Psoriatic Arthritis Treatment: Combined Rheumatology and Dermatology Clinics Make Sense
Collaborative clinics, with rheumatologists and dermatologists under one roof, show promise in creating better results in psoriatic arthritis care.
Psoriatic disease is an autoimmune disorder that includes psoriasis and psoriatic arthritis (PsA). The first causes itchy or sore patches of thick, dry, discolored skin; the second also affects the joints. Around 30 percent of people with psoriasis eventually develop PsA as well. Studies have shown that multidisciplinary clinics that house rheumatologists and dermatologists under one roof can provide optimal care and deliver better outcomes.
A Multidisciplinary Approach Is Key to Providing Comprehensive PsA Care
With more treatment options available than ever before, it is important for a person with PsA to receive collaborative care from both a dermatologist and a rheumatologist. “There are many health issues where a dermatologist definitely knows more than a rheumatologist, and vice versa. When we both work together, we cover more bases, eliminating gaps in care,” says Juan J. Maya-Villamizar, MD, of the Rheumatology Center of Palm Beach, Florida, and medical advisor to CreakyJoints.
Dermatologists Typically Diagnose Psoriatic Disease First
People with psoriatic disease are generally under the care of a dermatologist who is in the best place to identify the possible onset of PsA — and to refer the patient to a rheumatologist. “By the time a patient does start to develop symptoms of psoriatic arthritis and active inflammation, they are usually under the care of only a dermatologist for their psoriatic disease. That definitely puts dermatologists in a unique position to either make that diagnosis or to ensure that the patient sees a rheumatologist to confirm the diagnosis and start treatment as soon as possible to preserve that joint anatomy,” says Anthony Fernandez, MD, PhD, codirector of the Cleveland Clinic Dermatology and Rheumatology Collaborative Care Center.
Early Diagnosis and Treatment Are Essential With a?Progressive Disease Such as PsA
When researchers have looked at the lag time between the onset of skin lesions and the onset of joint pain and psoriatic arthritis, they found that, on average, it can be as long as 10 years?in some people, says Dr. Fernandez. The earlier that PsA is picked up and treated, the better the results, because it helps prevent joint erosion and disability, according to a study published in The?Journal of Rheumatology Supplement.
Why Combined Clinics Can Provide Excellent and Efficient Care
A study published in 2018 in Current Rheumatology Reports?concluded that “Recent findings show that combined clinic models may improve quality of care by raising awareness of psoriatic disease, fostering educational activities for both patients and physicians, and allowing for comprehensive evaluation and management of patients through improved communications between disciplines.”
When rheumatologists and dermatologists collaborate in a combination clinic, it is more likely that PsA will be diagnosed and treated sooner, allowing for more communication that happens faster and in real time. “This team allows for a lot of different ideas from each side. It is certainly our hypothesis that not only does the collaboration lead to better outcomes but also better patient satisfaction. And it’s more convenient for patients when they’re coming to one or two clinic appointments in our setting on the same day,” says Fernandez.
Integrated Dermatology and Rheumatology Care Can Deliver Up-to-Date Treatment
The treatment?of PsA has changed dramatically over the past 20 years. Today, there are a wide variety of treatments. “It is extremely important?to discuss with a rheumatologist?and a dermatologist which ones are the best options based on the patients’ psoriatic arthritis characteristics, comorbidities, and administration preferences, such as intravenous, subcutaneous, or oral routes,” says Dr. Maya-Villamizar.
Medication Access May Be Better at Combo Clinics
Medications to treat PsA can be prescribed by either a dermatologist or a rheumatologist, but if a patient is receiving care from a combo clinic, they can be reassured that the treatment choice has been thoroughly vetted by both specialists. “Another important point is that the resources from both specialties could be combined in order to obtain the medication from the insurance provider or from a patient assistance program,” Maya-Villamizar says.
How Combined Rheumatology and Dermatology Clinics Work
Most often, the dermatologist and the rheumatologist are in the same clinic at the same time. They see and have conversations about patients together. The patients can listen to those conversations and weigh in with questions and opinions. When that is not feasible, there are places where the patient may go to two different clinic appointments, one in dermatology and then one in rheumatology. And then at the end of the day, the rheumatologist and the dermatologist discuss their various patients and communicate their thoughts to the patients later.
Combined Clinics Can Offer Holistic Care
“I think combination clinics really do lead to optimal care for the patient as a whole and not just one specific organ system, because our teams emphasize listening to the patients,” says Fernandez. “We know that patients want to be involved in their care, they want to be educated, they want to play a role in their treatment decisions. And we are strong believers in shared decision-making. Everything we do is really about them and trying to optimize their care and quality of life.”
What About Other Specialists Who Help Treat PsA Patients?
People with PsA usually have other healthcare practitioners on their team as well, such as a dietitian, physical therapist, and occupational therapist. They will probably not be in the clinic — so how do patients loop in those team members? Find someone who will act like a quarterback to facilitate communication and coordinate outcome goals, says Maya-Villamizar: “In many settings, either the rheumatologist or the dermatologist will oversee the case. But what we probably see the most is that the primary care doctor is the point person when you’re involved in more specialties than just rheumatology and dermatology.”
Patients can make communication easier if they ask their team for recommendations for outside specialists that the team has often worked with.
Where to Find a Combined Rheumatology and Dermatology Clinic
These kinds of clinics are still not plentiful throughout the country. Right now, they are found mostly at university hospitals and major teaching hospitals. To find the one that is nearest to you, check out the?Psoriasis and Psoriatic Arthritis Clinics Multicenter Advancement Network.
If You Aren’t Near a Combined Clinic
You can still try to get your rheumatologist and dermatologist to work together in a collaborative and coordinated way without a combo clinic. If you are starting with a dermatologist, ask if there is a rheumatologist they work with, and vice versa. “In private practice, there’s usually a group of dermatologists that works with a group of rheumatologists. That connection makes it easier for the two groups to talk,” says Maya-Villamizar. “Having good communication between specialties is very important for any type of patient and illness.”