The Dermatologists' Role in Managing Psoriatic Arthritis: Results of a Swiss Delphi Exercise Intended to Improve Collaboration with Rheumatologists

Abstract

BACKGROUND Psoriatic arthritis (PsA) substantially impacts the management of psoriatic disease. OBJECTIVE This study aimed to generate an interdisciplinary national consensus on recommendations of how PsA should be managed. METHODS Based on a systematic literature search, an interdisciplinary expert group identified important domains and went through 3 rounds of a Delphi exercise, followed by a nominal group discussion to generate specific recommendations. RESULTS A strong consensus was reached on numerous central messages regarding the impact of PsA, screening procedures, organization of the interaction between dermatologists and rheumatologists, and treatment goals. CON-CLUSION These recommendations can serve as a template for similar initiatives in other countries. At the same time, they highlight the need to take into account the impact of the respective national health care system. These recommendations can serve as a template for similar initiatives in other countries. At the same time, they highlight the need to take into account the impact of the respective national health care system.

Promoting patient‐centred care in psoriatic arthritis: a multidisciplinary European perspective on improving the patient experience

“…Ideally, dermatologists and GPs should be familiar with the signs and symptoms of PsA; at the very least they should be aware that PsA is a common problem among patients with psoriasis, be able to differentiate between inflammatory and non‐inflammatory joint pain and be aware of the appropriate referral pathway 23. It is important to recognize that PsA is a multisystemic disease, to make HCPs aware of the possibility of the recurrence of PsA among patients with psoriasis, and to make screening for PsA standard practice.…”

“…Early and regular screening, including validated measures of patient symptoms and with attention to joint symptoms, would help move towards the ideal situation that no patient with psoriasis would have their PsA unrecognized and, if it were to develop during the course of their life, they would receive appropriate treatment as soon as required. As soon as PsA is suspected, the patient should be referred to a rheumatologist for assessment and advice about planning their care 23, 24. In the UK, guidelines issued by the National Institute for Health and Care Excellence (NICE) recommend that annual assessments for PsA should be offered to people with any type of psoriasis 24.…”

“…Ideally, dermatologists and GPs should be familiar with the signs and symptoms of PsA; at the very least they should be aware that PsA is a common problem among patients with psoriasis, be able to differentiate between inflammatory and non-inflammatory joint pain and be aware of the appropriate referral pathway. 23 It is important to recognize that PsA is a multisystemic disease, to make HCPs aware of the possibility of the recurrence of PsA among patients with psoriasis, and to make screening for PsA standard practice. Early and regular screening, including validated measures of patient symptoms and with attention to joint symptoms, would help move towards the ideal situation that no patient with psoriasis would have their PsA unrecognized and, if it were to develop during the course of their life, they would receive appropriate treatment as soon as required.…”

Psoriasis and Psoriatic Arthritis: Flip Sides of the Coin?

“…At the same time, identifying novel targets to treat PsO as well as PsA remains an important objective in drug discovery, as drugs with convincing efficacy in both entities would make treatment regimens simpler and thus patientfriendlier (46) (Table II). These targets will most likely represent "common check points" of inflammation, for example in signal transduction cascades, rather than "common denominators" such as cytokines.…”

Evidence-based algorithm for diagnosis and assessment in psoriatic arthritis: results by Italian DElphi in psoriatic Arthritis (IDEA)

“…In addition, a comprehensive assessment of other potential related conditions should be considered, including uveitis, inflammatory bowel disease (IBD), cardiovascular disease, obesity, MS, gout, diabetes mellitus (DM), liver disease, depressive and anxiety-symptoms (18)(19)(20)(21)(22). In recent years, in psoriasis (23) and PsA (24)(25)(26)(27)(28)(29), several studies have applied Delphi procedures (30,31) for different aims, mainly focused on better diagnosis and assessment of these clinical conditions. In particular, in 2015, in the context of psoriasis, Italian dermatologists performed a Delphi procedure involving 50 dedicated dermatological centres (23).…”