Psoriatic disorder (also known as psoriatic arthritis or psoriatic sprue) is an autoimmune disorder that can include psoriasis, psoriatic arthritis (PsA). The first can cause itchy, dry patches on the skin, while the second can also affect the joints. About 30 percent of people suffering from psoriasis develop PsA. Multidisciplinary clinics that include dermatologists and rheumatologists can offer better care and result. Studies have shown this.
To provide comprehensive PsA care, a multidisciplinary approach is key
There are many treatment options now available. It is crucial that a person suffering from PsA receives collaborative care from both a dermatologist as well as a rheumatologist. A dermatologist is able to provide more information than a rheumatologist on many health issues. Juan J. Mayas-Villamizar MD, medical advisor to CreakyJoints, says that when we work together we can cover more ground and eliminate gaps in care.
Psoriatic disease is usually diagnosed first by dermatologists
Psoriatic patients should be seen by a dermatologist. This is the best way to diagnose the condition and refer them to a rheumatologist. Patients with psoriatic diseases are typically under the care only of a dermatologist when they develop active inflammation and psoriatic arthritis symptoms. This puts dermatologists in an ideal position to diagnose and treat the patient.
For a progressive disease like PsA, early diagnosis and treatment are essential.
According to Dr. Fernandez, researchers looked at the time period between the onset skin lesions and the onset or psoriatic arthritis and joint pain. They found that it can take as much as 10 years for some people. According to a study published by The Journal of Rheumatology Supplement, PsA can be treated sooner than it is too late. It helps prevent joint erosion and disability.
How Combined Clinics can Provide Efficient and Excellent Care
In 2018, Current Rheumatology Reports published a study that concluded that combined clinic models could improve the quality of care. This was done by raising awareness about psoriatic diseases, encouraging educational activities for patients and doctors, and allowing for complete evaluation and management of patients through better communication between disciplines.
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Combination clinics are more likely to diagnose and treat PsA sooner if dermatologists and rheumatologists collaborate. This allows for faster communication and better results. This team is open to all ideas. Our hypothesis is that collaboration leads to better outcomes and better patient satisfaction. Fernandez says that patients find it easier to come to one or more clinic appointments in the same setting.
Integrated Dermatology and Rheumatology Can Provide Up-To-Date Treatment
Over the past 20-years, PsA treatment has evolved dramatically. There are many options available today. Dr. Maya Maya-Villamizar says, “It’s important to talk with a rheumatologist, dermatologist, and other medical professionals about which options are best based on patients’ psoriatic joint characteristics, comorbidities and administration preferences such as intravenous or subcutaneous routes, oral routes, or oral routes.”
Combo Clinics may offer better access to medication
PsA medication can be prescribed by either dermatologists or rheumatologists. However, patients who are receiving care at a combination clinic can rest assured that both doctors have thoroughly reviewed the decision. Maya-Villamizar states that both the medical and financial resources could be combined to get the medication from an insurance company or through a patient assistance program.
How combined Rheumatology/dermatology clinics work
The dermatologist and rheumatologist often work together in one clinic. They can see patients and have discussions about them together. Patients can also listen and offer their opinions and questions. If that is impossible, the patient can go to two clinic appointments: one in dermatology, and one in rheumatology. The rheumatologist will discuss the patient with the dermatologist and then communicate their thoughts to them later.
Holistic Care Can Be Provided by Combined Clinics
Fernandez says that combination clinics can provide optimal care for patients as a whole, not just one organ. This is because the teams listen to patients. Fernandez says, “We know patients want to participate in their care. They want to be educated. They want to have a say in their treatment decisions.” We believe in sharing decision-making. We care deeply about our patients and strive to improve their quality of life.
What about other specialists who treat PsA patients?
PsA patients often have additional healthcare professionals on their team, such as a dietitian or physical therapist. These healthcare professionals will not be present at the clinic, so how can patients get in touch with them? Maya-Villamizar suggests that you find someone to act as a quarterback in order to facilitate communication and coordinate outcomes. “In many settings, either a rheumatologist, or a dermatologist, will oversee the case. We see most often that the primary care physician is the one to contact if you are involved in other specialties than rheumatology or dermatology.
It can help patients communicate better if they ask their team to recommend outside specialists with whom they have worked before.
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Where can I find a combined Rheumatology and Dermatology clinic?
These types of clinics are not yet common in the country. They are currently found mainly at major teaching hospitals and university hospitals. Check out the Psoriatic Arthritis Clinics Multicenter Advancement Network to find the nearest one.
If you aren’t near a Combined Clinic,
It is possible to still get your dermatologist and rheumatologist to work in a coordinated and collaborative manner without having to open a joint clinic. Ask your dermatologist if they have a rheumatologist that they can work with. “In private practice there is usually a group that works with a group rheumatologists. Maya-Villamizar says that this connection makes it easier for them to communicate. For any type of patient or illness, it is important to have good communication between specialists.