Bridging the Gaps in the Care of Psoriasis and Psoriatic Arthritis: the Role of Combined Clinics

Haberman, Rebecca H.; Pérez-Chada, Lourdes M.; Merola, Joseph F.; Scher, Jose U.; Ogdie, Alexis; Reddy, Soumya

doi:10.1007/s11926-018-0785-6

Cited by 27 publications

(38 citation statements)

References 71 publications

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“…Results of screening questionnaires administered by healthcare providers in nonrheumatology settings may allow for timely rheumatologist referral and lead to an earlier diagnosis of PsA. Integrated, multidisciplinary clinics involving dermatologists and rheumatologists may substantially increase PsA referral and detection [34]; such settings are available in the United States and in Europe-in Munich, an increase in PsA diagnoses was observed among patients with psoriasis under the primary care of dermatologists when given access to the rheumatology unit [7].…”

Section: Discussionmentioning

confidence: 99%

Patient perspectives on the pathway to psoriatic arthritis diagnosis: results from a web-based survey of patients in the United States

et al. 2020

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Background: There are limited real-world data on the diagnostic experiences of patients with psoriatic arthritis (PsA), including medical care sought and potential barriers to diagnosis. We aim to describe patient experiences related to receiving a PsA diagnosis. Methods: Ours was a mixed-method, 2-phase study. Phase 1 comprised concept elicitation and cognitive interviews with clinical experts and adults diagnosed with PsA to develop a cross sectional, web-based survey. US adults with a self-reported PsA diagnosis were recruited through a patient support community (CreakyJoints), an online patient research registry (ArthritisPower), and social media outreach. In Phase 2, the online survey collected data on sociodemographics, clinical symptoms, disease burden, and diagnosis history of survey respondents with PsA. Results: Of the 203 respondents included, 172 (84.7%) were female, and the mean (SD) age was 51.6 (10.8) years. The time between seeking medical attention and receiving a diagnosis was < 6 months for 69 respondents, 6 months to 4 years for 68 respondents, and ≥ 5 years for 66 respondents. Most respondents sought care from general practitioners (79.8%) and rheumatologists (66.5%). Common initial symptoms that led respondents to seek medical attention were joint pain (70.0%) and stiffness (53.7%). Among the initial symptoms that led respondents to seek care, joint pain, swollen joints, and sausage-like fingers or toes (indicating dactylitis) were more common among respondents with shorter time to diagnosis, whereas stiffness, fatigue, enthesitis (indicated by foot problems, tendon and ligament pain), and back pain were more common among respondents with longer time to diagnosis. Common misdiagnoses were psychosomatic issues (26.6%) and osteoarthritis (21.7%). Respondents with shorter times to diagnosis had lower frequencies of misdiagnosis. Conclusions: Respondents with PsA reported delays in diagnosis and misdiagnoses on their journey to a PsA diagnosis. Symptom differences, such as enthesitis and stiffness, were noted among respondents with shorter vs longer time to diagnosis. Increased understanding of diagnostic barriers may lead to earlier diagnosis and appropriate management to improve outcomes.

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Section: Discussionmentioning

confidence: 99%

Patient perspectives on the pathway to psoriatic arthritis diagnosis: results from a web-based survey of patients in the United States

et al. 2020

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“…The aim of our PPAC is to (a) improve patient's journey in the Greek medical system; (b) provide early diagnosis of PsA in Pso patients; (c) recognize signs of Pso in undiagnosed seronegative arthritis patients; and (d) improve management of these complex disorders in patients that require multidisciplinary approach. Our model shares common characteristics with other combined clinics worldwide, all demonstrating the benefits of these collaborations (Cobo‐Ibáñez et al, 2016; Haberman et al, 2018; Luchetti et al, 2018; Velez et al, 2012).…”

Section: Methodsmentioning

confidence: 69%

“…Seminal studies focusing on the management of chronic illness have demonstrated that patients with chronic conditions similar to Pso and PsA use a greater array of services than other patients (Hemmelgarn et al, 2007; Pawlik et al, 2008; Turk & Okifuji, 1998). In several academic medical centers of Europe and the United States, new clinical models of shared Pso and PsA management have recently been developed and implemented in the health care routine of patients, who suffer from both diseases (Cobo‐Ibáñez et al, 2016; Haberman et al, 2018; Luchetti et al, 2018; Velez, Wei‐Passanese, Husni, Mody, & Qureshi, 2012). Nowadays, there is significant evidence in the literature to support the manifold advantages of the joint dermatology–rheumatology clinics, including improved quality of care for patients and multidiscipline training for new physicians (Cobo‐Ibáñez et al, 2016; Luchetti et al, 2018).…”

Section: Introductionmentioning

confidence: 99%

How does the joint dermatology–rheumatology clinic benefit both patients and dermatologists?

Theodorakopoulou

Katsimbri

Boumpas

et al. 2020

Dermatologic Therapy

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Psoriasis (Pso) and psoriatic arthritis (PsA) are chronic and debilitating diseases which often develop in the same patient and are linked to a wide range of comorbid conditions. Dermatologists and rheumatologists need to cooperate in combined clinics, especially when they deal with severe, recalcitrant disease, and multiple comorbidities. The clinical and research benefits of this collaboration have been previously described to contribute to a better and more sustainable health care system. To apply a more holistic approach of patients with Pso and PsA, we established the first dual care clinic in Greece, for Pso and PsA patients, based at Attikon General University Hospital. Hereby, we describe the infrastructure and operation of a combined Pso and PsA clinic (PPAC), in the national health care system of Greece, and its impact on the management of Pso and PsA. The PPAC is a single‐day joint clinic, held once a week, which consists of three dermatologists and three rheumatologists. We present the results of 185 newly diagnosed patients between December 2018 and January 2019. Mean age of onset of Pso was 34 ± 16 years old and 47 ± 12 years old for PsA. Most patients suffered from severe plaque Pso (144/185, 78%) and asymmetric oligoarticular arthritis (59/185, 32%), for which they were receiving treatment with biologic agents (105/185, 57%). Many required monitoring for hypertension (74/185, 40%), dyslipidemia (69/185, 37%), diabetes (17/185, 9%), and depression (20/185, 11%). Patients reported high levels of care satisfaction (visual analogue scale: 86 ± 11.5), using the PPAC facility, compared to different referrals between specialties. This is the first joint dermatology–rheumatology clinic in Greece, providing comprehensive care in patients with Pso and PsA. Our results support the concept of combined clinics delivering better integrated care for such patients.

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“…Rheumatologists and dermatologists are in an ideal position to mediate collaborations with other healthcare providers and patient advocacy and support groups for the design of a patient-centric intervention and treatment strategy [35,36]. An improvement in skin and joint symptoms was observed in more than half of patients with psoriasis and PsA after treatment modi cations facilitated by rheumatologists and dermatologists [35,37]. However, as the number of rheumatologists is predicted to decline by 30% by the year 2030 [38], more innovative approaches to patient care are needed.…”

Section: Discussionmentioning

confidence: 99%

Longitudinal Analysis of the Patient Pathways to Diagnosis of Psoriatic Arthritis

Ogdie

Rozycki²,

Arndt³

et al. 2021

Preprint

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Background: The occurrence of health events preceding a psoriatic arthritis (PsA) diagnosis may serve as predictors of diagnosis. We sought to assess patients’ real-world experiences in obtaining a PsA diagnosis. Methods: This retrospective cohort study analyzed MarketScan claims data from January 2006 to April 2019. Included were adult patients with ≥2 PsA diagnoses (ICD-9-CM/ICD-10-CM) ≥30 days apart with ≥6 years of continuous enrolment before PsA diagnosis. Controls were matched 2:1 to patients with PsA. Health events (diagnoses and provider types) were analyzed before PsA diagnosis and additionally stratified by presence of psoriasis.Results: Of 13,661 patients, those with PsA had an increased history of coding for arthritis and dermatologic issues (osteoarthritis [48% vs 22%], rheumatoid arthritis [18% vs 2%], and psoriasis [61% vs 2%]) vs those without PsA. Diagnoses of arthritis, axial symptoms, and tendonitis/enthesitis increased over time preceding PsA diagnosis; notably, a sharp rise in psoriasis diagnoses was observed 6 months before PsA diagnosis. Rheumatology consults were more common immediately preceding a PsA diagnosis. Dermatologists were unlikely to code for arthritis and musculoskeletal issues, while rheumatologists were unlikely to code for psoriasis; general practitioners focused on axial and musculoskeletal symptoms. PsA was most commonly diagnosed by rheumatologists (40%), general practitioners (22%), and dermatologists (7%).Conclusions: Rheumatologists, general practitioners, and dermatologists diagnosed two-thirds of patients with PsA. Musculoskeletal symptoms were common preceding a PsA diagnosis. Greater awareness of patterns of health events may alert healthcare providers to suspect a diagnosis of PsA.

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Bridging the Gaps in the Care of Psoriasis and Psoriatic Arthritis: the Role of Combined Clinics

Cited by 27 publications

References 71 publications

Patient perspectives on the pathway to psoriatic arthritis diagnosis: results from a web-based survey of patients in the United States

Patient perspectives on the pathway to psoriatic arthritis diagnosis: results from a web-based survey of patients in the United States

How does the joint dermatology–rheumatology clinic benefit both patients and dermatologists?

Longitudinal Analysis of the Patient Pathways to Diagnosis of Psoriatic Arthritis

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