Back Back
Cholestatic Pruritus

CME

The Impact of Cholestatic Pruritus in PBC

Physicians: Maximum of 0.75 AMA PRA Category 1 Credit™

Released: June 18, 2024

Expiration: June 17, 2025

Christopher L. Bowlus
Christopher L. Bowlus, MD
CME/CE Information

Activity

Progress
1 2
Course Completed

Pruritus Evaluation: Guideline Recommendations3,4

The importance of PBC-related pruritus is illustrated by the attention that is given to this symptom by both the American Association for the Study of Liver Diseases guidelines and the European Association for the Study of the Liver guidelines. Both specifically address pruritus as an important feature of PBC and note that it deserves a separate evaluation and treatment plan.

Download

Your colleague has a patient with newly diagnosed PBC and moderate cholestatic pruritus and asks you how to approach treatment. How do you respond?

United Kingdom PBC Care Delivery Audit

Unfortunately, we do not always do a good job evaluating pruritus in our patients with PBC. In this audit of care of patients with PBC in the United Kingdom, more than one third of patients had not been assessed for pruritus in the previous 2 years.15,16 This gap in care aligns with a PBC Foundation survey of people with PBC, where 40% of patients had not been assessed for pruritus in the previous year.17

Download

Pruritus Assessment Tools: VAS and NRS18-20

To address this gap in care, we should take the step of asking our patients about the severity of their pruritus, and we should do this at every visit.

In the clinic setting, simply asking a patient if they are experiencing pruritus—and how they would rate it on a scale of mild, moderate, or severe and understanding how it is affecting their life—is probably sufficient to understand the treatment needed.

In the clinical trial setting, however, study investigators aim to measure pruritus in a more objective way, and this is done using various measurements.

The more commonly used tools are the Visual Analogue Scale, which involves simply having a patient mark on a scale from 0 to 10—where 0 is no itching and 10 is the worst possible itching—how their itching feels.

Similarly, the Numerical Rating Scale requires the patient to report their worst itch during the past 24 hours on a similar scale of 0 (no itching) to 10 (worst itch imaginable).

Although this level of detail is not required in clinical practice, having this information on a patient intake form could be an easy way to ensure that you are asking about their pruritus at every visit.

Download

Rate your agreement: In my practice, I now plan to ask my patients with PBC about the severity of their PBC-related pruritus at every visit.

Pruritus Assessment Tools: 5-D Itch Scale and PBC-40

More detailed measurements of itch include the 5-D itch scale14,21 and the PBC-40.14 The 5-D itch scale captures the duration, the degree (severity), the direction (whether it is getting better or worse), the disability associated with the itch, and the distribution of itch on the body. The PBC-40 is a validated quality-of-life measure that includes an itch domain.

The 5-D itch scale and the PBC-40 itch domain give a more comprehensive view of the impact of itch on the patient as opposed to the Visual Analogue Scale or Numerical Rating Scale, which is more unidimensional.

Download
BACK | NEXT