Management of psoriasis and psoriatic arthritis in a combined dermatology and rheumatology clinic

Abstract

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.

Multidisciplinary dermatology–rheumatology management for patients with moderate-to-severe psoriasis and psoriatic arthritis: a systematic review

“…Another article was identified following the manual search [26]. Finally, only three studies complied with the selection criteria [23][24][25]. The flowchart of the literature search summarizes these results (Fig.…”

“…Two studies evaluated efficacy [23,24], while the third assessed patient satisfaction with the multidisciplinary approach [25]. The percentage of patients according to sex and age was described in two studies (58 % male in one and 53 % female in the other), and the age ranged from 35 to 65 years [23,24].…”

“…The literature search produced 195 articles, of which 186 were excluded after screening the title and abstract, leaving nine for a full detailed review [2,14,[19][20][21][22][23][24][25]. Another article was identified following the manual search [26].…”

Most Common Dermatologic Topics Published in Five High-Impact General Medical Journals, 1970–2012: Melanoma, Psoriasis, Herpes Simplex, Herpes Zoster, and Acne

“…With a prevalence of 1% to 3%, psoriasis is likely to be encountered by general practitioners. 10 Moreover, as a systemic inflammatory disease, psoriasis is compounded by psoriatic arthritis in 10% to 30% of cases. 10 Psoriasis has also been associated with a significantly increased risk of myocardial infarction, stroke, and peripheral vascular disease, possibly because of accelerated atherosclerosis in the setting of an inflammatory state.…”

“…10 Moreover, as a systemic inflammatory disease, psoriasis is compounded by psoriatic arthritis in 10% to 30% of cases. 10 Psoriasis has also been associated with a significantly increased risk of myocardial infarction, stroke, and peripheral vascular disease, possibly because of accelerated atherosclerosis in the setting of an inflammatory state. 11 These systemic manifestations, as well as the increasing prevalence of this dermatologic condition, make psoriasis a very relevant disease to internal medicine and the general medical journals.…”