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

Abstract

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.

Specialized Dermatological - Rheumatological Patient Management Improves Diagnostic Outcome and Patient Journey: A Four-Year Analysis

“…This is commonly observed in clinical practice, although the literature suggests a better diagnostic yield (19,20). Despite this, the higher level of DLQI in patients with PsA, which primarily affects the impact of the skin symptoms on health-related quality of life, indicated a greater degree of impairment in those patients (21). On the other hand, the dermatologist should not stop asking for joint complaints in psoriasis patients as PsA is often developed in the later history of psoriasis (4).…”

“…There are several examples of collaboration between different departments such as uveitis clinics or reproduction and pregnancy clinics in which the patient is seen by various experts for chronic medical complaints (21,24,25). These experiences demonstrate a signi cant diagnostic and therapeutic bene t. Positive aspects of these specialized centers include avoiding excessive laboratory testing, minimizing the number of visits, e cient decision-making and e cient ow of knowledge leading to fastened diagnosis and procedures for patient management.…”

Development of a digital toolkit to improve quality of life of patients with systemic lupus erythematosus

“…food and housing insecurity and transportation) and behavioral health, and which are enhanced by digital tools, such as the e-toolkit described here. 48 , 49 …”

Specialized dermatological-rheumatological patient management improves diagnostic outcome and patient journey in psoriasis and psoriatic arthritis: a four-year analysis

“…This is commonly observed in clinical practice, although the literature suggests a better diagnostic yield [17,18]. Despite this, the higher level of DLQI in patients with PsA, which primarily affects the impact of the skin symptoms on health-related quality of life, indicated a greater degree of impairment in those patients [19]. On the other hand, the dermatologist should not stop asking for joint complaints in psoriasis patients as PsA is often developed in the later history of psoriasis [4].…”