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.
[Show abstract][Hide abstract] ABSTRACT: Spondyloarthritis can be considered one of the prototypes (besides rheumatoid arthritis) of an inflammatory rheumatic disease. The locomotor system is prominently involved with arthritis, enthesitis, dactylitis, sacroiliitis, and/or axial disease; but besides the rheumatologic component, other body systems are frequently affected. Extra-articular manifestations are all the medical conditions and symptoms that are not directly related to the locomotor system. Besides inflammatory bowel diseases, the major concept-related extra-articular manifestations are located in the eye (acute anterior uveitis) and the skin (psoriasis). This review focuses on the possible implications of these nonrheumatologic manifestations regarding the treatment of spondyloarthritis.
Rheumatic diseases clinics of North America 08/2012; 38(3):583-600. DOI:10.1016/j.rdc.2012.08.017 · 2.69 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Introduction and objectives
Up to 30% of patients with psoriasis develop joint disease, the course of which can be improved by early diagnosis and treatment. The aim of this study was to describe our experience with a new multidisciplinary psoriasis and psoriatic arthritis unit over a period of 4 years (2009-2012).
Material and methods
Implementation of a PSOriasis Rheumatology and Dermatology unit (PSORD) to provide patient care and physician training. In the first phase of the project, referral criteria for the unit were defined and several meetings were organized to train and prepare the specialists involved in the program. In the second phase, a schedule was drawn up for monthly patient visits with the PSORD team. Starting in 2011, training was offered to dermatologists and rheumatologists from other hospitals interested in implementing a similar model.
A total of 259 visits (71% first visits, 8% no-shows) were scheduled during the period analyzed, with a median of 8 visits (range, 2-14 visits) per session. Sixty-three percent of the patients were referred from the rheumatology department. Diagnosis and treatment were modified in 32% and 47% of cases, respectively. Three training courses were held with 15 physicians from 6 hospitals, 3 of which created similar units.
The PSORD model improved the management of difficult-to-diagnose and/or uncontrolled disease, the early diagnosis and treatment of psoriatic arthritis, and collaboration between dermatologists and rheumatologists. Finally, the model lends itself to being exported to other settings.
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