Recommendations for the Coordinated Management of Psoriatic Arthritis by Rheumatologists and Dermatologists: A Delphi Study

Abstract

Psoriatic arthritis, a chronic inflammatory musculoskeletal disease that is associated with psoriasis, causes joint erosions, accompanied by loss of function and quality-of-life. The clinical presentation is variable, with extreme phenotypes that can mimic rheumatoid arthritis or ankylosing spondylitis. Because psoriasis usually presents before psoriatic arthritis, the dermatologist plays a key role in early detection of the latter. As many treatments used in psoriasis are also used in psoriatic arthritis, treatment recommendations should take into consideration the type and severity of both conditions. This consensus paper presents guidelines for the coordinated management of psoriatic arthritis by rheumatologists and dermatologists. The paper was drafted by a multidisciplinary group (6rheumatologists, 6dermatologists, and 2epidemiologists) using the Delphi method and contains recommendations, tables, and algorithms for the diagnosis, referral, and treatment of patients with psoriatic arthritis.

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

“…Therefore, there is increasing interest in coordinated management by dermatologists and rheumatologists both for the early diagnosis of PsA and for the therapeutic management of PsA patients with moderate-to-severe cutaneous and/ or musculoskeletal involvement. Recommendations for the coordinated management of the disease based on PsA screening in dermatology and rheumatology clinics and on a concerted monitoring and treatment plan have been developed [7]. Another option is multidisciplinary consultations [14,15], which are supported by the experience of multidisciplinary ophthalmologyrheumatology clinics.…”

“…Two main approaches have been suggested to improve the detection of PsA in the dermatology clinic. First, some clinical signs and symptoms which dermatologists should be searching for in a psoriasis patient in addition to specific skin features and nail involvement have been suggested [2,[6][7][8]. Second, several self-administered PsA screening questionnaires have been developed and validated for use in psoriasis patients, but they are rarely used due to issues of diagnostic sensitivity and specificity [9][10][11][12][13].…”

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).…”

Osteoarticular Injury in Psoriatic Patients According to the Data of Pest (Psoriasis Epidemiology Screening Tool) Questionnaire and Rheumatological Clinicoinstrumental Examination

“…УЗИ правого коленного сустава: а -глубокий инфрапателлярный бурсит дис-тального отдела собственной связки надколенника, большеберцовая кость; б -сниже-ние эхоплотности и васкуляризация новления точного диагноза, так как у больного псориазом может встречаться любое другое РЗ помимо ПсА, о чем свидетельствуют результаты нашей работы. Важность меж-дисциплинарного взаимодействия дерматолога и ревмато-лога подтверждена в опубликованных недавно испанских рекомендациях по совместному скринингу и ведению па-циентов с ПсА [18].…”