Multidisciplinary working in the management of axial and peripheral spondyloarthritis

Abstract

Multidisciplinary (MD) care is essential in the management of patients with spondyloarthritis (SpA) and is one of the main pillars of disease management and patient care. However, evidence supporting the effectiveness and benefits of this strategy in SpA is scarce. In this review we discuss the three types of MD care models: (i) combined clinics (MD units), including ‘face to face’, ‘parallel’ and ‘circuit approach’ clinics; (ii) MD team meetings; (iii) group consultations. The most frequently used model in SpA studies has been the ‘parallel’ combined clinic and usually encompasses a rheumatologist and another specialist, most commonly a dermatologist or a gastroenterologist, that work in tandem according to predefined referral criteria and treatment algorithms. MD working seems to improve the care of patients with SpA by a better identification and diagnosis of the disease, an earlier and more comprehensive treatment approach, and better outcomes for patients in terms of disease activity, physical function, quality of life and patient satisfaction. Nevertheless, challenges remain. Data on effectiveness and feasibility are scarce and are mostly derived from studies with design issues and often without a unidisciplinary care comparator arm. Although patient centricity is one of the core values of patient care and MD setting in SpA, the patient often does not play an active role in most of the MD settings studied or in common clinical practice. Further efforts should be made so that MD care reflects patients’ expectations and needs. Overcoming these limits will help to implement successfully SpA MD care in daily clinical practice and subsequently to achieve a higher quality of care for our patients.

Management of Concomitant Inflammatory Bowel Disease or Uveitis in Patients With Psoriatic Arthritis: An Updated Review Informing the 2021 GRAPPA Treatment Recommendations

“…As a result, therapeutic algorithms are becoming more complex, with an increasing proportion of patients needing a more personalized approach, independent of algorithms. 49 This is an approach increasingly advocated by international recommendations, including GRAPPA 2021, 12 the American College of Rheumatology, 50 and the European Alliance of Associations for Rheumatology 2019 treatment recommendations for PsA. 51 The aim is to more effectively diagnose different IMID manifestations, intervene early to prevent clinical sequelae -especially those that are irreversible, reduce disease activity in multiple domains to prevent morbidity and irreversible damage, prevent disease related complications, and improve prognosis and QOL.…”

The role of the multidisciplinary team in the management of psoriatic arthritis

“…A variety of different MDST models of care exist in clinical practice and have been reported. They are described and critiqued in detail by Gudu et al (Gudu & Jadon, 2020). In brief, two HCPs may: simultaneously consult the patient; consult sequentially; or both might be available and the patient choses one to consult on that particular occasion.…”

“…As is discussed by Gudu et al. few centres have collected rigorous clinical practice or research study clinical outcome data evidencing the benefit to patients, institutions and healthcare systems of MDST working (Gudu & Jadon, 2020 ). For those of us practising MDST working, we appreciate its benefits.…”

Elevating the Standard of Care for Patients with Axial Spondyloarthritis: ‘Calls to Action’ from Rheumacensus, a Multistakeholder Pan-European Initiative

“…Therefore, a multidisciplinary approach is needed to optimise care, but this varies in the clinic and feasibility (e.g. human resources, administrative burden and economic cost) is not well defined [ 14 ].…”