Clinical outcomes and feasibility of the multidisciplinary management of patients with psoriatic arthritis: two-year clinical experience of a dermo-rheumatologic clinic

Abstract

Psoriatic arthritis (PsA) is a chronic inflammatory autoimmune arthritis, occurring in patients with psoriasis (Pso), that may affect the whole musculoskeletal system but also nails, eye, and gastrointestinal tract. Dermatologists and rheumatologists usually manage Pso and PsA separately, but early diagnosis and integrated management could achieve better outcomes of both skin and musculoskeletal manifestations, thus improving the health-related quality of life (HRQoL) of patients. In this work, we have described a model of integrated dermo-rheumatologic approach for the early diagnosis of PsA and to present the outcomes of the multidisciplinary management of PsA patients after 48 weeks of follow-up. Pso patients complaining musculoskeletal symptoms were enrolled in a DErmo-Rheumatologic Clinic (DERC) in order to screen, classify, and treat patients with PsA, employing an operative working procedure and a specific flowchart. The integrated dermatologic and rheumatologic management of PsA patients allowed a prompt establishment of the diagnosis and the best therapeutic approach in these patients, with a significant improvement of skin and articular diseases and, eventually, a consistent amelioration of HRQoL. Dermatologists and rheumatologists usually manage the "psoriatic disease" in separated outpatient clinics. In our study, we have demonstrated that a combined DERC, by means of a tight cooperation between the dermatologist and the rheumatologist, which use a specific working procedure and treatment flowchart, may achieve the optimal clinical management of these patients, with a consistent clinical remission of the disease and a significant amelioration of the HRQoL.

Association between clinical specialty setting and disease management in patients with psoriatic arthritis: results from LOOP, a cross‐sectional, multi‐country, observational study

“…Furthermore, studies have demonstrated that patients managed in a multidisciplinary manner by both dermatologists and rheumatologists show improvements in disease activity and quality of life. 21,22 Our results suggest a need for a rheumatologist-dermatologist collaborative approach to optimize management of patients with PsA.…”

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

“…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).…”

“…Differential diagnosis is difficult and early management of PsA significantly improves the loss of function and quality of life of patients, as well as achieve control of the structural changes of bone and cartilage (Nystad, Husum, Furnes, & Fevang, 2018) There are several reports underlying the delay between development of PsA symptoms and diagnosis, which usually leads to various orthopedic, surgical operations, before actually these patients receive the right therapeutic agent (Nystad et al, 2018; Strauss et al, 2008). Previous studies also suggest that there are remarkable deviations in clinical handling and follow‐up of Pso and PsA patients, depending on the specialist they choose to initially see, and this often leads to misdiagnosis and loss of compliance (Cobo‐Ibáñez et al, 2016; Luchetti et al, 2018; Yélamos, Ros, & Puig, 2015). The previous problems are prevented using the PPAC pathway.…”

“…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). Moreover, available evidence in the literature from clinical specialists, treating chronic, disabling conditions, or clinical experts on cancer care show a collective benefit in the management of these patients in multidisciplinary clinics (Hemmelgarn et al, 2007; Pawlik et al, 2008; Turk & Okifuji, 1998).…”

Improving the standard of care for patients with spondyloarthritis-related immune inflammatory conditions: results of a Delphi study and proposal for early detection

“…These perceptions are in accord with recent studies indicating that PsO and PsA multidisciplinary units may facilitate early diagnosis of these conditions, offer a more comprehensive treatment approach and timely treatment initiation, and increase patient satisfaction and quality of life. [21][22][23] Similarly, patients with IBD exposed to a multidisciplinary IBD clinic may have lower rates of IBD-related hospitalization, lower odds of corticosteroid dependence, and lower risk of IBD-related surgeries as compared with patients under standard practice. 24 In addition to the clinical impact of IMIDs on patients in terms of physical suffering, impaired function, and diminished quality of life, these conditions have a significant economic impact on both the individual patient and society as a whole.…”