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Mercadal-Orfila G, Herrera-Pérez S, Piqué N, Mateu-Amengual F, Ventayol-Bosch P, Maestre-Fullana MA, Serrano-López de Las Hazas JI, Fernández-Cortés F, Barceló-Sansó F, Rios S. Person-Centered Coordinated Care Experience of People With Long-Term Conditions in the Balearic Islands Measured by the P3CEQ. Health Serv Insights 2024; 17:11786329241258856. [PMID: 38883804 PMCID: PMC11177739 DOI: 10.1177/11786329241258856] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2023] [Accepted: 05/16/2024] [Indexed: 06/18/2024] Open
Abstract
Objective This study aimed to use the Person-Centered Coordinated Care Experience Questionnaire (P3CEQ) to assess the experience of person-centered coordinated care among people with long-term conditions in the Balearic Islands, Spain. Methods Over 1300 participants receiving treatment for chronic conditions or HIV pre-exposure prophylaxis were invited to complete the P3CEQ and a socio-demographic questionnaire, both administered electronically via the Naveta app. The P3CEQ assesses the key domains of the P3C through an 11-item questionnaire. Items 1, 2, 3, 4, 5, 8, 9 and 10 assess specifically person-centredness (PC subscale), while items 5, 6, 7, 8 and 9 measure care coordination (CC subscale; question 7 includes 4 sub-questions to specifically assess care plans). Descriptive statistics were used to summarize patient characteristics and P3CEQ items scores. Data analysis included chi-squared test of independence, Student's t-test and analysis of variance test. Pairwise comparisons were adjusted by Bonferroni correction. Results The P3CEQ and a socio-demographic questionnaire were sent to 1313 individuals (651 men, 657 women, 5 'other gender'). A response rate of 35.34% was achieved, with 464 P3CEQ responders (223 men and 241 women). Significant differences in response rates were observed by age, smoking status, alcohol consumption, membership of patient organizations, and use of alternative medicine. Care planning was rated significantly lower than other measured domains. Women experienced less person-centered care than men (16.64 vs 17.91) and rated care coordination worse than their male counterparts (9.18 vs 10.23). There were also differences in scores between medical condition types, with cancer and inflammatory bowel disease patients rating highest for both person-centered care (21.20 and 19.13, respectively) and care coordination (10.70 vs 10.88, respectively). Patients with skin and rheumatic diseases rated lowest their experience of person-centered care. People with higher education and those employed or studying experienced better person-centeredness. Conclusion Using the P3CEQ, we detected significant differences in the care experiences of people with chronic conditions, suggesting the need to address potential gender biases, social inequalities, and the poorer ratings observed for certain conditions in the study population.
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Affiliation(s)
- Gabriel Mercadal-Orfila
- Pharmacy Department, Hospital Mateu Orfila, Maó, Spain
- Department of Biochemistry and Molecular Biology, Universitat de les Illes Balears (UIB), Palma de Mallorca, Spain
| | - Salvador Herrera-Pérez
- CIBER Epidemiología y Salud Pública (CIBERESP), Barcelona, Spain
- Health Services Research Group, IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain
| | - Núria Piqué
- Microbiology Section, Department of Biology, Healthcare and Environment, Faculty of Pharmacy and Food Sciences, Universitat de Barcelona (UB), Barcelona, Spain
- Research Institute of Nutrition and Food Safety, Universitat de Barcelona (INSA-UB), Barcelona, Spain
| | | | - Pedro Ventayol-Bosch
- Pharmacy Department, Hospital Universitari Son Espases, Palma de Mallorca, Spain
| | | | | | | | | | - Santiago Rios
- Departament de Genètica, Microbiologia i Estadística, Facultat de Biologia, Universitat de Barcelona, Barcelona, Spain
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Brazzelli V, Bobbio Pallavicini F, Maggi P, Chętko Ł, Isoletta E, Di Giuli N, Bonelli A, Fornaroli V. A multidisciplinary dermatology-gastroenterology-rheumatology (DER.RE.GA) unit for the care of patients with immune-mediated inflammatory diseases: analysis of the first 5 years from the dermatologist's perspective. Front Med (Lausanne) 2023; 10:1290018. [PMID: 38098849 PMCID: PMC10720650 DOI: 10.3389/fmed.2023.1290018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2023] [Accepted: 11/16/2023] [Indexed: 12/17/2023] Open
Abstract
Immune-mediated inflammatory diseases (IMIDs) constitute a heterogenous group of chronic and highly disabling conditions. The clinical challenges they often pose led to formation of numerous dermo-rheumatological interdisciplinary units around the world, which are reported to benefit their patients in various ways. The present paper describes our experience with a multidisciplinary dermatology-rheumatology-gastroenterology unit DERREGA at the IRCCS Foundation Policlinico San Matteo of Pavia over a period of 5 years of its activity (2017-2022). A digital database was created, containing the medical records of 146 patients referred to the dermatology unit only by rheumatologists or gastroenterologists belonging to the multidisciplinary unit DERREGA. Then, aspects such as demographics, initial basis of referral and final diagnosis among the patients were analyzed retrospectively. Patients were classified as either gastroenterological or rheumatological, and then categorized according to the specific basis of referral. Most of the gastroenterological patients (97%) were affected by inflammatory bowel diseases (IBDs). Rheumatological patients were divided in three subgroups, including patients referred with vasculitis, arthropathies (undifferentiated arthritis, psoriatic arthritis and other arthritis) and other rheumatological diseases. Then, final diagnoses were evaluated in each group. Almost a third of IBD patients received a diagnosis of paradoxical psoriasis. Dermatological examination allowed diagnosis of minimal psoriasis based on Caspar criteria in over 70% of the patients admitted with undifferentiated arthritis. A multidisciplinary approach is suggested to provide more effective management of IMIDs and, specifically, from a dermatological perspective, allows for the diagnosis of minimal manifestations of psoriasis in patients with a provisional diagnosis of undifferentiated arthritis.
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Affiliation(s)
- Valeria Brazzelli
- Institute of Dermatology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
- Department of Clinical, Surgical, Diagnostic and Pediatric Sciences, Institute of Dermatology, Università degli Studi di Pavia, Pavia, Italy
| | | | - Paolo Maggi
- Institute of Dermatology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Łukasz Chętko
- Institute of Dermatology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
- Student Scientific Research Club of Experimental, Clinical and Procedural Dermatology, Medical University of Lodz, Łódź, Poland
| | - Eugenio Isoletta
- Institute of Dermatology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Nicolò Di Giuli
- Institute of Dermatology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Alice Bonelli
- Institute of Dermatology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Valentina Fornaroli
- Rheumatology Department, Fondazione IRCCS Policlinico S. Matteo, Pavia, Italy
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Rondags A, van Marle L, Horváth B, Wink FR, Arends S, Spoorenberg A. Psoriasis seems often underdiagnosed in patient with axial spondyloarthritis. Arthritis Res Ther 2023; 25:145. [PMID: 37559146 PMCID: PMC10410990 DOI: 10.1186/s13075-023-03119-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2023] [Accepted: 07/18/2023] [Indexed: 08/11/2023] Open
Abstract
BACKGROUND Axial spondyloarthritis (axSpA) is known to be associated with several extra-skeletal manifestations (ESM), including the inflammatory skin disease psoriasis. It is important to recognize and diagnose psoriasis timely in axSpA in order to provide optimal treatment and outcome for both axSpA and psoriasis. METHODS In this observational study, all patients from the Dutch Groningen Leeuwarden Axial Spondyloarthritis (GLAS) cohort included before June 2016 were sent a questionnaire with self-screening psoriasis questions including prototypical color pictures. RESULTS Of the 592 questionnaires sent, 448 (75.7%) were eligible for analysis. Of these 448 respondents, 58 (13%) had a positive self-screening for psoriasis symptoms, currently or in the past. In 28 (48%) of 58 patients, psoriasis diagnosis could be verified by medical records, resulting in a psoriasis prevalence rate of 6.3%. In comparison with patients with a confirmed psoriasis diagnosis, patients reporting psoriasis symptoms without a verified diagnosis mentioned more mild than moderate-severe psoriasis symptoms (25% vs. 3%, p = 0.02), and their psoriasis lesions were less often located on the torso area (3% vs. 18%, p = 0.04), the intergluteal cleft (0% vs. 25%, p = 0.02), and legs (7% vs. 43%, p < 0.01). Of the 31 axSpA patients who reported currently active psoriasis, 74% had only mild psoriasis symptoms. CONCLUSIONS Especially mild psoriasis seems often underdiagnosed in patients with axSpA using a patient questionnaire with prototypical pictures of psoriasis lesions. This questionnaire could be beneficial in tracing patients with undiagnosed psoriasis in daily clinical practice. As a next step, further validation of this questionnaire is needed.
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Affiliation(s)
- Angelique Rondags
- Department of Dermatology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.
| | - Laura van Marle
- Department of Rheumatology and Clinical Immunology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Barbara Horváth
- Department of Rheumatology and Clinical Immunology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Freke R Wink
- Department of Rheumatology, Medical Center Leeuwarden, Leeuwarden, The Netherlands
| | - Suzanne Arends
- Department of Dermatology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
- Department of Rheumatology, Medical Center Leeuwarden, Leeuwarden, The Netherlands
| | - Anneke Spoorenberg
- Department of Dermatology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
- Department of Rheumatology, Medical Center Leeuwarden, Leeuwarden, The Netherlands
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Motta F, Morandini P, Maffia F, Vecellio M, Tonutti A, De Santis M, Costanzo A, Puggioni F, Savevski V, Selmi C. Connecting the use of innovative treatments and glucocorticoids with the multidisciplinary evaluation through rule-based natural-language processing: a real-world study on patients with rheumatoid arthritis, psoriatic arthritis, and psoriasis. Front Med (Lausanne) 2023; 10:1179240. [PMID: 37387783 PMCID: PMC10301822 DOI: 10.3389/fmed.2023.1179240] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2023] [Accepted: 05/15/2023] [Indexed: 07/01/2023] Open
Abstract
Background The impact of a multidisciplinary management of rheumatoid arthritis (RA), psoriatic arthritis (PsA), and psoriasis on systemic glucocorticoids or innovative treatments remains unknown. Rule-based natural language processing and text extraction help to manage large datasets of unstructured information and provide insights into the profile of treatment choices. Methods We obtained structured information from text data of outpatient visits between 2017 and 2022 using regular expressions (RegEx) to define elastic search patterns and to consider only affirmative citation of diseases or prescribed therapy by detecting negations. Care processes were described by binary flags which express the presence of RA, PsA and psoriasis and the prescription of glucocorticoids and biologics or small molecules in each cases. Logistic regression analyses were used to train the classifier to predict outcomes using the number of visits and the other specialist visits as the main variables. Results We identified 1743 patients with RA, 1359 with PsA and 2,287 with psoriasis, accounting for 5,677, 4,468 and 7,770 outpatient visits, respectively. Among these, 25% of RA, 32% of PsA and 25% of psoriasis cases received biologics or small molecules, while 49% of RA, 28% of PsA, and 40% of psoriasis cases received glucocorticoids. Patients evaluated also by other specialists were treated more frequently with glucocorticoids (70% vs. 49% for RA, 60% vs. 28% for PsA, 51% vs. 40% for psoriasis; p < 0.001) as well as with biologics/small molecules (49% vs. 25% for RA, 64% vs. 32% in PsA; 51% vs. 25% for psoriasis; p < 0.001) compared to cases seen only by the main specialist. Conclusion Patients with RA, PsA, or psoriasis undergoing multiple evaluations are more likely to receive innovative treatments or glucocorticoids, possibly reflecting more complex cases.
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Affiliation(s)
- Francesca Motta
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy
- Division of Rheumatology and Clinical Immunology, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
| | - Pierandrea Morandini
- Artificial Intelligence Center, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
| | - Fiore Maffia
- Artificial Intelligence Center, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
| | - Matteo Vecellio
- Division of Rheumatology and Clinical Immunology, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
- Wellcome Centre for Human Genetics, University of Oxford, Oxford, United Kingdom
- Centro Ricerche Fondazione Italiana Ricerca Sull'Artrite (FIRA), Fondazione Pisana per la Scienza ONLUS, San Giuliano Terme (Pisa), Milan, Italy
| | - Antonio Tonutti
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy
- Division of Rheumatology and Clinical Immunology, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
| | - Maria De Santis
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy
- Division of Rheumatology and Clinical Immunology, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
| | - Antonio Costanzo
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy
- Division of Dermatology, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
| | - Francesca Puggioni
- Division of Asthma, Allergy and Personalized Medicine, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
| | - Victor Savevski
- Artificial Intelligence Center, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
| | - Carlo Selmi
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy
- Division of Rheumatology and Clinical Immunology, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
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Melo AT, Dourado E, Campanilho-Marques R, Bandeira M, Barreira SC, Costa J, Pimenta R, Antunes-Duarte S, Cordeiro I, Fonseca JE. Myositis Multidisciplinary Clinic in a Tertiary Referral Center. J Multidiscip Healthc 2023; 16:1127-1139. [PMID: 37131932 PMCID: PMC10149065 DOI: 10.2147/jmdh.s404017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2023] [Accepted: 03/28/2023] [Indexed: 05/04/2023] Open
Abstract
Background Idiopathic inflammatory myopathies (IIM) are a rare heterogeneous group of diseases characterised by chronic skeletal muscle inflammation, but other organs are also frequently involved. IMM represent a diagnostic challenge and a multidisciplinary approach is important to ensure successful diagnosis and adequate follow-up of these patients. Objective To describe the general functioning of our multidisciplinary myositis clinic, highlighting the benefits of multidisciplinary team management in patients with confirmed or suspected IIM and to characterise our clinical experience. Methods Description of the organization of a dedicated multidisciplinary myositis outpatient clinic, supported by IMM specific electronic assessment tools and protocols based on our Portuguese Register - Reuma.pt. In addition, an overview of our activity between 2017 and 2022 is provided. Results An IIM multidisciplinary care clinic, based on a close collaboration between Rheumatologists, Dermatologists and Physiatrist is detailed in this paper. One hundred and eighty-five patients were assessed in our myositis clinic; 138 (75%) of those were female, with a median age of 58 [45-70] years. At the last appointment, 130 patients had a confirmed IIM diagnosis, and the mean disease duration was 4 [2-6] years. The most frequent diagnosis was dermatomyositis (n = 34, 26.2%), followed by antisynthetase syndrome (n = 27, 20.8%) and clinically amyopathic/paucimyopathic dermatomyositis (n = 18, 13.8%). Twenty-four patients (18.5%) were on monotherapy and 94 (72.3%) were on combination therapy. Conclusion A multidisciplinary approach is important to ensure the correct diagnosis and follow-up of these patients. A myositis clinic, with a standardised practice at a tertiary hospital level, contributes to a standardization of care and opens research opportunities.
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Affiliation(s)
- Ana Teresa Melo
- Rheumatology Department, Hospital de Santa Maria, Centro Hospitalar Universitário Lisboa Norte, Centro Académico de Medicina de Lisboa, Lisbon, Portugal
- Rheumatology Investigation Unit, Instituto de Medicina Molecular, Faculdade de Medicina, Universidade de Lisboa, Centro Académico de Medicina de Lisboa, Lisbon, Portugal
- Correspondence: Ana Teresa Melo, Serviço de Reumatologia, Centro Hospitalar Universitário Lisboa Norte, Hospital de Santa Maria, EPE, R. Prof. Egas Moniz, Lisboa, 1700, Portugal, Tel +351 217805139, Email
| | - Eduardo Dourado
- Rheumatology Department, Hospital de Santa Maria, Centro Hospitalar Universitário Lisboa Norte, Centro Académico de Medicina de Lisboa, Lisbon, Portugal
- Rheumatology Investigation Unit, Instituto de Medicina Molecular, Faculdade de Medicina, Universidade de Lisboa, Centro Académico de Medicina de Lisboa, Lisbon, Portugal
| | - Raquel Campanilho-Marques
- Rheumatology Department, Hospital de Santa Maria, Centro Hospitalar Universitário Lisboa Norte, Centro Académico de Medicina de Lisboa, Lisbon, Portugal
- Rheumatology Investigation Unit, Instituto de Medicina Molecular, Faculdade de Medicina, Universidade de Lisboa, Centro Académico de Medicina de Lisboa, Lisbon, Portugal
| | - Matilde Bandeira
- Rheumatology Department, Hospital de Santa Maria, Centro Hospitalar Universitário Lisboa Norte, Centro Académico de Medicina de Lisboa, Lisbon, Portugal
- Rheumatology Investigation Unit, Instituto de Medicina Molecular, Faculdade de Medicina, Universidade de Lisboa, Centro Académico de Medicina de Lisboa, Lisbon, Portugal
| | - Sofia C Barreira
- Rheumatology Department, Hospital de Santa Maria, Centro Hospitalar Universitário Lisboa Norte, Centro Académico de Medicina de Lisboa, Lisbon, Portugal
- Rheumatology Investigation Unit, Instituto de Medicina Molecular, Faculdade de Medicina, Universidade de Lisboa, Centro Académico de Medicina de Lisboa, Lisbon, Portugal
| | - José Costa
- Physical Medicine and Rehabilitation Department, Hospital de Santa Maria, Centro Hospitalar Universitário Lisboa Norte, Centro Académico de Medicina de Lisboa, Lisbon, Portugal
| | - Rita Pimenta
- Dermatology Department, Hospital de Santa Maria, Centro Hospitalar Universitário Lisboa Norte, Centro Académico de Medicina de Lisboa, Lisbon, Portugal
| | - Sofia Antunes-Duarte
- Dermatology Department, Hospital de Santa Maria, Centro Hospitalar Universitário Lisboa Norte, Centro Académico de Medicina de Lisboa, Lisbon, Portugal
| | - Inês Cordeiro
- Rheumatology Department, Hospital de Santa Maria, Centro Hospitalar Universitário Lisboa Norte, Centro Académico de Medicina de Lisboa, Lisbon, Portugal
- Rheumatology Investigation Unit, Instituto de Medicina Molecular, Faculdade de Medicina, Universidade de Lisboa, Centro Académico de Medicina de Lisboa, Lisbon, Portugal
| | - João E Fonseca
- Rheumatology Department, Hospital de Santa Maria, Centro Hospitalar Universitário Lisboa Norte, Centro Académico de Medicina de Lisboa, Lisbon, Portugal
- Rheumatology Investigation Unit, Instituto de Medicina Molecular, Faculdade de Medicina, Universidade de Lisboa, Centro Académico de Medicina de Lisboa, Lisbon, Portugal
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Multidisciplinary Rheuma–Derma Clinics: 5 Years of Experience at the San Marco Hospital in Catania. Dermatol Ther (Heidelb) 2022; 12:2829-2837. [PMID: 36333617 PMCID: PMC9674801 DOI: 10.1007/s13555-022-00837-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2022] [Accepted: 10/14/2022] [Indexed: 11/06/2022] Open
Abstract
Introduction Early psoriatic arthritis (PsA) diagnosis is critical to prescribe timely treatment to prevent the irreversible joint damage and the many other problems that patients with PsA experience. This retrospective study aimed to highlight the benefits of a Rheuma–Derma Clinic focused on the early diagnosis and prompt treatment of PsA with a shared approach among Italian psoriasis patients. Diagnosing PsA early is the main goal to reduce joint damage and disability in the patients affected. Studies describing the results of rheuma–derma clinics aimed to reach this goal emerged in the last decade. This study presents limitations and advantages typical of retrospective designs. Methods A Rheuma–Derma Clinic was created in 2017 at the Rheumatology Department of the Hospital Policlinico Gaspare Rodolico of the University of Catania in San Marco, Italy. This study compared the number of patients under disease-modifying antirheumatic treatment 5 years before and after the joint clinic was created. A rheumatologist and dermatologist simultaneously assessed patients with psoriasis and/or PsA to obtain a rapid multidisciplinary diagnostic approach and a shared therapeutic strategy. In addition, demographic, clinical, and clinimetrics data were collected. Results The number of patients with PsA receiving biological disease-modifying antirheumatic drugs increased 47% (from 255 to 374 patients) before and after the joint clinic was implemented. Likewise, those receiving conventional synthetic disease-modifying antirheumatic drugs increased by 47% (from 367 to 539) as well. Additionally, for all the clinimetrics evaluated (DAS28, HAQ, BASDAI, DAPSA, PASI, PGA), there was an improvement over the 12 months under the Rheuma–Derma Clinic care. The measures that improved the most were DAPSA, PGA, PASI, and BASDAI. Conclusion The implementation of the Rheuma–Derma Clinic was associated with an increase in the number of patients diagnosed, the number of patients with PsA receiving DMARD treatments, and improvements in clinimetrics among the study participants. Psoriatic arthritis needs to be detected early to treat it correctly and for its consequences in patients with psoriasis to be prevented. This study was carried out to find out if shared clinics where rheumatologists and dermatologists care for patients together helped to control psoriatic arthritis better and improve the life of the patients affected by it. The shared clinic was created in 2017 at the Rheumatology Department of the Hospital Policlinico Gaspare Rodolico of the University of Catania in San Marco, Italy. The study collected information about the number of patients diagnosed with psoriasis and psoriatic arthritis, the number of patients receiving treatments, and the results of quality of life and other standard tests. During the time that the joint clinic was in place, the number of patients receiving treatments specific for diseases such as psoriatic arthritis increased from 622 (before the clinic was started) to 913. The patients treated in this clinic also had improvements in their quality of life and other aspects. This study found that a clinic where rheumatologists and dermatologists work together to care for patients can increase the number of patients treated with drugs that are specific for their disease and improve their overall health.
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Cusano F, Sampogna F, Brunasso Vernetti AMG, Stisi S, Sandri G, Malara G, Naldi L, Pellegrino M, Tripepi GL, Di Luzio Paparatti U, Agnusdei CP, Bonifati C, Celano A, Corazza V, D'Agostino F, De Pasquale R, Filippucci E, Foti R, Galdo G, Gai F, Ganzetti G, Graceffa D, Maccarone M, Mazzotta A, Melchionda G, Molinaro F, Paoletti F, Tonolo S, Vercellone A, Vitetta R, Massone C, Sebastiani GD. A consensus-based approach on the management of patients with both psoriasis and psoriatic arthritis in the dermatological and rheumatological settings in Italy: The ADOI PSO-Amore Project. Dermatol Reports 2022; 14:9541. [PMID: 36199897 PMCID: PMC9527681 DOI: 10.4081/dr.2022.9541] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2022] [Accepted: 07/20/2022] [Indexed: 11/23/2022] Open
Abstract
Psoriasis is a complex disease often needing a multidisciplinary approach. In particular, the collaboration between dermatologist and rheumatologist is crucial for the management of patients suffering from both psoriasis (PSO) and psoriatic arthritis (PsA). Here we report a series of recommendations from a group of experts, as a result of a Consensus Conference, defining the circumstances in which it is preferable or even mandatory, depending on the available settings, to rely on the opinion of the two specialists, jointly or in a deferred manner. Indications are given on how to organize a 3rd level joint Dermatology- Rheumatology care unit, in connection with 1st and 2nd level clinicians of both specialties, GPs, and other specialists involved in the management of psoriasis. A potential patient journey is suggested, that can be used as a basis for future design and validation of national and/or local diagnostic therapeutic and assistance pathways.
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8
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Hong C, Fang S, Yeo YW, Koh HY, Lee HY, Low AHL, Leung YY. Patient and learner experience in a new set up of a multidisciplinary dermatology-rheumatology clinic care model for psoriatic arthritis. Int J Rheum Dis 2022; 25:861-868. [PMID: 35773971 DOI: 10.1111/1756-185x.14359] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2022] [Revised: 04/28/2022] [Accepted: 05/10/2022] [Indexed: 11/30/2022]
Abstract
OBJECTIVES We described the set-up of a new multidisciplinary psoriatic arthritis-psoriasis (PsA-PsO) clinic incorporating service, education, and research between rheumatologists and dermatologists for PsA. We describe the patients' and learners' experience of this shared-care model. METHODS A PsA-PsO clinic was newly set up in 2019. Each patient was first seen by a trainee, followed by both a dermatologist and a rheumatologist simultaneously in the same consultation room. We collected patients' and learners' experience through self-administered surveys. RESULTS From May 2019 to January 2020, we collected data from 44 visits (55% new referrals, 45% follow up) from 30 patients: 22.7% were referred for diagnostic doubts, 77.3% were for therapeutic issues. Eight of the 10 patients referred for diagnosis had PsA confirmed. Medication changes occurred in 63.6% of visits; 63.6% of patients continued follow up in the PsA-PsO clinic, and 36.4% were discharged back to the original respective care. The median (interquartile range) rating of patient satisfaction of the care was 8 (7-8) out of 10; 96.1% of patients would "probably" or "definitely recommend" the care to others. From 20 learners, 95% reported the experience as "extremely" or "very" beneficial to training. The PsA-PsO clinic was suspended during the COVID-19 pandemic from February 2020 because of lack of available staff. The service was resumed gradually from May 2021. CONCLUSION Despite challenges, we report the set-up of a new care model between dermatologists and rheumatologists for care of patients with psoriatic disease. The care model was well received by patients. Learners from various levels reported benefit from the learning experience.
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Affiliation(s)
- Cassandra Hong
- Department of Rheumatology & Immunology, Singapore General Hospital, Singapore, Singapore
| | - Sarah Fang
- Department of Rheumatology & Immunology, Singapore General Hospital, Singapore, Singapore
| | - Yi-Wei Yeo
- Department of Dermatology, Singapore General Hospital, Singapore, Singapore
| | - Hong-Yi Koh
- Department of Dermatology, Singapore General Hospital, Singapore, Singapore
| | - Haur Yueh Lee
- Department of Dermatology, Singapore General Hospital, Singapore, Singapore
| | - Andrea Hsiu-Ling Low
- Department of Rheumatology & Immunology, Singapore General Hospital, Singapore, Singapore.,Duke-NUS Medical School, Singapore, Singapore
| | - Ying-Ying Leung
- Department of Rheumatology & Immunology, Singapore General Hospital, Singapore, Singapore.,Duke-NUS Medical School, Singapore, Singapore
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Zinterl C, Costa-Reis P, Esteves IC, Marques JG, Sousa AB, Fonseca JE, Oliveira Ramos F. The Added Value of a Multidisciplinary Clinic for Systemic Autoinflammatory Diseases. J Multidiscip Healthc 2022; 15:999-1010. [PMID: 35548670 PMCID: PMC9081005 DOI: 10.2147/jmdh.s351546] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2021] [Accepted: 04/05/2022] [Indexed: 11/23/2022] Open
Affiliation(s)
- Carolina Zinterl
- Pediatric Rheumatology Unit, Hospital de Santa Maria, Centro Hospitalar Universitário Lisboa Norte, Centro Académico de Medicina de Lisboa, Lisbon, Portugal
- Rheumatology Research Unit, Instituto de Medicina Molecular, Faculdade de Medicina, Universidade de Lisboa, Centro Académico de Medicina de Lisboa, Lisbon, Portugal
- Rheumatology Department, Hospital de Santa Maria, Centro Hospitalar Universitário Lisboa Norte, Centro Académico de Medicina de Lisboa, Lisbon, Portugal
- Correspondence: Carolina Zinterl, Serviço de Reumatologia, Centro Hospitalar Lisboa Norte, Hospital de Santa Maria, EPE, R. Prof. Egas Moniz, Lisboa, 1700, Portugal, Tel +351 217805139, Email
| | - Patrícia Costa-Reis
- Pediatric Rheumatology Unit, Hospital de Santa Maria, Centro Hospitalar Universitário Lisboa Norte, Centro Académico de Medicina de Lisboa, Lisbon, Portugal
- Faculdade de Medicina, Universidade de Lisboa, Centro Académico de Medicina de Lisboa, Lisbon, Portugal
- Pediatrics Department, Hospital de Santa Maria, Centro Hospitalar Universitário Lisboa Norte, Centro Académico de Medicina de Lisboa, Lisbon, Portugal
| | - Isabel Castro Esteves
- Pediatrics Department, Hospital de Santa Maria, Centro Hospitalar Universitário Lisboa Norte, Centro Académico de Medicina de Lisboa, Lisbon, Portugal
| | - José Gonçalo Marques
- Pediatrics Department, Hospital de Santa Maria, Centro Hospitalar Universitário Lisboa Norte, Centro Académico de Medicina de Lisboa, Lisbon, Portugal
| | - Ana Berta Sousa
- Pediatrics Department, Hospital de Santa Maria, Centro Hospitalar Universitário Lisboa Norte, Centro Académico de Medicina de Lisboa, Lisbon, Portugal
- Department of Basic Immunology, Faculty of Medicine, Universidade de Lisboa, Centro Académico de Medicina de Lisboa, Lisbon, Portugal
| | - João Eurico Fonseca
- Rheumatology Research Unit, Instituto de Medicina Molecular, Faculdade de Medicina, Universidade de Lisboa, Centro Académico de Medicina de Lisboa, Lisbon, Portugal
- Rheumatology Department, Hospital de Santa Maria, Centro Hospitalar Universitário Lisboa Norte, Centro Académico de Medicina de Lisboa, Lisbon, Portugal
| | - Filipa Oliveira Ramos
- Pediatric Rheumatology Unit, Hospital de Santa Maria, Centro Hospitalar Universitário Lisboa Norte, Centro Académico de Medicina de Lisboa, Lisbon, Portugal
- Rheumatology Research Unit, Instituto de Medicina Molecular, Faculdade de Medicina, Universidade de Lisboa, Centro Académico de Medicina de Lisboa, Lisbon, Portugal
- Rheumatology Department, Hospital de Santa Maria, Centro Hospitalar Universitário Lisboa Norte, Centro Académico de Medicina de Lisboa, Lisbon, Portugal
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10
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Ziob J, Behning C, Brossart P, Bieber T, Wilsmann-Theis D, Schäfer VS. Specialized dermatological-rheumatological patient management improves diagnostic outcome and patient journey in psoriasis and psoriatic arthritis: a four-year analysis. BMC Rheumatol 2021; 5:45. [PMID: 34715940 PMCID: PMC8556909 DOI: 10.1186/s41927-021-00217-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2021] [Accepted: 07/03/2021] [Indexed: 11/23/2022] Open
Abstract
Background Management of psoriasis patients with arthralgia suffering from suspected psoriatic arthritis (PsA) requires an interdisciplinary approach involving dermatologists and rheumatologists. The aim of the study was to analyze the specialized dermatological-rheumatological management of these patients before and after foundation of a PsA center. Methods A retrospective cohort study of all dermatological-rheumatological consultations during two periods was conducted. Period one, from April 1st, 2016 to February 28th, 2018 versus period two, from March 1st, 2018 to January 31st, 2020, after foundation of a PsA center. Clinical data on patient characteristics including psoriasis subtypes, clinical symptoms and signs, disease activity scores, classification criteria and comorbidities as well as patient journey were extracted and analyzed. Results Four hundred four consultations were studied. Close collaboration in a PsA center lead to a relevantly shortened patient journey concerning rheumatological complaints: period 1: median (IQR): 36.0 (10.0–126.0) months, period 2: median (IQR): 24.0 (6.0–60.0) months. Established scores and classification criteria such as GEPARD or CASPAR did not assist in diagnosis of PsA. Arthralgia (p = 0.0407), swollen joints (p = 0.0151), morning stiffness (p = 0.0451) and dactylitis (p = 0.0086) helped to distinguish between osteoarthritis and PsA. Conclusions Clinical signs and symptoms, scores and classification criteria usually assessed were less helpful than expected in diagnosis of PsA. Close collaboration in a specialized PsA center yielded the fastest way of diagnosis.
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Affiliation(s)
- Jana Ziob
- Department of Dermatology and Allergy, University Hospital of Bonn, Venusberg-Campus 1, 53127, Bonn, Germany.
| | - Charlotte Behning
- Department of Medical Biometry, Informatics and Epidemiology, University Hospital of Bonn, Bonn, Germany
| | - Peter Brossart
- Clinic of Internal Medicine III, Department of Oncology, Hematology, Rheumatology and Clinical Immunology, University Hospital of Bonn, Bonn, Germany
| | - Thomas Bieber
- Department of Dermatology and Allergy, University Hospital of Bonn, Venusberg-Campus 1, 53127, Bonn, Germany
| | - Dagmar Wilsmann-Theis
- Department of Dermatology and Allergy, University Hospital of Bonn, Venusberg-Campus 1, 53127, Bonn, Germany
| | - Valentin Sebastian Schäfer
- Clinic of Internal Medicine III, Department of Oncology, Hematology, Rheumatology and Clinical Immunology, University Hospital of Bonn, Bonn, Germany
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11
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Ogdie A, Rozycki M, Arndt T, Shi C, Kim N, Hur P. Longitudinal analysis of the patient pathways to diagnosis of psoriatic arthritis. Arthritis Res Ther 2021; 23:252. [PMID: 34598717 PMCID: PMC8485539 DOI: 10.1186/s13075-021-02628-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2021] [Accepted: 09/12/2021] [Indexed: 02/08/2023] Open
Abstract
Background The occurrence of health events preceding a psoriatic arthritis (PsA) diagnosis may serve as predictors of diagnosis. We sought to assess patients’ real-world experiences in obtaining a PsA diagnosis. Methods This retrospective cohort study analyzed MarketScan claims data from January 2006 to April 2019. Included were adult patients with ≥ 2 PsA diagnoses (ICD-9-CM/ICD-10-CM) ≥ 30 days apart with ≥ 6 years of continuous enrolment before PsA diagnosis. Controls were matched 2:1 to patients with PsA. Health events (diagnoses and provider types) were analyzed before PsA diagnosis and additionally stratified by presence of psoriasis. Results Of 13,661 patients, those with PsA had an increased history of coding for arthritis and dermatologic issues (osteoarthritis [48% vs 22%], rheumatoid arthritis [18% vs 2%], and psoriasis [61% vs 2%]) vs those without PsA. Diagnoses of arthritis, axial symptoms, and tendonitis/enthesitis increased over time preceding PsA diagnosis; notably, a sharp rise in psoriasis diagnoses was observed 6 months before PsA diagnosis. Rheumatology consults were more common immediately preceding a PsA diagnosis. Dermatologists were unlikely to code for arthritis and musculoskeletal issues, while rheumatologists were unlikely to code for psoriasis; general practitioners focused on axial and musculoskeletal symptoms. PsA was most commonly diagnosed by rheumatologists (40%), general practitioners (22%), and dermatologists (7%). Conclusions Rheumatologists, general practitioners, and dermatologists diagnosed two thirds of patients with PsA. Musculoskeletal symptoms were common preceding a PsA diagnosis. Greater awareness of patterns of health events may alert healthcare providers to suspect a diagnosis of PsA.
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Affiliation(s)
- Alexis Ogdie
- Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA.
| | | | | | - Cheng Shi
- Novartis Pharmaceuticals Corporation, East Hanover, NJ, USA
| | - Nina Kim
- The University of Texas at Austin, Austin, TX, USA.,Baylor Scott and White Health, Temple, TX, USA
| | - Peter Hur
- Novartis Pharmaceuticals Corporation, East Hanover, NJ, USA
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12
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Abstract
Psoriatic arthritis (PsA) is a complex inflammatory disease with heterogeneous clinical features, which complicates psoriasis in 30% of patients. There are no diagnostic criteria or tests available. Diagnosis is most commonly made by identifying inflammatory musculoskeletal features in joints, entheses or the spine in the presence of skin and/or nail psoriasis and in the usual absence of rheumatoid factor and anti-cyclic citrullinated peptide. The evolution of psoriasis to PsA may occur in stages, although the mechanisms are unclear. In many patients, there may be little or no relationship between severity of musculoskeletal inflammation and severity of skin or nail psoriasis. The reason for this disease heterogeneity may be explained by differences in genotype, especially in the HLA region. New targeted therapies for PsA have been approved with additional therapies in development. These developments have substantially improved both short-term and long-term outcomes including a reduction in musculoskeletal and skin manifestations and in radiographic damage. With efforts underway aimed at improving our understanding of the molecular basis for the heterogeneity of PsA, a personalized approach to treating PsA may become possible.
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13
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So H, Tam LS. Cardiovascular disease and depression in psoriatic arthritis: Multidimensional comorbidities requiring multidisciplinary management. Best Pract Res Clin Rheumatol 2021; 35:101689. [DOI: 10.1016/j.berh.2021.101689] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
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14
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Gratacós J, Behrens F, Coates LC, Lubrano E, Thaçi D, Bundy C, de la Torre-Aboki J, Luelmo J, Voorneveld H, Richette P. A 12-point recommendation framework to support advancement of the multidisciplinary care of psoriatic arthritis: A call to action. Joint Bone Spine 2021; 88:105175. [PMID: 33771760 DOI: 10.1016/j.jbspin.2021.105175] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2020] [Accepted: 02/22/2021] [Indexed: 12/21/2022]
Abstract
OBJECTIVE Making a differential diagnosis of psoriatic arthritis (PsA) is not straightforward. This is partly because of its heterogeneous presentation and partly because many patients with PsA are initially diagnosed with psoriasis and treated in primary care or by dermatologists, with referral to rheumatologists being delayed. Once diagnosed, optimal disease control requires frequent specialist monitoring, adjustment or switching of therapies, and management of comorbidities and concomitant diseases, as well as attention to patients' overall well-being. Given the breadth of expertise that diagnosis and management of PsA requires, we sought to define a collaborative, structured framework that supports the optimisation of multidisciplinary care for patients with PsA in Europe. METHODS An expert panel comprising four rheumatologists, three dermatologists, two specialist nurses and one psychologist-from Spain, the United Kingdom, The Netherlands, Germany, France and Italy-met face-to-face to take part in a modified Delphi exercise. RESULTS The result of this exercise is a set of recommendations that are based on combining published evidence with the panel's extensive clinical experience. Recommendations can be implemented in a number of ways, but the central call-to-action of this framework is the need for improved collaboration between dermatologists (or primary care physicians) and rheumatologists. This could occur in a variety of different formats: standard referral pathways, multidisciplinary physician meetings to discuss patient cases, or 'one stop', combined clinics. CONCLUSION We anticipate that when the majority of patients with PsA receive regular multidisciplinary care, improved patient outcomes will follow, although robust research is needed to explore this assumption.
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Affiliation(s)
- Jordi Gratacós
- Rheumatology Department, Hospital Universitario Parc Taulí de Sabadell, I3PT, UAB, Parc Taulí, 1 Sabadell, Barcelona, Spain
| | - Frank Behrens
- CIRI/Rheumatologie und Fraunhofer IME-Translationale Medizin und Pharmakologie, Goethe-Universität, Frankfurt am Main, Germany
| | - Laura C Coates
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, Botnar Research Centre, Windmill Road, Oxford, UK
| | - Ennio Lubrano
- Academic Rheumatology Unit, Dipartimento di Medicina e Scienze della Salute "Vincenzo Tiberio", Università degli Studi del Molise, Campobasso, Italy
| | - Diamant Thaçi
- Institute and Comprehensive Center for Inflammation Medicine, University of Lübeck, Lübeck, Germany
| | - Christine Bundy
- School of Healthcare Sciences, Cardiff University, Cardiff, UK
| | | | - Jesus Luelmo
- Department of Dermatology, Hospital of Sabadell, Corporació Sanitària Parc Taulí, Autonomous University of Barcelona, Barcelona, Spain
| | | | - Pascal Richette
- Service de Rhumatologie, Hôpital Lariboisiere Centre Viggo Petersen, Université de Paris, 2, Rue Ambroise-Pare, 75010 Paris, France; Inserm UMR1132 Bioscar, Universite Paris Diderot UFR de Medecine, Paris, France.
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15
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Leal I, Romão VC, Mano S, Khmelinskii N, Campanilho-Marques R, Ponte C, Macieira C, Oliveira-Ramos F, Vieira-Sousa E, Rosa CM, Rodrigues W, Abegão Pinto L, Marques-Neves C, Fonseca JE. A Non-Infectious Uveitis Multidisciplinary Clinic in a Tertiary Referral Center: Clinical Impact and Added Value. J Multidiscip Healthc 2021; 14:695-704. [PMID: 33790568 PMCID: PMC7997415 DOI: 10.2147/jmdh.s292981] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2020] [Accepted: 01/29/2021] [Indexed: 12/17/2022] Open
Abstract
Non-infectious uveitis (NIU) is a group of sight-threatening diseases that generates significant burden for the healthcare systems due to its adverse outcomes, irreversible structural complications in the eye with loss of visual function, limited clinical expertise and low-grade evidence for best practice. The usefulness of multidisciplinary care, specifically close collaboration between Rheumatologists and Ophthalmologists in NIU, has been emphasized in the literature. In this paper, the assessment tools and protocols used in our clinic are depicted and an overview of our activity with a brief description of the patients included in our registry, between 2018 and 2020 is provided. The cohort of 290 patients assessed in our NIU clinic, their demographics, sources of referral, details about immunosuppression treatment, and internal and external collaborations is described. This experience-based manuscript aims to describe the general functioning of our multidisciplinary NIU clinic, highlighting the benefits and drawbacks of multidisciplinary team management in patients with NIU, ultimately initiating a dialogue on what an NIU clinic should be and providing information for newly NIU clinics start-up. In conclusion, establishing a standardized and multidisciplinary clinic in NIU allows to systematically observe and follow-up this infrequent disease at a tertiary hospital level, thus improving quality of care delivery and research avenues.
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Affiliation(s)
- Inês Leal
- Ophthalmology Department, Hospital de Santa Maria, Centro Hospitalar Univeristário Lisboa Norte, Centro Académico de Medicina de Lisboa, Lisbon, Portugal.,Centro de Estudos das Ciências da Visão, Clínica Universitária de Oftalmologia, Faculdade de Medicina, Universidade de Lisboa, Lisbon, Portugal
| | - Vasco C Romão
- Rheumatology Department, Hospital de Santa Maria, Centro Hospitalar Universitário Lisboa Norte, Centro Académico de Medicina de Lisboa, Lisbon, Portugal.,Rheumatology Research Unit, Instituto de Medicina Molecular, Faculdade de Medicina, Universidade de Lisboa, Lisbon, Portugal
| | - Sofia Mano
- Ophthalmology Department, Hospital de Santa Maria, Centro Hospitalar Univeristário Lisboa Norte, Centro Académico de Medicina de Lisboa, Lisbon, Portugal.,Centro de Estudos das Ciências da Visão, Clínica Universitária de Oftalmologia, Faculdade de Medicina, Universidade de Lisboa, Lisbon, Portugal
| | - Nikita Khmelinskii
- Rheumatology Department, Hospital de Santa Maria, Centro Hospitalar Universitário Lisboa Norte, Centro Académico de Medicina de Lisboa, Lisbon, Portugal.,Rheumatology Research Unit, Instituto de Medicina Molecular, Faculdade de Medicina, Universidade de Lisboa, Lisbon, Portugal
| | - Raquel Campanilho-Marques
- Rheumatology Department, Hospital de Santa Maria, Centro Hospitalar Universitário Lisboa Norte, Centro Académico de Medicina de Lisboa, Lisbon, Portugal.,Rheumatology Research Unit, Instituto de Medicina Molecular, Faculdade de Medicina, Universidade de Lisboa, Lisbon, Portugal
| | - Cristina Ponte
- Rheumatology Department, Hospital de Santa Maria, Centro Hospitalar Universitário Lisboa Norte, Centro Académico de Medicina de Lisboa, Lisbon, Portugal.,Rheumatology Research Unit, Instituto de Medicina Molecular, Faculdade de Medicina, Universidade de Lisboa, Lisbon, Portugal
| | - Carla Macieira
- Rheumatology Department, Hospital de Santa Maria, Centro Hospitalar Universitário Lisboa Norte, Centro Académico de Medicina de Lisboa, Lisbon, Portugal
| | - Filipa Oliveira-Ramos
- Rheumatology Department, Hospital de Santa Maria, Centro Hospitalar Universitário Lisboa Norte, Centro Académico de Medicina de Lisboa, Lisbon, Portugal.,Rheumatology Research Unit, Instituto de Medicina Molecular, Faculdade de Medicina, Universidade de Lisboa, Lisbon, Portugal
| | - Elsa Vieira-Sousa
- Rheumatology Department, Hospital de Santa Maria, Centro Hospitalar Universitário Lisboa Norte, Centro Académico de Medicina de Lisboa, Lisbon, Portugal.,Rheumatology Research Unit, Instituto de Medicina Molecular, Faculdade de Medicina, Universidade de Lisboa, Lisbon, Portugal
| | - Carlos Miranda Rosa
- Rheumatology Department, Hospital de Santa Maria, Centro Hospitalar Universitário Lisboa Norte, Centro Académico de Medicina de Lisboa, Lisbon, Portugal
| | - Walter Rodrigues
- Ophthalmology Department, Hospital de Santa Maria, Centro Hospitalar Univeristário Lisboa Norte, Centro Académico de Medicina de Lisboa, Lisbon, Portugal.,Centro de Estudos das Ciências da Visão, Clínica Universitária de Oftalmologia, Faculdade de Medicina, Universidade de Lisboa, Lisbon, Portugal
| | - Luís Abegão Pinto
- Ophthalmology Department, Hospital de Santa Maria, Centro Hospitalar Univeristário Lisboa Norte, Centro Académico de Medicina de Lisboa, Lisbon, Portugal.,Centro de Estudos das Ciências da Visão, Clínica Universitária de Oftalmologia, Faculdade de Medicina, Universidade de Lisboa, Lisbon, Portugal
| | - Carlos Marques-Neves
- Ophthalmology Department, Hospital de Santa Maria, Centro Hospitalar Univeristário Lisboa Norte, Centro Académico de Medicina de Lisboa, Lisbon, Portugal.,Centro de Estudos das Ciências da Visão, Clínica Universitária de Oftalmologia, Faculdade de Medicina, Universidade de Lisboa, Lisbon, Portugal
| | - João Eurico Fonseca
- Rheumatology Department, Hospital de Santa Maria, Centro Hospitalar Universitário Lisboa Norte, Centro Académico de Medicina de Lisboa, Lisbon, Portugal.,Rheumatology Research Unit, Instituto de Medicina Molecular, Faculdade de Medicina, Universidade de Lisboa, Lisbon, Portugal
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16
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Tsai TF, Hsieh TY, Chi CC, Chou CT, Hsieh LF, Chen HH, Hui RCY, Lee CH, Liu CH, Liu HC, Yeo KJ, Chen CH, Chen HA, Chen YC, Chen YJ, Chiu HY, Ho JC, Huang YH, Lai PJ, Lee WR, Liao HT, Lin SH, Tseng JC, Wang TS, Wu NL, Yang DH, Tsai WC, Wei JCC. Recommendations for psoriatic arthritis management: A joint position paper of the Taiwan Rheumatology Association and the Taiwanese Association for Psoriasis and Skin Immunology. J Formos Med Assoc 2021; 120:926-938. [PMID: 33012636 DOI: 10.1016/j.jfma.2020.08.026] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2020] [Revised: 05/25/2020] [Accepted: 08/18/2020] [Indexed: 01/14/2023] Open
Abstract
In Taiwan, the incidence and prevalence of psoriatic arthritis (PsA) have risen significantly in recent years. Moreover, data from the Taiwan National Health Insurance Research Database (NHIRD) show that more than 85% of PsA patients are treated with just non-steroidal anti-inflammatory drugs (NSAIDs) and/or conventional synthetic disease-modifying anti-rheumatic drugs (csDMARDs). Taiwanese clinicians have also expressed concerns regarding uncertainties in the diagnosis of PsA and the delayed, interrupted, and/or tapered use of biologics, as well as differences in therapeutic preferences between and within dermatologists and rheumatologists. To address these issues, the Taiwan Rheumatology Association and the Taiwanese Association for Psoriasis and Skin Immunology jointly convened a committee of 28 clinicians from the fields of rheumatology, dermatology, orthopedics, and rehabilitation, to develop evidence-based consensus recommendations for the practical management of PsA in Taiwan. A total of six overarching principles and 13 recommendations were developed and approved, as well as a treatment algorithm with four separate tracks for axial PsA, peripheral PsA, enthesitis, and dactylitis. Psoriasis (PsO) management was not discussed here, as the Taiwanese Dermatological Association has recently published a comprehensive consensus statement on the management of PsO. Together, these recommendations provide an up-to-date, evidence-based framework for PsA care in Taiwan.
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Affiliation(s)
- Tsen-Fang Tsai
- Department of Dermatology, College of Medicine, National Taiwan University, Taipei, Taiwan; Department of Dermatology, National Taiwan University Hospital, Taipei, Taiwan
| | - Tsu-Yi Hsieh
- Division of Allergy-Immunology-Rheumatology, Taichung Veterans General Hospital, Taichung, Taiwan; Program of Business, College of Business, Feng Chia University, Taichung, Taiwan
| | - Ching-Chi Chi
- Department of Dermatology, Chang Gung Memorial Hospital-Linkou, Taoyuan, Taiwan; College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Chung-Tei Chou
- Division of Allergy, Immunology and Rheumatology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Lin-Fen Hsieh
- Department of Physical Medicine and Rehabilitation, Shin Kong Wu Ho-Su Memorial Hospital, Taipei, Taiwan; School of Medicine, Fu Jen Catholic University, New Taipei City, Taiwan
| | - Hsin-Hua Chen
- Division of Allergy-Immunology-Rheumatology, Taichung Veterans General Hospital, Taichung, Taiwan
| | - Rosaline Chung-Yee Hui
- Department of Dermatology, Chang Gung Memorial Hospital-Linkou, Taoyuan, Taiwan; College of Medicine, Chang Gung University, Taoyuan, Taiwan; Department of Dermatology, Chang Gung Memorial Hospital-Keelung, Keelung, Taiwan
| | - Chih-Hung Lee
- College of Medicine, Chang Gung University, Taoyuan, Taiwan; Department of Dermatology, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan
| | - Chin-Hsiu Liu
- Division of Allergy, Immunology and Rheumatology, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, New Taipei City, Taiwan; School of Medicine, Tzu Chi University, Hualien, Taiwan
| | - Hwa-Chang Liu
- Department of Orthopedic Surgery, National Taiwan University Hospital, Taipei, Taiwan; Department of Orthopedics Surgery, Taiwan Adventist Hospital, Taipei, Taiwan
| | - Kai-Jieh Yeo
- Division of Rheumatology and Immunology, China Medical University Hospital, Taichung, Taiwan
| | - Chun-Hsiung Chen
- Division of Allergy, Immunology and Rheumatology, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, New Taipei City, Taiwan
| | - Hung-An Chen
- Department of Allergy, Immunology, and Rheumatology, Chi Mei Medical Center, Tainan, Taiwan
| | - Ying-Chou Chen
- Department of Rheumatology, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Yi-Ju Chen
- Department of Dermatology, Taichung Veterans General Hospital, Taichung, Taiwan
| | - Hsien-Yi Chiu
- Department of Dermatology, College of Medicine, National Taiwan University, Taipei, Taiwan; Department of Dermatology, National Taiwan University Hospital, Taipei, Taiwan; Department of Dermatology, National Taiwan University Hospital Hsin-Chu Branch, Hsinchu, Taiwan
| | - Ji-Chen Ho
- College of Medicine, Chang Gung University, Taoyuan, Taiwan; Department of Dermatology, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan; Department of Dermatology, Chang Gung Memorial Hospital-Chiayi, Chiayi, Taiwan
| | - Yu-Huei Huang
- Department of Dermatology, Chang Gung Memorial Hospital-Linkou, Taoyuan, Taiwan; College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Po-Ju Lai
- Division of Dermatology, Chung Shan Medical University Hospital, Taichung, Taiwan
| | - Woan-Ruoh Lee
- Department of Dermatology, Taipei Medical University Shuang Ho Hospital, Taipei, Taiwan; Department of Dermatology, School of Medicine, Taipei Medical University, Taipei, Taiwan; Graduate Institute of Medical Science, Taipei Medical University, Taipei, Taiwan
| | - Hsien-Tzung Liao
- Division of Allergy, Immunology and Rheumatology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan; Faculty of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Shang-Hung Lin
- College of Medicine, Chang Gung University, Taoyuan, Taiwan; Department of Dermatology, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan
| | - Jui-Cheng Tseng
- Division of Allergy, Immunology, and Rheumatology, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan
| | - Ting-Shun Wang
- Department of Dermatology, College of Medicine, National Taiwan University, Taipei, Taiwan; Department of Dermatology, National Taiwan University Hospital, Taipei, Taiwan; Division of Dermatology, Chung Shan Medical University Hospital, Taichung, Taiwan; Department of Dermatology, Chung Shan Medical University, Taichung, Taiwan
| | - Nan-Lin Wu
- Department of Dermatology, MacKay Memorial Hospital, Taipei, Taiwan; Department of Medicine, MacKay Medical College, New Taipei City, Taiwan
| | - Deng-Ho Yang
- Division of Rheumatology/Immunology/Allergy, Department of Internal Medicine, Taichung Armed-Forces General Hospital, Taichung, Taiwan; Department of Medical Laboratory Science and Biotechnology, Central Taiwan University of Science and Technology, Taichung, Taiwan; Division of Rheumatology/Immunology/Allergy, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | - Wen-Chan Tsai
- Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
| | - James Cheng-Chung Wei
- Institute of Medicine, Chung Shan Medical University, Taichung, Taiwan; Division of Allergy, Immunology and Rheumatology, Chung Shan Medical University Hospital, Taichung, Taiwan; Graduate Institute of Integrated Medicine, China Medical University, Taichung, Taiwan.
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17
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Dermatologists’ Role in the Early Diagnosis of Psoriatic Arthritis: Expert Recommendations. ACTAS DERMO-SIFILIOGRAFICAS 2020. [DOI: 10.1016/j.adengl.2020.10.025] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023] Open
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18
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Belinchón I, Salgado-Boquete L, López-Ferrer A, Ferran M, Coto-Segura P, Rivera R, Vidal D, Rodríguez L, de la Cueva P, Queiro R. Dermatologists' Role in the Early Diagnosis of Psoriatic Arthritis: Expert Recommendations. ACTAS DERMO-SIFILIOGRAFICAS 2020; 111:835-846. [PMID: 32659259 PMCID: PMC7351070 DOI: 10.1016/j.ad.2020.06.004] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2020] [Revised: 06/25/2020] [Accepted: 06/29/2020] [Indexed: 12/31/2022] Open
Abstract
Psoriatic arthritis is a common type of inflammatory arthritis found in up to 40% of patients with psoriasis. Because skin involvement usually precedes joint involvement, dermatologists play a key role in early detection. Early diagnosis is important for reducing the risk of irreversible structural damage, attenuating the deterioration of physical function, and improving patients' quality of life. This consensus statement was drafted by a group of 9 dermatologists and 1 rheumatologist to provide simple recommendations to help dermatologists screen for psoriatic arthritis in patients with psoriasis. The experts offer consensus-based guidelines that draw on a review of available scientific evidence and on experience acquired in routine clinical practice.
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Affiliation(s)
- I Belinchón
- Servicio de Dermatología, Hospital General Universitario de Alicante-ISABIAL-UMH, Alicante, España
| | - L Salgado-Boquete
- Servicio de Dermatología, Complejo Hospitalario Universitario de Pontevedra, Pontevedra, España
| | - A López-Ferrer
- Servicio de Dermatología, Hospital de la Santa Creu i Sant Pau, Barcelona, España
| | - M Ferran
- Servicio de Dermatología, Hospital del Mar, Barcelona, España
| | - P Coto-Segura
- Servicio de Dermatología, Hospital Álvarez-Buylla, Mieres, Asturias, España
| | - R Rivera
- Servicio de Dermatología, Hospital Universitario 12 de Octubre, Madrid, España
| | - D Vidal
- Servicio de Dermatología, Hospital de Sant Joan Despí Moisès Broggi, Sant Joan Despí, Barcelona, España
| | - L Rodríguez
- Servicio de Dermatología, Hospital Universitario Virgen del Rocío, Sevilla, España
| | - P de la Cueva
- Servicio de Dermatología, Hospital Universitario Infanta Leonor, Madrid, España.
| | - R Queiro
- Servicio de Reumatología, Hospital Universitario Central de Asturias, Oviedo, España
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19
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Patient-Centered Care in Psoriatic Arthritis-A Perspective on Inflammation, Disease Activity, and Psychosocial Factors. J Clin Med 2020; 9:jcm9103103. [PMID: 32992983 PMCID: PMC7600723 DOI: 10.3390/jcm9103103] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2020] [Revised: 09/11/2020] [Accepted: 09/23/2020] [Indexed: 12/14/2022] Open
Abstract
Psoriatic arthritis (PsA) is a seronegative spondyloarthropathy characterized by skin lesions, dactylitis, and enthesitis. Patients with PsA suffer from a variety of psychosocial difficulties and nonspecific symptoms early on in the disease course and continue to experience progressive disease due to delays in diagnosis and treatment. Symptoms initially viewed as somatization could lead to undertreatment and promote psychological distress, poor coping, and negative patient-provider relationships. Pain and fatigue are important complaints that affect the patient's perception and may need to be addressed with a multidisciplinary approach. Maladaptive cognitive responses can lead to a negative illness perception and impact patient beliefs and concerns over treatment, as well as nonadherence. An underlying inflammatory component in affective disorders has been examined, though whether and how it may interact mechanistically in PsA warrants interest. Cognitive behavioral therapy represents a nonpharmacological treatment modality that can be combined with cytokine-targeted therapy to address both somatic and psychological complaints. Future directions for research include: (1) Elucidating nonspecific manifestations (e.g., subclinical stage, differential with functional syndromes) of PsA and how they impact diagnosis and management; (2) characterizing immune-mediated components of mood disorders in PsA; and (3) whether a bidirectional approach with abrogating inflammation and psychotherapeutic support leads to improved outcomes.
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20
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Sumpton D, Hannan E, Kelly A, Tunnicliffe D, Ming A, Hassett G, Craig JC, Tong A. Clinicians' perspectives of shared care of psoriatic arthritis and psoriasis between rheumatology and dermatology: an interview study. Clin Rheumatol 2020; 40:1369-1380. [PMID: 32935247 DOI: 10.1007/s10067-020-05391-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2020] [Revised: 08/26/2020] [Accepted: 09/09/2020] [Indexed: 10/23/2022]
Abstract
OBJECTIVE Shared care between rheumatologists and dermatologists is advocated for patients with psoriasis and psoriatic arthritis, but care provided by rheumatologists and dermatologists is often siloed, leading to inconsistencies in patient care and outcomes. This study aimed to describe rheumatologists' and dermatologists' perspectives on shared care. METHODS Face-to-face semi-structured interviews were conducted with 15 rheumatologists and 12 dermatologists across 27 centers in Australia. Transcripts were thematically analyzed. RESULTS Five themes were identified: uncertainties in disciplinary tensions (lacking expertise to make diagnosis, hesitation managing outside of scope, doubting screening tools, defaulting to own disciplinary priorities, hampered by lack of evidence), working in fragmented care (frustration with working in silos, striving to coordinate with primary care, persevering despite inequities in access to care, overwhelmed by managing comorbidities, under-resourced for complexity), building trusting relationships (establishing a culture of collaboration, seeking reliable cross-specialty help, depending on unique skills), prioritizing efficiency (minimizing burden for patients, avoiding resource overuse, deferring to pragmatic decisions), and strengthened by integrated care models (improving the timeliness and accuracy of care, centering on patient goals and understanding, enhancing cross-specialty partnerships, providing opportunities for education and training). CONCLUSIONS Rheumatologists and dermatologists endeavor to provide comprehensive care to their patients in disjointed healthcare settings but are hampered by a lack of training and a sense of feeling overburdened in the management of comorbidities. Interdisciplinary models are perceived to improve the care of patients but are limited by financial barriers to implementation and concerns about wasting health resources and improperly burdening patients. Key Points • Rheumatologists and dermatologists perceive that shared care models improve the care for their patients with psoriatic arthritis and psoriasis by improving the timeliness and accuracy of management, making the patient the center of care, and enhancing shared care relationships between specialties. • Screening tools to detect psoriatic arthritis may be under-utilized by dermatologists due to doubt about the accuracy of instruments and competing priorities in time-limited consultations. • Management of comorbid disease is challenging for rheumatologists and dermatologists due to a need to prioritize their specialty area and a sense of feeling overburdened while working in fragmented healthcare systems.
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Affiliation(s)
- Daniel Sumpton
- Department of Rheumatology, Concord Repatriation General Hospital, Sydney, NSW, Australia. .,The University of Sydney School of Public Health, Sydney, NSW, Australia. .,Centre for Kidney Research, The Children's Hospital Westmead, Sydney, NSW, Australia.
| | - Elyssa Hannan
- The University of Sydney School of Public Health, Sydney, NSW, Australia.,Centre for Kidney Research, The Children's Hospital Westmead, Sydney, NSW, Australia
| | - Ayano Kelly
- The University of Sydney School of Public Health, Sydney, NSW, Australia.,Centre for Kidney Research, The Children's Hospital Westmead, Sydney, NSW, Australia.,Australian National University, Canberra, ACT, Australia.,Department of Rheumatology, Liverpool Hospital, Sydney, NSW, Australia
| | - David Tunnicliffe
- The University of Sydney School of Public Health, Sydney, NSW, Australia.,Centre for Kidney Research, The Children's Hospital Westmead, Sydney, NSW, Australia
| | - Andrew Ming
- Department of Dermatology, The Children's Hospital Westmead, Sydney, NSW, Australia
| | - Geraldine Hassett
- Department of Rheumatology, Liverpool Hospital, Sydney, NSW, Australia.,South Western Sydney Clinical School, University of New South Wales, Sydney, NSW, Australia.,Ingham Institute for Applied Medical Research, Sydney, NSW, Australia
| | - Jonathan C Craig
- College of Medicine and Public Health, Flinders University, Adelaide, South Australia, Australia
| | - Allison Tong
- The University of Sydney School of Public Health, Sydney, NSW, Australia.,Centre for Kidney Research, The Children's Hospital Westmead, Sydney, NSW, Australia
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21
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García EI, Guilabert M, Queiro R, Carrillo I, Mira JJ. Evaluating standards of care in psoriatic arthritis of the QUANTUM project (qualitative initiative to improve outcomes): results of an accreditation project in Spain. Rheumatol Int 2020; 40:1817-1823. [PMID: 32588190 PMCID: PMC7519894 DOI: 10.1007/s00296-020-04632-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2020] [Accepted: 06/15/2020] [Indexed: 11/16/2022]
Abstract
In Spain, the QUANTUM project has been promoted to reduce variability in clinical practice and improve the care and quality of life of people with psoriatic arthritis (PsA) by accrediting PsA units throughout the Spanish national health system. To present the results of this approach which sought to ensure an optimum level of quality for patients with PsA. Descriptive analysis of the self-assessments that the PsA units have carried out assessing their degree of compliance with the quality standards established in the QUANTUM project grouped into four blocks: shortening time to diagnosis; optimizing disease management; improving multidisciplinary collaboration; and improving patient monitoring. A total of 41 PsA units were self-evaluated. They met 64.1% of the defined quality standards. Optimize disease management obtained a higher level of standards compliance (72%) and improve multidisciplinary collaboration the lesser (63.9%). Accessibility to the treatments available for PsA in all hospitals was guaranteed (100%). Appropriate diagnostic equipment is available (97.6%). Compliance with specific quality standards leads to detect actions that should be implemented: quality of life assessment (9.8%), locomotor system assessment (12.2%), physical examination data record (14.6%), periodic cardiovascular risk assessment (17.1%). The QUANTUM project results make it possible to visualise how to care for patients with PsA is being developed in Spain. Problems identified in recent multinational reports are also identified in Spain.
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Affiliation(s)
| | - Mercedes Guilabert
- Calite Research Group, Universidad Miguel Hernández de Elche., Health Psychology Department, Altamira Building, Avenida de la Universidad, s/n, 03202, Elche, Spain.
| | - Rubén Queiro
- Rheumatology Division, Hospital Universitario Central de Asturias, Oviedo, Spain
| | - Irene Carrillo
- Calite Research Group, Universidad Miguel Hernández de Elche., Health Psychology Department, Altamira Building, Avenida de la Universidad, s/n, 03202, Elche, Spain.,The Foundation for the Promotion of Health and Biomedical Research of Valencia Region, FISABIO, Sant Joan d'Alacant, Spain
| | - José Joaquín Mira
- Calite Research Group, Universidad Miguel Hernández de Elche., Health Psychology Department, Altamira Building, Avenida de la Universidad, s/n, 03202, Elche, Spain.,Alicante-Sant Joan Health District, Alicante, Spain.,REDISSEC, Madrid, Spain
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22
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Sanz Sanz J, Beltrán E, Díaz-Miguel Pérez MC, Fernández-Carballido C, Galíndez E, García Porrua C, Gratacós J, Medina J, Queiro R, Ramírez J, Reina D, Rodríguez Lozano C, Rodríguez Martínez FJ, Rubio E, Veroz R. Norma de calidad para el manejo del paciente con artritis psoriásica: proyecto QUANTUM. ACTA ACUST UNITED AC 2020; 16:203-215. [DOI: 10.1016/j.reuma.2018.06.011] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2018] [Revised: 06/12/2018] [Accepted: 06/26/2018] [Indexed: 12/27/2022]
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23
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Theodorakopoulou E, Dalamaga M, Katsimbri P, Boumpas DT, Papadavid E. How does the joint dermatology-rheumatology clinic benefit both patients and dermatologists? Dermatol Ther 2020; 33:e13283. [PMID: 32092214 DOI: 10.1111/dth.13283] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2019] [Revised: 02/17/2020] [Accepted: 02/18/2020] [Indexed: 11/30/2022]
Abstract
Psoriasis (Pso) and psoriatic arthritis (PsA) are chronic and debilitating diseases which often develop in the same patient and are linked to a wide range of comorbid conditions. Dermatologists and rheumatologists need to cooperate in combined clinics, especially when they deal with severe, recalcitrant disease, and multiple comorbidities. The clinical and research benefits of this collaboration have been previously described to contribute to a better and more sustainable health care system. To apply a more holistic approach of patients with Pso and PsA, we established the first dual care clinic in Greece, for Pso and PsA patients, based at Attikon General University Hospital. Hereby, we describe the infrastructure and operation of a combined Pso and PsA clinic (PPAC), in the national health care system of Greece, and its impact on the management of Pso and PsA. The PPAC is a single-day joint clinic, held once a week, which consists of three dermatologists and three rheumatologists. We present the results of 185 newly diagnosed patients between December 2018 and January 2019. Mean age of onset of Pso was 34 ± 16 years old and 47 ± 12 years old for PsA. Most patients suffered from severe plaque Pso (144/185, 78%) and asymmetric oligoarticular arthritis (59/185, 32%), for which they were receiving treatment with biologic agents (105/185, 57%). Many required monitoring for hypertension (74/185, 40%), dyslipidemia (69/185, 37%), diabetes (17/185, 9%), and depression (20/185, 11%). Patients reported high levels of care satisfaction (visual analogue scale: 86 ± 11.5), using the PPAC facility, compared to different referrals between specialties. This is the first joint dermatology-rheumatology clinic in Greece, providing comprehensive care in patients with Pso and PsA. Our results support the concept of combined clinics delivering better integrated care for such patients.
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Affiliation(s)
- Elina Theodorakopoulou
- 2nd Dermatology Clinic, Attikon General University Hospital, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Maria Dalamaga
- 2nd Dermatology Clinic, Attikon General University Hospital, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece.,Department of Biological Chemistry, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Pelagia Katsimbri
- 4th Department of Internal Medicine, Rheumatology Clinic, Attikon General University Hospital, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Dimitrios T Boumpas
- 4th Department of Internal Medicine, Rheumatology Clinic, Attikon General University Hospital, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Evangelia Papadavid
- 2nd Dermatology Clinic, Attikon General University Hospital, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
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24
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Boca AN, Ilies RF, Vesa S, Pop R, Tataru AD, Buzoianu AD. The first nation-wide study revealing epidemiologic data and life quality aspects of psoriasis in Romania. Exp Ther Med 2019; 18:900-904. [PMID: 31384321 DOI: 10.3892/etm.2019.7652] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2018] [Accepted: 02/27/2019] [Indexed: 11/05/2022] Open
Abstract
Psoriasis is a chronic, immune mediated, inflammatory condition, which primarily affects the patient's skin. It is known to associate a variable array of comorbidities such as cardiovascular, metabolic and psychiatric ones, with an important impact on the patients' quality of life. The purpose of this study is to provide a first image of the prevalence, comorbidities, as well as the social impact of psoriasis in Romania. We devised a questionnaire, and with the aid of general practitioners throughout the country, delivered it to patients seeking medical care in their office. The questionnaire assessed demographic criteria as well as patient-related issues. It was completed in the presence of the general practitioner, and clear written instructions for completion were included. After statistical analysis, the resulting data formed the basis of this study. The reported prevalence of psoriasis in Romania is 5.18%. Almost half of the subjects who completed the questionnaire stated they knew somebody affected by the disease, yet almost a third believed it is a contagious condition. Cardiovascular and psychiatric comorbidities, as well as negative impact on social interactions were reported by the subjects in the study. These findings indicate the clear need for better quality of life for patients in a social context and increased awareness of the disease. All these could, in turn, help decrease the rate of psoriasis complications in Romania.
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Affiliation(s)
- Andreea Nicoleta Boca
- Department of Pharmacology, Toxicology and Clinical Pharmacology, 'Iuliu Hatieganu' University of Medicine and Pharmacy, 400337 Cluj-Napoca, Romania
| | - Roxana Flavia Ilies
- Department of Medical Genetics, Faculty of Medicine, 'Iuliu Hatieganu' University of Medicine and Pharmacy, 400349 Cluj-Napoca, Romania
| | - Stefan Vesa
- Department of Pharmacology, Toxicology and Clinical Pharmacology, 'Iuliu Hatieganu' University of Medicine and Pharmacy, 400337 Cluj-Napoca, Romania
| | - Raluca Pop
- Department of Pharmacology, Toxicology and Clinical Pharmacology, 'Iuliu Hatieganu' University of Medicine and Pharmacy, 400337 Cluj-Napoca, Romania
| | - Alexandru Dumitru Tataru
- Department of Dermatology, 'Iuliu Hatieganu' University of Medicine and Pharmacy, 400006 Cluj-Napoca, Romania
| | - Anca Dana Buzoianu
- Department of Pharmacology, Toxicology and Clinical Pharmacology, 'Iuliu Hatieganu' University of Medicine and Pharmacy, 400337 Cluj-Napoca, Romania
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25
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Experience and satisfaction with a multidisciplinary care unit for patients with psoriasis an psoriatic arthritis. ACTA ACUST UNITED AC 2019; 15:237-241. [DOI: 10.1016/j.reuma.2017.07.007] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2017] [Revised: 07/04/2017] [Accepted: 07/06/2017] [Indexed: 01/31/2023]
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26
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Luchetti MM, Benfaremo D, Bendia E, Bolognini L, Fava G, Marini F, Di Sario A, Ciferri M, Di Nicola F, Marconi V, Perini L, Manfredi L, Pomponio G, Mosca P, Benedetti A, Gabrielli A. Clinical and patient reported outcomes of the multidisciplinary management in patients with inflammatory bowel disease-associated spondyloarthritis. Eur J Intern Med 2019; 64:76-84. [PMID: 31047747 DOI: 10.1016/j.ejim.2019.04.015] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2019] [Revised: 04/19/2019] [Accepted: 04/23/2019] [Indexed: 02/07/2023]
Abstract
OBJECTIVE Arthritis is the most frequent extra-intestinal manifestation in patients with inflammatory bowel diseases (IBD). The coexistence of intestinal and articular inflammation advocates the need for a multidisciplinary management of patients with IBD-associated spondyloarthritis. METHODS Consecutive IBD patients were evaluated jointly by the gastroenterologist and the rheumatologist in a combined clinic. All the patients were assessed and screened for articular involvement, disease activity and health related quality of life. After the prescription of a shared treatment, patients with spondyloarthritis were followed up for 24 months. RESULTS Two hundred sixty-two IBD patients, including 80 who were classified as affected by spondyloarthritis according to the ASAS criteria, were included in the study. At baseline, patients with both IBD and spondyloarthritis showed worse quality of life in both the physical and mental domains. The multidisciplinary management provided a significant improvement of gastrointestinal and articular manifestations, as well as the health-related quality of life. Moreover, global and gastrointestinal-specific quality of life significantly correlated with articular disease activity. CONCLUSION The multidisciplinary management significantly improves both articular and gastrointestinal disease activities and the quality of life of patients with IBD-associated spondyloarthritis. An appropriate screening strategy and the integrated management of these patients should be encouraged and employed in clinical practice.
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Affiliation(s)
- Michele Maria Luchetti
- Dipartimento Scienze Cliniche e Molecolari, Clinica Medica, Università Politecnica delle Marche, 60020 Ancona, Italy.
| | - Devis Benfaremo
- Dipartimento Scienze Cliniche e Molecolari, Clinica Medica, Università Politecnica delle Marche, 60020 Ancona, Italy
| | - Emanuele Bendia
- Clinica di Gastroenterologia, Università Politecnica delle Marche, 60020 Ancona, Italy; IBD-UNIT, and Dipartimento Gastroenterologico e dei Trapianti, Polo Ospedaliero-Universitario "Umberto I-G.M. Lancisi- G. Salesi", 60126 Ancona, Italy
| | - Laura Bolognini
- IBD-UNIT, and Dipartimento Gastroenterologico e dei Trapianti, Polo Ospedaliero-Universitario "Umberto I-G.M. Lancisi- G. Salesi", 60126 Ancona, Italy
| | - Giammarco Fava
- IBD-UNIT, and Dipartimento Gastroenterologico e dei Trapianti, Polo Ospedaliero-Universitario "Umberto I-G.M. Lancisi- G. Salesi", 60126 Ancona, Italy
| | - Francesco Marini
- IBD-UNIT, and Dipartimento Gastroenterologico e dei Trapianti, Polo Ospedaliero-Universitario "Umberto I-G.M. Lancisi- G. Salesi", 60126 Ancona, Italy
| | - Antonio Di Sario
- Clinica di Gastroenterologia, Università Politecnica delle Marche, 60020 Ancona, Italy; IBD-UNIT, and Dipartimento Gastroenterologico e dei Trapianti, Polo Ospedaliero-Universitario "Umberto I-G.M. Lancisi- G. Salesi", 60126 Ancona, Italy
| | - Monia Ciferri
- Dipartimento Scienze Cliniche e Molecolari, Clinica Medica, Università Politecnica delle Marche, 60020 Ancona, Italy
| | - Francesca Di Nicola
- Dipartimento Scienze Cliniche e Molecolari, Clinica Medica, Università Politecnica delle Marche, 60020 Ancona, Italy
| | - Valentina Marconi
- Dipartimento Scienze Cliniche e Molecolari, Clinica Medica, Università Politecnica delle Marche, 60020 Ancona, Italy
| | - Lucia Perini
- Dipartimento Scienze Cliniche e Molecolari, Clinica Medica, Università Politecnica delle Marche, 60020 Ancona, Italy
| | - Lucia Manfredi
- Dipartimento Scienze Cliniche e Molecolari, Clinica Medica, Università Politecnica delle Marche, 60020 Ancona, Italy
| | - Giovanni Pomponio
- Dipartimento Scienze Cliniche e Molecolari, Clinica Medica, Università Politecnica delle Marche, 60020 Ancona, Italy
| | - Piergiorgio Mosca
- IBD-UNIT, and Dipartimento Gastroenterologico e dei Trapianti, Polo Ospedaliero-Universitario "Umberto I-G.M. Lancisi- G. Salesi", 60126 Ancona, Italy
| | - Antonio Benedetti
- Clinica di Gastroenterologia, Università Politecnica delle Marche, 60020 Ancona, Italy; IBD-UNIT, and Dipartimento Gastroenterologico e dei Trapianti, Polo Ospedaliero-Universitario "Umberto I-G.M. Lancisi- G. Salesi", 60126 Ancona, Italy
| | - Armando Gabrielli
- Dipartimento Scienze Cliniche e Molecolari, Clinica Medica, Università Politecnica delle Marche, 60020 Ancona, Italy
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Kiltz U, Legeler C, Maier-Peuschel M, Mann C, Tony HP. Baseline Characteristics of Patients with Ankylosing Spondylitis and Psoriatic Arthritis Treated with Secukinumab in the Real-World Setting: AQUILA, a Non-Interventional Study. Open Rheumatol J 2019. [DOI: 10.2174/1874312901913010053] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
Objective:
AQUILA is an ongoing, multicenter, prospective, Non-Interventional Study (NIS) with secukinumab, designed to evaluate real-world evidence for different aspects of treatment in patients with Ankylosing Spondylitis (AS) and psoriatic arthritis (PsA) in Germany. Here we report the study design and baseline characteristics including comorbidities and prior medication of patients as well as insights into medical care in Germany.
Methods:
Patients (age ≥18 years) with active AS or PsA, who were under secukinumab treatment or just about initiating secukinumab therapy based on medical therapeutic need,
are
enrolled. Each patient
is
observed for 52 weeks.
Results:
A total of 572 patients (AS, n = 187; PsA, n = 385) have been recruited in this ongoing study. Mean age, weight, and BMI were similar between the subgroups. About 66.4% of patients had previously received biologics other than secukinumab. Depression was the most common comorbidity (AS, 9.1%; PsA, 15.6%). Plaque psoriasis was also frequently reported (AS, 9.6%; PsA, 62.3%).
Conclusion:
The Non-Interventional Study (NIS) baseline characteristics indicate that the demographics were similar to populations of previous secukinumab trials of AS and PsA patients except
to
comorbidities and exposure to biologics. A majority of the patients who received secukinumab in this setting had previously received biologics. Comorbidities relating to obesity and cardiovascular disease were particularly evident in PsA patients whereas the elevated depression prevalence was equally distributed.
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28
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Visalli E, Crispino N, Foti R. Multidisciplinary Management of Psoriatic Arthritis: The Benefits of a Comprehensive Approach. Adv Ther 2019; 36:806-816. [PMID: 30805821 DOI: 10.1007/s12325-019-00901-0] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2018] [Indexed: 12/11/2022]
Abstract
Psoriatic arthritis (PsA) is a lifelong disease associated with extra-articular manifestations and several comorbidities, as well as reduced quality of life and psychosocial burden. Diagnostic delay is associated with poorer outcomes, while a short delay between symptom onset and diagnosis is linked with preservation of function. Overcoming the barriers to early diagnosis of PsA is often difficult to achieve in the absence of well-characterized disease markers and/or a definitive screening procedure. Once a diagnosis is made, approaches to care may differ between countries, but a treat-to-target approach can be advocated, with constant patient follow-up visits and specialist monitoring and treatment of comorbidities. Adequately addressing all aspects of care can help to drive patient-centered care and encourage better adherence. Given the mounting number of therapeutic options and the complexity of management of PsA, the disease can be optimally treated by a multidisciplinary approach, and a collaborative approach between rheumatologists and dermatologists can be advocated. The need for multidisciplinary management is reinforced by consensus among experts. Patient satisfaction has emerged as a central indicator of quality, and patient-centered care must remain a central goal for the care of patients with PsA. Definition of a minimum set of standards for care will help to achieve the goal of multidisciplinary care for patients with PsA. Optimal care of PsA and greater collaboration among clinicians should always be encouraged so that patients can receive the best possible quality of care.Funding: Pfizer Italy.
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Affiliation(s)
- Elisa Visalli
- Rheumatology Unit A. O. U. Policlinico Vittorio Emanuele, Catania, Italy.
| | | | - Rosario Foti
- Rheumatology Unit A. O. U. Policlinico Vittorio Emanuele, Catania, Italy
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29
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Winthrop KL, Weinblatt ME, Crow MK, Burmester GR, Mease PJ, So AK, Bykerk V, Van Vollenhoven RF, Dougados M, Kay J, Mariette X, Sieper J, Melchers F, Cronstein BN, Shevach E, Breedfeld FC, Kalden J, Smolen JS, Furst DE. Unmet need in rheumatology: reports from the Targeted Therapies meeting 2018. Ann Rheum Dis 2019; 78:872-878. [PMID: 30712015 DOI: 10.1136/annrheumdis-2018-214280] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2018] [Revised: 11/16/2018] [Accepted: 01/19/2019] [Indexed: 12/13/2022]
Abstract
To develop a comprehensive listing of the greatest unmet scientific and clinical needs in rheumatology. The 20th annual international Targeted Therapies meeting brought more than 100 leading basic scientists and clinical researchers in rheumatology, immunology, epidemiology, molecular biology and other specialties. During the meeting, breakout sessions were convened, consisting of five disease-specific groups with 20-30 experts assigned to each group based on expertise. Specific groups included rheumatoid arthritis, psoriatic arthritis, axial spondyloarthritis, systemic lupus erythematosus, connective tissue diseases and a basic science immunology group spanning all of these clinical domains. In each group, experts were asked to consider recent accomplishments within their clinical domain in the last year and update the unmet needs in three categorical areas: basic/translational science, clinical science and therapeutic development, and clinical care. While progress was noted among some of previously identified needs, both new needs were identified and themes from prior meetings were re-iterated: the need for better understanding the heterogeneity within each disease, and for identifying preclinical states of disease allowing treatment and prevention of disease in those at risk, and the elusive ability to cure disease. Within the clinical care realm, improved comorbidity management and patient-centred care continue to be unmet needs, and the need for new and affordable therapeutics was highlighted. Unmet needs for new and accessible targeted therapies, disease prevention and ultimately cure remain a priority in rheumatology.
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Affiliation(s)
| | | | - Mary K Crow
- Hospital for Special Surgery, New York City, New York, USA
| | | | - Philip J Mease
- Swedish Medical Center, University of Washington, Seattle, Washington, USA
| | | | - Vivian Bykerk
- Hospital for Special Surgery, New York City, New York, USA
| | | | | | - Jonathan Kay
- University of Massachusetts Medical School, Worcester, Massachusetts, USA
| | | | - Joachim Sieper
- Department of Gastroenterology, Infectious Diseases and Rheumatology, Campus Benjamin Franklin, Charité, Berlin, Germany
| | - Fritz Melchers
- Max Planck Institute for Infection Biology, Berlin, Germany.,Deutsches Rheumaforschungszentrum, Berlin, Germany
| | | | - Ethan Shevach
- National Institutes of Health, Bethesda, Maryland, USA
| | | | | | - Josef S Smolen
- Division of Rheumatology, Department of Medicine 3, Medical University of Vienna, Vienna, Austria
| | - Daniel E Furst
- Swedish Medical Center, University of Washington, Seattle, Washington, USA.,Los Angeles Medical Center, University of California, Los Angeles, California, USA.,University of Florence, Florence, Italy
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30
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Campagna M, Castillo R, Mattessich S, Mandhadi R, Lu J. Impact of a combined dermatology-rheumatology clinic on management of autoimmune connective tissue disorders. Clin Exp Dermatol 2018; 44:e24-e25. [PMID: 30264536 DOI: 10.1111/ced.13766] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/23/2018] [Indexed: 11/26/2022]
Affiliation(s)
- M Campagna
- Department of Dermatology, UConnHealth Center, Farmington, CT, USA
| | - R Castillo
- Department of Internal Medicine, UConnHealth Center, Farmington, CT, USA
| | - S Mattessich
- University of Connecticut School of Medicine, 263 Farmington Avenue, Farmington, CT, USA
| | - R Mandhadi
- Department of Rheumatology, UConnHealth Center, Farmington, CT, USA
| | - J Lu
- Department of Dermatology, UConnHealth Center, Farmington, CT, USA
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Clinical outcomes and feasibility of the multidisciplinary management of patients with psoriatic arthritis: two-year clinical experience of a dermo-rheumatologic clinic. Clin Rheumatol 2018; 37:2741-2749. [PMID: 30056525 DOI: 10.1007/s10067-018-4238-4] [Citation(s) in RCA: 36] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2018] [Revised: 07/19/2018] [Accepted: 07/23/2018] [Indexed: 01/05/2023]
Abstract
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.
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Foulkes AC, Ferguson F, Grindlay DJC, Williams HC, Griffiths CEM, Warren RB. What's new in psoriasis treatment? An analysis of systematic reviews published in 2015. Clin Exp Dermatol 2018; 43:759-765. [PMID: 29806111 DOI: 10.1111/ced.13601] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/24/2018] [Indexed: 12/16/2022]
Abstract
This review provides a summary of key findings from 27 systematic reviews of 51 articles first published or indexed during 2015, focusing on the treatment of psoriasis and on precision medicine in psoriasis. The evidence supports weight-loss interventions by dieting and exercise for improvement in disease severity in overweight and obese patients with psoriasis. No significant increased risk of serious infections was reported for the biologic therapies adalimumab, etanercept and ustekinumab compared with appropriate comparators. Evidence could not provide reliable estimates of rare adverse events, emphasizing the need for large prospective registries. Polymorphisms in the tumour necrosis factor (TNF)-α gene may confer improved responses to TNF inhibitor (TNFI) therapy, but the studies to date lack power to detect a true association. From the limited available evidence, multidisciplinary management is both more effective and more satisfactory for patients with psoriasis and psoriatic arthritis than conventional consultations. This summary of reviews provides a succinct guide for clinicians and patients wishing to remain up to date with high-quality evidence for the treatment of psoriasis.
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Affiliation(s)
- A C Foulkes
- The Dermatology Centre, NIHR Manchester Biomedical Research Centre, Manchester, UK
| | - F Ferguson
- The Dermatology Centre, NIHR Manchester Biomedical Research Centre, Manchester, UK
| | - D J C Grindlay
- Centre of Evidence Based Dermatology, University of Nottingham, Nottingham, UK
| | - H C Williams
- Centre of Evidence Based Dermatology, University of Nottingham, Nottingham, UK
| | - C E M Griffiths
- The Dermatology Centre, NIHR Manchester Biomedical Research Centre, Manchester, UK
| | - R B Warren
- The Dermatology Centre, NIHR Manchester Biomedical Research Centre, Manchester, UK
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Rizzello F, Olivieri I, Armuzzi A, Ayala F, Bettoli V, Bianchi L, Cimino L, Costanzo A, Cristaudo A, D'Angelo S, Daperno M, Fostini AC, Galeazzi M, Gilio M, Gionchetti P, Gisondi P, Lubrano E, Marchesoni A, Offidani A, Orlando A, Pugliese D, Salvarani C, Scarpa R, Vecchi M, Girolomoni G. Multidisciplinary Management of Spondyloarthritis-Related Immune-Mediated Inflammatory Disease. Adv Ther 2018. [PMID: 29516409 PMCID: PMC5910456 DOI: 10.1007/s12325-018-0672-6] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Introduction Immune-mediated inflammatory diseases (IMIDs) are chronic autoimmune conditions that share common pathophysiologic mechanisms. The optimal management of patients with IMIDs remains challenging because the coexistence of different conditions requires the intervention of several specialists. The aim of this study was to develop a series of statements defining overarching principles that guide the implementation of a multidisciplinary approach for the management of spondyloarthritis (SpA)-related IMIDs including SpA, psoriasis, psoriatic arthritis, Crohn’s disease, ulcerative colitis and uveitis. Methods A Delphi consensus-based approach was used to identify a core set of statements. The process included development of initial questions by a steering committee, an exhaustive search of the literature using complementary approaches to identify potential statements and two Delphi voting rounds for finalization of the statements. Results Consensus was achieved on the related nature of IMIDs, the existence of a high prevalence of multiple IMIDs in a single patient and the fact that a multidisciplinary approach can result in a more extensive evaluation and comprehensive approach to treatment. The goals of a multidisciplinary team should be to increase diagnosis of concomitant IMIDs, improve the decision-making process, and increase patient satisfaction and adherence. Early referral and diagnosis, early recognition of concomitant IMIDs and optimizing treatment to improve patient quality of life are some of the advantages of using multidisciplinary teams. To be effective, a multidisciplinary team should be equipped with the appropriate tools for diagnosis and follow-up, and at a minimum the multidisciplinary team should include a dermatologist, gastroenterologist and rheumatologist; providing psychologic support via a psychologist and involving an ophthalmologist, general practitioners and nurses in multidisciplinary care is also important. Conclusion The present Delphi consensus identified a set of overarching principles that may be useful for implementation of a multidisciplinary approach for the management of SpA-related IMIDs. Funding Aristea and Hippocrates.
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Affiliation(s)
- Fernando Rizzello
- IBD Unit, DIMEC, University of Bologna, S Orsola-Malpighi Hospital Bologna, Bologna, Italy
| | - Ignazio Olivieri
- Istituto Reumatologico Lucano (IReL), Potenza, Italy
- Dipartimento di Reumatologia della Regione Basilicata, Ospedale Madonna delle Grazie di Matera, Potenza, Italy
- Dipartimento di Reumatologia della Regione Basilicata, Ospedale San Carlo di Potenza, Potenza, Italy
- Fondazione BRB (Basilicata Ricerca Biomedica), Potenza, Italy
| | - Alessandro Armuzzi
- UOC di Medicina Interna e Malattie dell'Apparato Digerente, Presidio Columbus Fondazione Policlinico Gemelli Universita' Cattolica, Rome, Italy
| | - Fabio Ayala
- UOC di Dermatologia, Dipartimento di Medicina Clinica e Chirurgia, Università di Napoli Federico II, Naples, Italy
| | - Vincenzo Bettoli
- Department of Clinical and Experimental Dermatology, O.U. of Dermatology, Azienda Ospedaliero-Universitaria di Ferrara, Ferrara, Italy
| | - Luca Bianchi
- U.O.C. Dermatologia, Fondazione Policlinico Tor Vergata, Tor Vergata University of Rome, Rome, Italy
| | - Luca Cimino
- SSD di Immunologia Oculare, AUSL-IRCCS Reggio Emilia, Reggio Emilia, Italy
| | - Antonio Costanzo
- Unità Dermatologia Dipartimento di Scienze Biomediche Humanitas University, Rozzano, Milan, Italy
- UOC Dermatologia IRCCS Istituto Clinico Humanitas, Rozzano, Milan, Italy
| | - Antonio Cristaudo
- UO Dermatologia, MST, Ambientale e Tropicale San Gallicano Dermatological Institute-IRCCS, Rome, Italy
| | - Salvatore D'Angelo
- Istituto Reumatologico Lucano (IReL), Potenza, Italy.
- Dipartimento di Reumatologia della Regione Basilicata, Ospedale Madonna delle Grazie di Matera, Potenza, Italy.
- Dipartimento di Reumatologia della Regione Basilicata, Ospedale San Carlo di Potenza, Potenza, Italy.
- Fondazione BRB (Basilicata Ricerca Biomedica), Potenza, Italy.
| | - Marco Daperno
- Gastroenterology Unit, Mauriziano Hospital, Turin, Italy
| | - Anna Chiara Fostini
- Section of Dermatology and Venereology, Department of Medicine, University of Verona, Verona, Italy
| | - Mauro Galeazzi
- Dipartimento di Scienze Mediche, Chirurgiche e Neuroscienze, Università degli Studi di Siena, Siena, Italy
| | - Michele Gilio
- Istituto Reumatologico Lucano (IReL), Potenza, Italy
- Dipartimento di Reumatologia della Regione Basilicata, Ospedale Madonna delle Grazie di Matera, Potenza, Italy
- Dipartimento di Reumatologia della Regione Basilicata, Ospedale San Carlo di Potenza, Potenza, Italy
- Department of Health Science, University "Magna Grecia", Catanzaro, Italy
| | - Paolo Gionchetti
- IBD Unit, Department of Medical and Surgical Sciences, S. Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy
| | - Paolo Gisondi
- Section of Dermatology and Venereology, Department of Medicine, University of Verona, Verona, Italy
| | - Ennio Lubrano
- Dipartimento di Medicina e Scienze della Salute "Vincenzo Tiberio", Università degli Studi del Molise, Campobasso, Italy
| | - Antonio Marchesoni
- U.O.C. Day Hospital di Reumatologia, ASST Gaetano Pini-CTO, Milan, Italy
| | | | - Ambrogio Orlando
- UOSD MICI-A.O. Ospedali Riuniti "Villa Sofia-Cervello" Palermo, Palermo, Italy
| | - Daniela Pugliese
- UOC di Medicina Interna e Malattie dell'Apparato Digerente, Presidio Columbus Fondazione Policlinico Gemelli Universita' Cattolica, Rome, Italy
| | - Carlo Salvarani
- Azienda USL-IRCCS e Università di Modena e Reggio Emilia, Reggio Emilia, Italy
| | | | - Maurizio Vecchi
- Department of Biomedical Science for the Health, University of Milan, Milan, Italy
- Gastroenterology and Endoscopy Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Giampiero Girolomoni
- Section of Dermatology and Venereology, Department of Medicine, University of Verona, Verona, Italy
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Gratacós J, Luelmo J, Rodríguez J, Notario J, Marco TN, de la Cueva P, Busquets MP, Font MG, Joven B, Rivera R, Vega JLA, Álvarez AJC, Parera RS, Carrascosa JCR, Martínez FJR, Sánchez JP, Olmos CF, Pujol C, Galindez E, Barrio SP, Arana AU, Hergueta M, Coto P, Queiro R. Standards of care and quality indicators for multidisciplinary care models for psoriatic arthritis in Spain. Rheumatol Int 2018; 38:1115-1124. [PMID: 29417210 DOI: 10.1007/s00296-018-3986-4] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2017] [Accepted: 01/17/2018] [Indexed: 11/25/2022]
Abstract
To define and give priority to standards of care and quality indicators of multidisciplinary care for patients with psoriatic arthritis (PsA). A systematic literature review on PsA standards of care and quality indicators was performed. An expert panel of rheumatologists and dermatologists who provide multidisciplinary care was established. In a consensus meeting group, the experts discussed and developed the standards of care and quality indicators and graded their priority, agreement and also the feasibility (only for quality indicators) following qualitative methodology and a Delphi process. Afterwards, these results were discussed with 2 focus groups, 1 with patients, another with health managers. A descriptive analysis is presented. We obtained 25 standards of care (9 of structure, 9 of process, 7 of results) and 24 quality indicators (2 of structure, 5 of process, 17 of results). Standards of care include relevant aspects in the multidisciplinary care of PsA patients like an appropriate physical infrastructure and technical equipment, the access to nursing care, labs and imaging techniques, other health professionals and treatments, or the development of care plans. Regarding quality indicators, the definition of multidisciplinary care model objectives and referral criteria, the establishment of responsibilities and coordination among professionals and the active evaluation of patients and data collection were given a high priority. Patients considered all of them as important. This set of standards of care and quality indicators for the multidisciplinary care of patients with PsA should help improve quality of care in these patients.
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Affiliation(s)
- Jordi Gratacós
- Servicio de Reumatología, Rheumatology Department, Hospital universitario Parc Taulí de Sabadell, I3PT, UAB, Parc Taulí, 1 Sabadell, 08208, Barcelona, Spain.
| | - Jesús Luelmo
- Servicio de Dermatología, Hospital universitario Parc Taulí de Sabadell, I3PT, UAB, Barcelona, Spain
| | - Jesús Rodríguez
- Servicio de Reumatología, Hospital Universitari de Bellvitge, Barcelona, Spain
| | - Jaume Notario
- Servicio de Dermatología, Hospital Universitari de Bellvitge, Barcelona, Spain
| | - Teresa Navío Marco
- Servicio de Reumatología, Universitario el Hospital Universitario Infanta Leonor, Madrid, Spain
| | - Pablo de la Cueva
- Servicio de Dermatología, Universitario el Hospital Universitario Infanta Leonor, Madrid, Spain
| | | | - Mercè García Font
- Servicio de Dermatología, Hospital Mutua de Terrassa, Barcelona, Spain
| | - Beatriz Joven
- Servicio de Reumatología, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - Raquel Rivera
- Servicio de Dermatología, Hospital Universitario 12 de Octubre, Madrid, Spain
| | | | | | - Ricardo Sánchez Parera
- Servicio de Reumatología, Complejo Hospitalario Universitario de Granada, Granada, Spain
| | | | | | - José Pardo Sánchez
- Servicio de Dermatología, Hospital General Universitario Santa Lucía, Cartagena, Murcia, Spain
| | - Carlos Feced Olmos
- Servicio de Reumatología, Hospital Universitari i Politècnic La Fe, Valencia, Spain
| | - Conrad Pujol
- Servicio de Dermatología, Hospital Universitari i Politècnic La Fe, Valencia, Spain
| | - Eva Galindez
- Servicio de Reumatología, Hospital de Basurto, Bilbao, Bizkaia, Spain
| | | | | | | | - Pablo Coto
- Servicio de dermatología, Hospital Universitario Central de Asturias, Oviedo, Spain
| | - Rubén Queiro
- Servicio de Reumatología, Hospital Universitario Central de Asturias, Oviedo, Spain
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Early Recognition and Treatment Heralds Optimal Outcomes: the Benefits of Combined Rheumatology–Dermatology Clinics and Integrative Care of Psoriasis and Psoriatic Arthritis Patients. Curr Rheumatol Rep 2017; 20:1. [DOI: 10.1007/s11926-017-0706-0] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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36
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Queiro R, Coto P. Multidisciplinary care for psoriatic disease: Where we are and where we need to go. Rheumatology (Oxford) 2017; 56:1829-1831. [PMID: 28053273 DOI: 10.1093/rheumatology/kew485] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/09/2016] [Indexed: 11/13/2022] Open
Affiliation(s)
- Rubén Queiro
- Rheum-Derm Unit, Hospital Universitario Central de Asturias, Oviedo, Spain
| | - Pablo Coto
- Rheum-Derm Unit, Hospital Universitario Central de Asturias, Oviedo, Spain
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Winthrop KL, Strand V, van der Heijde D, Mease P, Crow M, Weinblatt M, Bathon J, Burmester GR, Dougados M, Kay J, Mariette X, Van Vollenhoven R, Sieper J, Melchers F, Breedfeld FC, Kalden J, Smolen JS, Furst DE. The unmet need in rheumatology: Reports from the targeted therapies meeting 2017. Clin Immunol 2017; 186:87-93. [PMID: 28811201 DOI: 10.1016/j.clim.2017.08.009] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2017] [Accepted: 08/11/2017] [Indexed: 12/21/2022]
Abstract
The 19th annual international Targeted Therapies meeting brought together over 100 leading basic scientists and clinical researchers from around the world in the field of immunology, molecular biology and rheumatology and other specialties. During the meeting, breakout sessions were held consisting of 5 disease-specific groups with 20-40 experts assigned to each group based on clinical or scientific expertise. Specific groups included: rheumatoid arthritis, psoriatic arthritis, axial spondyloarthritis, systemic lupus erythematous, connective tissue diseases (e.g. Sjogren's syndrome, Systemic sclerosis, vasculitis including Bechet's and IgG4 related disease), and a basic science immunology group spanning all of the above clinical domains. In each group, experts were asked to consider and update previously identified unmet needs in 3 categorical areas: basic/translational science, clinical science and therapeutic development, and clinical care. Overall, similar primary unmet needs were identified within each disease foci, and several additional needs were identified since the time of last year's congress. Within translational/basic science, the need for better understanding the heterogeneity within each disease was highlighted so that predictive tools for therapeutic responses can be developed. Within clinical science and therapeutic trials, a strong focus was placed upon the need to identify pre-clinical states of disease allowing prevention in those at risk. The ability to cure remains perhaps the ultimate unmet need. Further, the need to develop new and affordable therapeutics, as well as to conduct strategic trials of currently approved therapies was again highlighted. Within the clinical care realm, improved co-morbidity management and patient-centered care were identified as unmet needs. Lastly, it was strongly felt there was a need to develop a scientific infrastructure for well-characterized, longitudinal cohorts paired with biobanks and mechanisms to support data-sharing. This infrastructure could facilitate many of the unmet needs identified within each disease area.
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Affiliation(s)
| | - Vibeke Strand
- Stanford University School of Medicine, Palo Alto, CA, USA
| | | | - Philip Mease
- Swedish Medical Center, University of Washington, Seattle, WA, USA
| | - Mary Crow
- Hospital for Special Surgery, New York, NY, USA
| | | | | | | | | | - Johnathan Kay
- University of Massachusetts Medical School, Worcester, MA, USA
| | | | | | - Joachim Sieper
- Department of Gastroenterology, Infectious Diseases and Rheumatology, Campus Benjamin Franklin, Charité, Berlin, Germany
| | - Fritz Melchers
- Max Planck Institute for Infection Biology, Berlin, Germany; Deutsches Rheumaforschungszentrum, Berlin, Germany
| | | | | | - Josef S Smolen
- Division of Rheumatology, Department of Medicine 3, Medical University of Vienna, Austria
| | - Daniel E Furst
- University of California, Los Angeles Medical Center, Los Angeles, CA, USA
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38
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Queiro R, Coto P, Rodríguez J, Notario J, Navío Marco T, de la Cueva P, Pujol Busquets M, García Font M, Joven B, Rivera R, Alvarez Vega JL, Chaves Álvarez AJ, Sánchez Parera R, Ruiz Carrascosa JC, Rodríguez Martínez FJ, Pardo Sánchez J, Feced Olmos C, Pujol C, Galindez E, Pérez Barrio S, Urruticoechea Arana A, Hergueta M, Luelmo J, Gratacós J. Modelos de atención multidisciplinar en pacientes con artritis psoriásica en España. ACTA ACUST UNITED AC 2017; 13:85-90. [DOI: 10.1016/j.reuma.2016.03.005] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2015] [Revised: 02/16/2016] [Accepted: 03/03/2016] [Indexed: 11/24/2022]
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39
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Leijten EFA, Sigurdsson V, Wenink MH, Radstake TRDJ. Screening for psoriatic arthritis using the Psoriasis Epidemiology Screening Tool questionnaire: examining the optimal cut-off. Br J Dermatol 2017; 176:1357-1359. [PMID: 27515861 DOI: 10.1111/bjd.14953] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Affiliation(s)
- E F A Leijten
- Department of Rheumatology and Clinical Immunology, Universitair Medisch Centrum Utrecht, Utrecht, The Netherlands
| | - V Sigurdsson
- Department of Dermatology, Universitair Medisch Centrum Utrecht, Utrecht, The Netherlands
| | - M H Wenink
- Sint Maartenskliniek, Department of Rheumatology, Nijmegen, Gelderland, The Netherlands
| | - T R D J Radstake
- Department of Rheumatology and Clinical Immunology, Universitair Medisch Centrum Utrecht, Utrecht, The Netherlands
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Points to Consider in the Foundation of Multidisciplinary Units for Psoriatic Arthritis: A Delphi Study and a Systematic Review of the Literature. Adv Ther 2017; 33:2150-2159. [PMID: 27757814 DOI: 10.1007/s12325-016-0429-z] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2016] [Indexed: 10/20/2022]
Abstract
INTRODUCTION In numerous clinical practice guidelines, emphasis is placed on the need for coordinated care of psoriatic arthritis (PsA) between rheumatologists and the objective was to develop experience-based points to consider facilitating the implementation of multidisciplinary units (Dermatology/Rheumatology) for the management of patients with PsA. METHODS A scientific committee of rheumatology and dermatology experts in the management of PsA, and with experience in joint care, discussed the critical aspects of multidisciplinary PsA Units. The discussion became the basis for a Delphi survey in two rounds submitted to a panel of 24 specialists in rheumatology and dermatology not involved in PsA units. The statements and practices that reached a consensus were summarized and further elaborated. RESULTS After two Delphi rounds, agreement was reached for 49 of the 50 proposed statements. These included a justification of the units, objectives, and utilities, as well as operational aspects of the units, such as the minimal and ideal premises, referral criteria, and necessary resources. The statements were compiled in 11 points to consider. CONCLUSIONS This consensus offers some points to consider, including premises and recommendations, for the development of specialized Units in the management of PsA based on expert opinion. We trust these guidelines may facilitate their implementation in the future. FUNDING Pfizer.
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