The feasibility and efficacy of a joint dermatology-rheumatology clinic for the treatment of patients with psoriasis (PsO) and psoriatic arthritis (PsA) is supported by study data published in Dermatological Therapies.
Established at Attikon General University Hospital in Athens, Greece, the Psoriasis and Psoriatic Arthritis Clinic (PPAC) integrates expertise from dermatologists and rheumatologists for the treatment of patients with psoriasis and psoriatic arthritis. The dual clinic is held once a week by 6 specialists; the same hospital also holds regular psoriasis clinics twice weekly. On average, the PPAC receives 40 new patients per month. Patients typically belong to 2 categories: patients with psoriasis who are suspected to also have psoriatic arthritis, and patients with a rheumatology diagnosis in whom psoriatic arthritis is suspected. Demographic and clinical characteristics were extracted from patients who attended the clinic from 2017 to 2018. In addition, patient satisfaction with PPAC care was assessed using a Visual Analogue Scale (VAS).
The PPAC saw 185 patients with psoriasis who were diagnosed with psoriatic arthritis from December 2018 to January 2019. In these patients, mean age of psoriasis onset was 34 ± 16 years and mean age of psoriatic arthritis onset was 47± 12 years. The majority of patients had a diagnosis of severe plaque psorisis (78%). The most commonly diagnosed psoriatic arthritis was asymmetric oligoarticular arthritis (32%). More than half of patients were receiving biologic agents (57%) as treatment for psoriasis and psoriatic arthritis. Comorbidity rates were high, with 40% and 37% reporting hypertension and dyslipidemia, respectively. In addition, 9% and 11% were being monitored for diabetes and depression, respectively. Patients reported high levels of satisfaction with the PPAC facility compared with attending separate clinics on referrals. The mean satisfaction-VAS score was 86±11.5. Patients typically endorsed that the PPAC was “timely, efficient, and patient-centered.” Most patients also agreed that “collaboration” and “teamwork” between dermatologists and rheumatologists was essential to their care. When surveyed, dermatologists in the PPAC also agreed that interprofessional collaboration improved patient care quality and clinical outcomes.
These data support the feasibility of dual dermatology-rheumatology clinics for the management of psoriasis and psoriatic arthritis, study authors assert. Investigators noted that a strong “word of mouth” impact was observed from the PPAC, with many patients recommending the clinic to spouses or other family members. From a single clinical site and a relatively small cohort, results may not be generally applicable to other patient populations. Despite this, data “support the concept of combined clinics delivering better integrated care for…patients [with PsO and PsA],” the authors concluded.
Theodorakopoulou E, Dalamaga M, Katsimbri P, Boumpas DT, Papadavid E. How does the joint dermatology-rheumatology clinic benefit both patients and dermatologists? [published online February 24, 2020]. Dermatol Ther. doi: 10.1111/dth.13283