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Management of psoriasis and psoriatic arthritis in a combined dermatology and rheumatology clinic

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Abstract

Psoriasis and psoriatic arthritis (PsA) are chronic systemic inflammatory disorders with wide spectrums of cutaneous and musculoskeletal presentations. Management of joint disease in this population can be challenging and often requires the expertise of rheumatology in conjunction with dermatology. A multidisciplinary clinic setting may benefit these patients, and in this study we sought to evaluate the experience of such a model. We performed a retrospective chart review of patients evaluated between October 2003 and October 2009 in the Center for Skin and Related Musculoskeletal Diseases (SARM) at Brigham and Women’s Hospital, Boston, MA, USA, where patients are seen by both an attending rheumatologist and dermatologist. Main outcomes included the presence of comorbidities, accuracy of the initial diagnosis, and escalation of treatment modalities. Over the 6-year period, 510 patients were evaluated. Two hundred sixty-eight patients had psoriasis and/or PsA. The prevalence of comorbidities was high (45% hypertension, 46% hyperlipidemia, 19% diabetes, and 36% history of the past or current smoking). Visit in SARM resulted in a revised diagnosis that differed from the previous diagnosis at outside clinics in 46% of cases. Patients were more likely to receive a systemic medication after the evaluation in SARM as compared to before, 25 versus 15%, respectively, with an odds ratio of 5.1. Patients were also more likely to be treated with a biologic agent after the evaluation in SARM as compared to before, 37 versus 16%, respectively. Multidisciplinary care may facilitate the diagnosis of joint disease and offers a more comprehensive treatment approach for patients with both psoriasis and PsA. Our data can be used to support the efforts to provide integrated rheumatologic and dermatologic care for this population.

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Conflict of interest

AAQ is a consultant for Amgen, Centocor, Novartis and Pfizer, has received a research grant from Amgen and has developed a questionnaire that was licensed to Pfizer and Merck for clinical trials. MEH is a consultant for Amgen, UCB and Pfizer, and has developed a questionnaire that was licensed to Pfizer and Merck for clinical trials.

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Authors and Affiliations

  1. Department of Dermatology, Brigham and Women’s Hospital, Harvard Medical School, 221 Longwood Avenue, Boston, MA, 02115, USA

    Nicole F. Velez & Abrar A. Qureshi

  2. Harvard Medical School, Boston, MA, USA

    Erin X. Wei-Passanese

  3. Department of Rheumatic and Immunologic Diseases, Cleveland Clinic, Cleveland, OH, USA

    M. Elaine Husni

  4. Division of Allergy, Immunology and Rheumatology, Department of Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA

    Elinor A. Mody

Authors
  1. Nicole F. Velez
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  2. Erin X. Wei-Passanese
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  3. M. Elaine Husni
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  5. Abrar A. Qureshi
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Corresponding author

Correspondence to Abrar A. Qureshi.

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Velez, N.F., Wei-Passanese, E.X., Husni, M.E. et al. Management of psoriasis and psoriatic arthritis in a combined dermatology and rheumatology clinic. Arch Dermatol Res 304, 7–13 (2012). https://doi.org/10.1007/s00403-011-1172-6

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