Clinical outcomes and feasibility of the multidisciplinary management of patients with psoriatic arthritis: two-year clinical experience of a dermo-rheumatologic clinic

• Published in: Clinical rheumatology 2018-10, Vol.37 (10), p.2741-2749
• Main Authors: Luchetti, Michele Maria, Benfaremo, Devis, Campanati, Anna, Molinelli, Elisa, Ciferri, Monia, Cataldi, Serena, Capeci, William, Di Carlo, Marco, Offidani, Anna Maria, Salaffi, Fausto, Gabrielli, Armando
• Format: Article
• Language: English
• Subjects: Adult; Arthritis; Arthritis, Psoriatic - diagnosis; Arthritis, Psoriatic - diagnostic imaging; Arthritis, Psoriatic - therapy; Arthritis, Rheumatoid; Dermatology; Diagnosis; Diagnostic Imaging - methods; Disease management; Early Diagnosis; Feasibility Studies; Female; Gastrointestinal tract; Hospitals, Special; Humans; Inflammation; Male; Medicine; Medicine & Public Health; Middle Aged; Musculoskeletal system; Nail Diseases - diagnosis; Nail Diseases - therapy; Nails (Anatomy); Original Article; Patient Care Team - organization & administration; Patients; Psoriasis; Psoriasis - complications; Psoriasis - therapy; Psoriatic arthritis; Quality of Life; Remission; Rheumatology; Skin diseases; Treatment Outcome
• ISSN: 0770-3198; 1434-9949
• DOI: 10.1007/s10067-018-4238-4

Psoriatic arthritis (PsA) is a chronic inflammatory autoimmune arthritis, occurring in patients with psoriasis (Pso), that may affect the whole musculoskeletal system but also nails, eye, and gastrointestinal tract. Dermatologists and rheumatologists usually manage Pso and PsA separately, but early diagnosis and integrated management could achieve better outcomes of both skin and musculoskeletal manifestations, thus improving the health-related quality of life (HRQoL) of patients. In this work, we have described a model of integrated dermo-rheumatologic approach for the early diagnosis of PsA and to present the outcomes of the multidisciplinary management of PsA patients after 48 weeks of follow-up. Pso patients complaining musculoskeletal symptoms were enrolled in a DErmo-Rheumatologic Clinic (DERC) in order to screen, classify, and treat patients with PsA, employing an operative working procedure and a specific flowchart. The integrated dermatologic and rheumatologic management of PsA patients allowed a prompt establishment of the diagnosis and the best therapeutic approach in these patients, with a significant improvement of skin and articular diseases and, eventually, a consistent amelioration of HRQoL. Dermatologists and rheumatologists usually manage the “psoriatic disease” in separated outpatient clinics. In our study, we have demonstrated that a combined DERC, by means of a tight cooperation between the dermatologist and the rheumatologist, which use a specific working procedure and treatment flowchart, may achieve the optimal clinical management of these patients, with a consistent clinical remission of the disease and a significant amelioration of the HRQoL.