Better collaboration with rheumatology & dermatology needed in psoriatic arthritis

[Fred]

This study suggests improved collaboration between rheumatologists and dermatologists is needed for patients with psoriatic arthritis.

Quote:

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Background:
Psoriatic arthritis (PsA) is a chronic and debilitating disease that can be managed by different clinical specialists.

Objectives:
The objective of the LOOP study was to evaluate the impact of clinical specialty setting on the time to diagnosis and treatment of patients with PsA. Clinical disease activity and disease burden were also compared between clinical settings.

Methods:
LOOP was a cross‐sectional, multicentre, observational study conducted in 17 countries in Western and Eastern Europe, the Middle East, Latin America, and Asia. Adult patients (≥18 years) with a suspected or established diagnosis of PsA who were routinely visiting a rheumatologist, dermatologist or non‐rheumatology/non‐dermatology physician were enrolled. All patients were assessed by both a rheumatologist and a dermatologist.

Results:
Of 1483 enrolled patients, a total of 1273 had a confirmed diagnosis of PsA. There was no significant difference in the median time from onset of inflammatory musculoskeletal symptoms to PsA diagnosis between patients enrolled by rheumatologists and dermatologists (6.0 vs. 3.9 months). However, the median time from diagnosis to first treatment with a conventional synthetic disease‐modifying anti‐rheumatic drug (csDMARD) was significantly shorter in the rheumatology setting compared with the dermatology setting (0 vs. 2.0 months; P < 0.001). In addition, disease activity was significantly higher in the dermatology setting compared with the rheumatology setting.

Conclusions:
Differences in the management and clinical status of patients with PsA were observed between the rheumatology and dermatology settings. Importantly, median time from diagnosis to first csDMARD was significantly shorter in the rheumatology setting, and patients in the dermatology setting had higher disease activity. These data show the importance of improved collaboration between rheumatologists and dermatologists.

Source: onlinelibrary.wiley.com

*Early view funding unknown

[KatT]

Totally agree!  Unfortunately, it will still take a few years to see improved collaboration.  Tools are still being implemented (here anyway) to share patient information amongst doctors.

It also depends on the doctor of course....some just simply don't take the time

[Fred]

Totally agree!  Unfortunately, it will still take a few years to see improved collaboration.  Tools are still being implemented (here anyway) to share patient information amongst doctors.

It also depends on the doctor of course....some just simply don't take the time

I refuse to see my rheumatologist, she only ever wants to prescribe methotrexate. She also once told me that Cosentyx would never help psoriatic arthritis, which as I have proved is absolute rubbish.

[KatT]

Mine is no better 

As I said, it depends on the doctor also.

That being said, I was on MTX about 5 years ago and did not have side effects and my psoriasis cleared up.  PSA is another story.

[Turnedlight]

Ha yes they are a right pair of departments! Honestly it feels a bit silly the way they communicate

[Caroline]

Totally agree!  Unfortunately, it will still take a few years to see improved collaboration.  Tools are still being implemented (here anyway) to share patient information amongst doctors.

It also depends on the doctor of course....some just simply don't take the time

I refuse to see my rheumatologist, she only ever wants to prescribe methotrexate. She also once told me that Cosentyx would never help psoriatic arthritis, which as I have proved is absolute rubbish.

Mine is no better 

As I said, it depends on the doctor also.

That being said, I was on MTX about 5 years ago and did not have side effects and my psoriasis cleared up.  PSA is another story.

Both your reactions seem logical to me. And has been published already here Methotrexate not working for Synovitis in psoriatic arthritis by Fred himself.
The article shows that it is unlikely that MTX will work for Psoriatic Arthritis.
So I see why you wouldn’t meet with your rheumatologist.

[jiml]

I agree they need to collaborate I had had six good years on fumaderm when I got a bit of arthritis and asked my dermatologist if I could up my dose of fumaderm he told me I needed to see the rheumatologist.....who wanted to take me off fumaderm and put me on methotrexate and said she knew nothing about fumaderm / DMF and said it was up to my dermatologist to increase fumaderm but said there was no evidence it would work on psoriatic arthritis or she would know about it .....
I told her I could show her evidence from the club of DMF working to control psoriatic arthritis ... she discharged me and I went back to the dermatologist who said I could try increasing the dose but agreed with the rheumatologist that it wouldn't work ... that was about two years ago ...
My point is the 2 departments do need to cooperate and share information for the benefit of us the patients

[Caroline]

I agree they need to collaborate I had had six good years on fumaderm when I got a bit of arthritis and asked my dermatologist if I could up my dose of fumaderm he told me I needed to see the rheumatologist.....who wanted to take me off fumaderm and put me on methotrexate and said she knew nothing about fumaderm / DMF and said it was up to my dermatologist to increase fumaderm but said there was no evidence it would work on psoriatic arthritis or she would know about it .....
I told her I could show her evidence from the club of DMF working to control psoriatic arthritis ... she discharged me and I went back to the dermatologist who said I could try increasing the dose but agreed with the rheumatologist that it wouldn't work ... that was about  two years ago ...
My point is the 2 departments do need to cooperate and share information for the benefit of us the patients

And even the two can be wrong. That could be a disadvantage.

Your both doctors are thinking non scientific.
It has not been proven........ no that is obvious, there was no reseach. So there is a 50/50 chance. And it is smart to try as DMF is way less toxic than MTX.

And even the fact that there was no reseach is not true, there was reseach by Peeters, which has been published I think in the Lancet. It is a small reseach but with positive results on DMF working for Psoriatic Arthritis.

For me, looking with a logical eye to these observations, it is insane that they want to try MTX, certainly if you add the real scientific reseach of 2012 to it, which shows that MTX doesn’t work.

So we have proof that MTX doesn’t work
We have small proof that DMF works
We have further on NO reseach and thus NO proof at all that DMF should not work.

So what do you prescribe ? ........... MTX.