Journal Article

Interdisciplinary approach to patients with psoriatic arthritis: a prospective, single-center cohort study

Gross, Georg, Olsavszky, Victor, Schwaan, Johanna, Schmieder, Astrid, von Ahnen, Jan Alwin, Blauth, Mara, Leipe, Jan, Lull, Christian

2024

Overview

Background: Psoriatic arthritis (PsA) is a chronic systemic inflammatory disease that affects up to 30% of patients with psoriasis. Diagnosis and treatment could be improved by implementing an interdisciplinary dermatological-rheumatological consultation (IDRC). Objectives: This study aimed to assess the effect of a face-to-face IDRC involving both a dermatologist and a rheumatologist evaluating patients in a single visit, on disease activity and burden in patients with PsA. Design: Prospective, single-center, cohort study. Methods: 202 patients with psoriasis were enrolled, among whom 115 individuals with psoriasis and musculoskeletal symptoms underwent an IDRC. Disease manifestations, comorbidities, and both objective and subjective disease activity scores were evaluated. Results: Out of the participants, 56 were diagnosed with definite PsA, while the remaining 146 had psoriasis. Nail involvement was associated with axial PsA (odds ratio 4.11; 95% CI 1.22–13.82; p = 0.02). Patients with PsA often experienced a prolonged time to diagnosis (mean 187 weeks) and had a significant psychosocial burden (mean Hospital Anxiety and Depression Index Scale [HADS]-Anxiety score of 7.66 and mean HADS-Depression score of 5.63). Post-IDRC, both objective and subjective disease parameters showed improvement, and patients required less time for consultations with healthcare professionals compared to before the IDRC. Conclusion: These findings suggest that an IDRC approach could effectively expedite and optimize the diagnosis and treatment of patients with psoriasis and musculoskeletal symptoms. Plain language summary The effects of an interdisciplinary consultation on patients with psoriatic arthritis Psoriatic arthritis is a chronic inflammatory disease that occurs in one in three patients with psoriasis. Finding the right diagnosis and treatment is challenging and often time-consuming, so it is crucial to find ways to establish care models which accelerate and improve this care. In our presented study, we established a face-to-face consultation with a dermatologist and a rheumatologist consulting each patient in a single visit and assessed the effects of this consultation on diagnosis, disease activity and patient burden. We studied 202 patients with psoriasis. Out of these, 115 showed both skin and musculoskeletal symptoms and therefore underwent our interdisciplinary consultation. We looked at their symptoms, other health issues, and how they felt about their disease. We found that 56 of them had definite psoriatic arthritis, while the rest had psoriasis alone. Nail problems were linked to inflammation in the axial skeleton. People with psoriatic arthritis often got diagnosed late (after about 3-4 years) and felt a lot of stress. Our interdisciplinary consultation enabled a fast diagnosis and improved treatment - patients had fewer symptoms and higher quality of life. They also needed less time with doctors. These findings suggest that interdisciplinary care can improve diagnosis and treatment in patients with psoriasis and musculoskeletal symptoms.

• Publisher: SAGE Publications,SAGE PUBLICATIONS, INC,SAGE Publishing
• Subject: Cohort analysis / Interdisciplinary aspects / Medical diagnosis / Psoriasis / Psoriatic arthritis