Optimising co-management of PsA patients
Dr Laura Savage, Consultant Dermatologist, Leeds Teaching Hospitals NHS Trust, talks about how to better align rheumatology and dermatology practices and ensure optimal outcomes for patients with Psoriatic Arthritis (PsA).
The Six Domains of PsA, which separate the different facets of psoriatic disease, are extremely useful in helping both dermatologists and rheumatologists understand the heterogeneity of PsA and the different presentations that can occur amongst people with psoriasis. An understanding of these facets can greatly assist us in better identifying PsA, and ensure that our patients achieve both a timely diagnosis and an appropriate, comprehensive management plan. Within the clinic setting, consideration of the six domains during dermatology consultations for patients with psoriasis is something that we can easily introduce more routinely into daily practice.
The gold-standard of care for patients with PsA involves collaborative working between dermatologists and rheumatologists, which is advocated in all official guidelines - particularly those from the British Association for Dermatologists (BAD) and the British Society for Rheumatology (BSR).* At the pinnacle of collaborative care is offering patients follow up in a multidisciplinary dermatology/rheumatology clinic which has benefits not only for the clinician, for example in facilitating timely conversations and management decisions between the specialties, but also for the patient, who feels reassured that both clinical teams are best informed about their personal disease journey.
In Leeds, we are very fortunate to run a parallel dermatology/rheumatology clinic - if I suspect my psoriasis patient may be developing inflammatory arthritis, I can consult with my rheumatology colleague for advice and assessment without delay. However, funding and logistical restraints mean that a truly joint clinic is not always a reality in practice across much of the UK and Ireland. In areas where joint clinics are not yet taking place, there are other opportunities for collaborative working, for example virtual multidisciplinary team (MDT) discussions.
In a heterogenous disease such as PsA, it is key that there is a need to ensure regular and seamless contact between dermatology and rheumatology practices to ensure that patients are benefitting from the attention, experience and complementary expertise of both fields. And as new treatments emerge earlier in the pathway and for specific presentations, the six domains are a practical means to ensure that we identify patients early, understand their pattern of disease fully and to ensure that the most evidence-based therapies are prescribed to manage all facets, to truly ensure the best possible outcomes.