physician surveys suggest that available therapies may not be initiated because of long-term safety concerns, cost, need for injections and additional time requirements for therapies, and confirm the need for efficacious, less burdensome, cost-effective therapies with improved safety and tolerability profiles. As with any survey, MAPP was limited by factors such as accurate recall and interpretation of questions. Because the survey was blinded, physicians could not be re-contacted to clarify answers. The MAPP survey lacked a control group and was not designed to capture differences in use of or attitudes towards various agents within a class of drugs or the impact of healthcare system requirements on decision-making. The findings of the physician portion of the MAPP survey support the findings of the patient survey and highlight the importance of screening and assessing psoriasis patients for symptoms of PsA, aligning patient and physician severity assessments and treatment goals, and the ongoing need for safe and effective therapies for psoriasis and PsA. Additional research and education around these findings is warranted.The authors received editorial support in the preparation of this report from Jennifer Schwinn, RPh and Peloton Advantage, funded by Celgene Corporation. The authors, however, directed and are fully responsible for all content and editorial decisions for this manuscript. US Perspectives in the Management of Psoriasis and Psoriatic Arthritis: Patient and Physician Results from the PopulationBased Multinational Assessment of Psoriasis and Psoriatic Arthritis (MAPP) Survey Mark G. Lebwohl1 • Arthur Kavanaugh2 • April W. Armstrong3 • Abby S. Van Voorhees4 Published online: 30 December 2015 The Author(s) 2015. This article is published with open access at Springerlink.com Abstract Background The Multinational Assessment of Psoriasis and Psoriatic Arthritis (MAPP), a population-based survey of patients, dermatologists, and rheumatologists, was conducted for better understanding of the unmet needs of psoriasis and psoriatic arthritis (PsA) patients. Objective To report results from US physicians and patients. Methods Adults were contacted by household telephone, using random digit dialing, and asked to participate if they had ever been diagnosed with psoriasis or PsA. Physicians were identified through national databases and contacted through random sampling methods. Results In the USA, 1005 patients, 101 dermatologists, and 100 rheumatologists were surveyed. PsA had been diagnosed in 270 patients (26.9 %). Of those with psoriasis alone, fewer than 60 % (versus 85.6 % of PsA patients) had seen a healthcare provider within 12 months. Joint pain was reported by 51.8 % of psoriasis patients without a diagnosis of PsA, and 37.6 % of dermatologists cited their greatest challenge in managing PsA patients as being differentiating PsA from other arthritic diseases. Itching was reported by 36 % of psoriasis patients versus 12 % of dermatologists as the most important factor contributing to disease severity. Patients reported lower rates of current treatment than did dermatologists and rheumatologists. Conventional oral and biologic therapies were used by 24.9 and 17.7 % of patients, respectively. Among patients who had received injectable biologics, treatment dissatisfaction was related to long-term safety/tolerability, injection-related anxiety/fear, and cost. Conclusion This large, population-based survey identified unmet needs in the management of psoriasis and PsA patients in the USA, including assessment of disease severity, PsA diagnosis, undertreatment, and satisfaction with therapy. Key Points Both psoriasis and psoriatic arthritis remain undertreated in patients with moderate to severe disease. Unmet needs exist in screening, assessing, diagnosing, and treating psoriasis patients who have symptoms of psoriatic arthritis. Widespread dissatisfaction with current treatment options is reflected in patients not seeing a physician or not initiating or continuing therapies because of concerns with long-term safety, administration challenges, and cost. Our findings underscore differences in perceptions between patients and physicians regarding disease severity and its impact on treatment selection, and highlight the need for ongoing communication between patients and physicians for better understanding of perceptions of disease severity, as well as treatment options and goals. & Mark G. Lebwohl lebwohl@aol.com 1 The Icahn School of Medicine at Mount Sinai, Mount Sinai Medical Center, 5th Floor, 5 East 98th Street, Box 1048, New York, NY 10029, USA 2 School of Medicine, University of California, San Diego, La Jolla, CA, USA 3 Department of Dermatology, University of Southern California, Los Angeles, CA, USA 4 Department of