Psoriasis and psoriatic arthritis (PsA) are chronic systemic inflammatory disorders with wide spectrums of cutaneous and musculoskeletal presentations. Management of joint disease in this population can be challenging and often requires the expertise of rheumatology in conjunction with dermatology. A multidisciplinary clinic setting may benefit these patients, and in this study we sought to evaluate the experience of such a model. We performed a retrospective chart review of patients evaluated between October 2003 and October 2009 in the Center for Skin and Related Musculoskeletal Diseases (SARM) at Brigham and Women's Hospital, Boston, MA, USA, where patients are seen by both an attending rheumatologist and dermatologist. Main outcomes included the presence of comorbidities, accuracy of the initial diagnosis, and escalation of treatment modalities. Over the 6-year period, 510 patients were evaluated. Two hundred sixty-eight patients had psoriasis and/or PsA. The prevalence of comorbidities was high (45% hypertension, 46% hyperlipidemia, 19% diabetes, and 36% history of the past or current smoking). Visit in SARM resulted in a revised diagnosis that differed from the previous diagnosis at outside clinics in 46% of cases. Patients were more likely to receive a systemic medication after the evaluation in SARM as compared to before, 25 versus 15%, respectively, with an odds ratio of 5.1. Patients were also more likely to be treated with a biologic agent after the evaluation in SARM as compared to before, 37 versus 16%, respectively. Multidisciplinary care may facilitate the diagnosis of joint disease and offers a more comprehensive treatment approach for patients with both psoriasis and PsA. Our data can be used to support the efforts to provide integrated rheumatologic and dermatologic care for this population.

Non-melanoma skin cancer (NMSC) is one of the most common cancer in the US, and having multiple lesions conveys substantial cost and morbidity for the individual involved. Although there are data available on risk factors for NMSC, few studies currently identify specific risk factors for development of multiple NMSCs. We evaluated host risk factors for multiple NMSCs among men in the Health Professionals Follow-up Study and women in the Nurses’ Health Study. Compared with individuals with a single NMSC, having greater number of sunburns was a risk factor for developing ≥2 NMSCs [≥10 sunburns, cumulative relative risk (RR) = 1.21, 95% confidence interval (CI): 1.07–1.36] and a higher risk of developing ≥11 NMSCs (≥10 sunburns, RR = 2.33, 95% CI: 1.57–3.46). Inability-to-tan was associated with risk of developing ≥2 NMSCs (cumulative RR = 1.29, 95% CI: 1.18–1.40) and a higher risk of developing ≥11 NMSCs (RR = 1.91, 95% CI: 1.50–2.43). Men had an increased risk of developing ≥2 NMSCs (cumulative RR = 1.53, 95% CI: 1.40–1.66). Risk of developing 2–4, 5–10 and ≥11 NMSCs increased with age. Other risk factors for developing ≥2 NMSCs included red natural hair colour (cumulative RR = 1.23, 95% CI: 1.07–1.42), family history of melanoma (cumulative RR = 1.15, 95% CI: 1.03–1.28), and having ≥6 nevi on the left arm (cumulative RR = 1.22, 95% CI: 1.07–1.40). In conclusion, physicians caring for individuals with incident NMSCs may consider paying special attention to those at highest risk for developing additional tumours, especially males and those with a history of ≥10 lifetime sunburns, by performing routine full skin examinations and counselling for aggressive photo-protection.

Residence in high ultraviolet (UV) locations is associated with increased risk for incident nonmelanoma skin cancer (NMSC). However, the effect of geographic location on multiple NMSC development has not been well studied. We evaluated the association between state of residence at birth, age 15 and 30 and risk of multiple NMSCs among 80275 women and men. After adjusting for age, gender, hair color, number of sunburns, tanning ability, family history of melanoma and nevus count, the cumulative relative risks (RRs) of developing ≥1 NMSC for those consistently residing in medium- and high-UV index states were 1.20 (95% CI 1.14-1.27) and 1.42 (95% CI 1.32-1.53) respectively. We found that compared to individuals with one lifetime NMSC, the multivariate cumulative RRs of developing ≥2 NMSCs for those who stayed in medium- and high-UV index states at all three timepoints were 1.09 (95% CI 1.00-1.19) and 1.15 (95% CI 1.02-1.30) respectively. These results cannot account for migration during the interval period and seasonal changes in residence; further, as BCC is the predominant NMSC, the results may be BCC-driven. In conclusion, we found that consistent residence in medium- or high-UVR locations was significantly associated an incremental risk of ≥2 NMSCs later in life.