Diagnosis and management of psoriatic arthropathy in primary care

Lenman, Morag; Abraham, Sonya

doi:10.3399/bjgp14x681181

Cited by 9 publications

(5 citation statements)

References 7 publications

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“…Initially, dermatologists use the Pso Epidemiology Screening Tool (Ibrahim, Buch, Lawson, Waxman, & Helliwell, 2009), which is a general screening tool employed by the dermatologists at the general outpatient clinic to detect the possible presence of PsA. The diagnostic tools for PsA patients include the classification of PsA criteria (Taylor et al, 2006), the disease activity in PsA score, the Bath Ankylosing Spondylitis Disease Activity Index, the VAS of disease activity, joint pain and health status, the number of swollen and painful joints, the presence of dactylitis, the presence of enthesitis and the C‐reactive protein (Finlay & Khan, 1994; Helliwell & Taylor, 2005; Kirby et al, 2001; Lenman & Abraham, 2014; Michopoulos et al, 2008; Taylor et al, 2006). All clinical and demographic data are recorded on a clinical proforma and then transferred to an online database.…”

Section: Methodsmentioning

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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Section: Methodsmentioning

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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“…Four entrees are created on the dorsal side of the wrist by superficial incisions followed by insertion of a blunt tool through the joint capsule. There are two radiocarpal entrees, between the third and fourth extensor tendon compartment [ 3 , 4 ] and radially of the sixth extensor tendon compartment (6R), and two midcarpal entrees, on the ulnar (MCU) and radial (MCR) side (Fig. 1 ).…”

Section: Interventionsmentioning

confidence: 99%

“…Like RA, PsA is a chronic joint disease that is characterized by synovial hyperproliferation of several joints. Differentiation between RA and PsA can be challenging due to similarities in their clinical presentation [ 4 , 5 ]. When inadequately treated, both RA and PsA can lead to progressive joint destruction, functional disabilities and reduced quality of life [ 6 ].…”

Section: Introductionmentioning

confidence: 99%

Arthroscopic synovectomy versus intra-articular injection of corticosteroids for the management of refractory psoriatic or rheumatoid arthritis of the wrist: study protocol for a randomized controlled trial (ARCTIC trial)

d'Ailly

Deugd

Schep

et al. 2023

Trials

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Background Rheumatoid arthritis (RA) and psoriatic arthritis (PsA) are inflammatory diseases that often affect the wrist and, when affected, can lead to impaired wrist function and progressive joint destruction if inadequately treated. Standard care consists primarily of disease-modifying anti-rheumatic drugs (DMARDs), often supported by systemic corticosteroids or intra-articular corticosteroid injections (IACSI). IACSI, despite their use worldwide, show poor response in a substantial group of patients. Arthroscopic synovectomy of the wrist is the surgical removal of synovitis with the goal to relieve pain and improve wrist function. The primary objective of this study is to evaluate wrist function following arthroscopic synovectomy compared to IACSI in therapy-resistant patients with rheumatoid or psoriatic arthritis. Secondary objectives include radiologic progress, disease activity, health-related quality of life, work participation and cost-effectiveness during a 1-year follow-up. Methods This protocol describes a prospective, randomized controlled trial. RA and PsA patients are eligible with prominent wrist synovitis objectified by a rheumatologist, not responding to at least 3 months of conventional DMARDs and naïve to biological DMARDs. For 90% power, an expected loss to follow-up of 5%, an expected difference in mean Patient-Rated Wrist Evaluation score (PRWE, range 0–100) of 11 and α = 0.05, a total sample size of 80 patients will be sufficient to detect an effect size. Patients are randomized in a 1:1 ratio for arthroscopic synovectomy with deposition of corticosteroids or for IACSI. Removed synovial tissue will be stored for an ancillary study on disease profiling. The primary outcome is wrist function, measured with the PRWE score after 3 months. Secondary outcomes include wrist mobility and grip strength, pain scores, DAS28, EQ-5D-5L, disease progression on ultrasound and radiographs, complications and secondary treatment. Additionally, a cost-effectiveness analysis will be performed, based on healthcare costs (iMCQ questionnaire) and productivity loss (iPCQ questionnaire). Follow-up will be scheduled at 3, 6 and 12 months. Patient burden is minimized by combining study visits with regular follow-ups. Discussion Persistent wrist arthritis continues to be a problem for patients with rheumatic joint disease leading to disability. This is the first randomized controlled trial to evaluate the effect, safety and feasibility of arthroscopic synovectomy of the wrist in these patients compared to IACSI. Trial registration Dutch trial registry (CCMO), NL74744.100.20. Registered on 30 November 2020. ClinicalTrials.gov NCT04755127. Registered after the start of inclusion on 15 February 2021.

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“…2). In such cases, HCPs screening for PsA (e.g., PAs/NPs in primary or dermatology settings) should refer patients to a rheumatologist [43].…”

Section: Diagnosis Of Psamentioning

confidence: 99%

Psoriatic arthritis: the role of the nonphysician clinician in the diagnosis and treatment of patients with psoriasis

Overcash

Chillura

Fender

et al. 2021

Drugs Ther Perspect

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Psoriatic arthritis is a clinically heterogeneous, chronic, and progressive disease that develops in up to 30% of patients with psoriasis and is characterized by multiple and increasing joint defects caused by persistent immune-mediated inflammation. Several treatment options are available, including multiple biologic agents that inhibit specific cellular mediators of inflammation either directly or indirectly. Early detection and intervention are critical to preventing severe joint damage and pain, necessitating increased awareness and education about this disease for primary providers and nonphysician clinicians. Physician assistants and nurse practitioners, given their role in the primary care setting and within multiple specialty areas such as dermatology and rheumatology, are often the first to see patients who may have psoriatic arthritis. These healthcare providers are increasingly important in the early diagnosis and treatment of this disease. In this review, we provide an overview of psoriasis and psoriatic arthritis and discuss the multiple treatment options that are available for these patients. We also discuss ways to help recognize early joint involvement in the clinic and emphasize the role that nonphysician clinicians play in the care of patients with psoriatic arthritis. Key points Psoriatic arthritis, an inflammatory disease, may cause irreversible joint damage in patients with psoriasis. Physician assistants and nurse practitioners in dermatology and rheumatology, who are well positioned to recognize psoriatic arthritis early, treat patients, and prevent long-term complications, benefit from education on recognizing and treating psoriatic disease to improve outcomes. Biologics have demonstrated efficacy in several disease domains of psoriatic arthritis, and treatment guidelines generally recommend their use over that of nonbiologic agents.

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Diagnosis and management of psoriatic arthropathy in primary care

Cited by 9 publications

References 7 publications

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

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

Arthroscopic synovectomy versus intra-articular injection of corticosteroids for the management of refractory psoriatic or rheumatoid arthritis of the wrist: study protocol for a randomized controlled trial (ARCTIC trial)

Psoriatic arthritis: the role of the nonphysician clinician in the diagnosis and treatment of patients with psoriasis

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