and contraindications.

If a patient has a certain type of accompanying diseases or a tendency to such, one or both of the preparations that are the first choice may not be so suitable. I.e. treatment should be started with another medication. But we don't have that option.

And how do you handle this situation?

- In general, our duty in our work with patients to actually choose the best possible therapy has been taken away from us and we have been given a rather limited arsenal of medications. And we would like to be able to work with all medications as doctors, so that we can assess which preparation would be most suitable for the respective patient.

I have to face institutions on other issues as well. For example, in addition to the cost of our clinical pathways, which are outrageous - they are twice the cost of what it actually costs just to stay in the hospital.

Here we are not talking about treatment, consultation, medication, research. Hospitals receive two times less funds for one patient on a clinical pathway than the cost of his bed day alone. On this occasion, in an effort to change something, I tried to at least find out which institution is responsible for changing these things.

I can say that this is an incredible mess, everyone is passing the responsibility of how to change these things from one institution to another. I personally have no idea who to turn to anymore. It's the same with biologicals.

Naturally, the state is not happy about the fact that it has to pay for such expensive medicines. But ultimately, its primary function is to care for its citizens. What we do for our patients. We should be on the same team.