Evaluating Sentiment, Engagement, and Perception of Biologics Among Patients with Psoriasis and Psoriatic Arthritis on Reddit

for potential patients to refer to the platform for insight into experiences with biologic treatment. We found that a majority of patients felt positive about the efficacy of biologics as an anti-psoriatic medication, with the most frequent theme being that biologics work well for the management of psoriasis signs and symptoms. Other users reported that they were hoping to get on a biologic and/or hopeful that they would improve symptoms. Some responses praised the speed at which they saw their skin and joint pain improve. Positive sentiment can be attributed in part to efficacy but also convenience, ease of dosing, and manageable side effects.

Some users had discussed biologics with their dermatologist and were looking for more advice or anecdotal experiences with the medication. If patients express hesitation when counseled on biologics, their dermatologists may find that referring them to other patient anecdotes may help them feel more comfortable with starting these medications. Additionally, the volume of users seeking anecdotal advice or experiences may indicate that general counseling might not be sufficient for some patients.

While the mean sentiment score was overall positive, there were still a notable number of posts expressing dissatisfaction with biologics. This included claims that they did not work, stopped working, or simply masked the problem. Some users expressed dissatisfaction with having to switch biologics multiple times, although others tried to instill hope by ensuring that there are multiple options available should one need them. Some posts expressed frustration with delayed time to efficacy, and others complained of stubborn areas, such as the scalp or palms and soles. Because residual psoriasis while on a biologic is not uncommon, patient expectations should be managed appropriately so they understand that complete clearance might not be immediately achievable. Providers can reassure them, however, that a trial of multiple biologics, or adding a topical medication, may help target any stubborn areas.⁹

Previous research has shown that online support groups for psoriasis patients can improve patient empowerment and provide valuable support and advice.¹⁰ By accessing these forums, patients can share advice, provide hope, and connect with others who are experiencing similar struggles. As such, patients should not be discouraged from seeking health information on Reddit in particular. However, while subreddit forums for psoriasis and psoriatic arthritis can provide ample benefits, they also carry risks. For instance, they are not moderated nor fact-checked, and as a result, users may interact with misinformation or opinions stated as fact.¹¹

A limitation of this study is that the population of Reddit users may not be representative of the greater psoriasis and psoriatic arthritis patient population. Additionally, the accuracy of the information conveyed on these platforms may be variable. 

For physicians, it is important to recognize the benefits of social media for patients while also educating them on the potential downsides. This study aims to better understand the content of discussions on Reddit so that providers can anticipate common concerns regarding biologics and their efficacy. Physicians should understand what information individuals are seeking on these forums, but they should also caution that some of the provided information may be based on the individual experience and does not necessarily apply to all patients with psoriatic disease. In addition to more in-depth counseling during patient visits, providers can encourage patients to seek additional information from reputable sources such as the National Psoriasis Foundation. Providers must remain aware of content on these online forums to anticipate common patient concerns and understand how patients use social media for dermatologic advice. 

AWA has served as a research investigator and/or scientific advisor to AbbVie, Almirall, Arcutis, ASLAN, BI, BMS, EPI, Incyte, Leo, UCB, Janssen, Lilly, Nimbus, Novartis, Ortho Dermatologics, Sun, Dermavant, Dermira, Sanofi, Regeneron, Pfizer, and Modmed.

All other authors have no conflict of interest to report.