Cross-specialty care can be rewarding for both patients, providers
Click Here to Manage Email Alerts
This month’s cover story is an important reminder of just how essential cross-specialty coordination is to patient care.
Inflammatory bowel disease and ankylosing spondylitis are two chronic autoimmune disorders. While their names suggest they may involve only the bowel in the case of IBD and only the joints in the case of AS, it is common for patients with both diseases to have manifestations involving other organ systems as well. In fact, patients with IBD are known to have an increased frequency of concomitant AS, and, conversely, patients with AS are known to have an increased frequency of concomitant IBD.
However, each disease is managed by a different specialist, and if those specialists focus solely on their primary area of expertise (the gut for gastroenterology and the joints for rheumatology) these dual diagnoses can be easily missed. As the gastroenterologists and rheumatologists featured in the cover story point out, this can have a negative impact on patient care. Both IBD and AS can present with progressive courses that might lead to irreversible organ damage if not caught early and treated appropriately.
Luckily, there is a variety of simple strategies and tools available to providers to help prevent this. Gastroenterologists can incorporate asking their IBD patients about joint pain during their appointments. As Brett Smith, DO, notes, this can easily be accomplished via administration of a screening questionnaire for inflammatory back pain, given to patients when they come for routine IBD clinic visits. Prompt referral to rheumatology can be pursued if any concerns or red flag symptoms are identified.
Meanwhile, rheumatologists can incorporate asking their AS patients about any gastrointestinal symptoms. Ashwin Ananthakrishnan, MD, offers an overview of symptoms that are especially concerning for IBD, such as persistent or nocturnal diarrhea, while Miguel Regueiro, MD, highlights the utility of a fecal calprotectin stool test as a noninvasive screening tool for bowel inflammation in the setting of suspected IBD. As Sharon Dudley-Brown, PhD, FNP-BC, notes, there also is a screening bowel disease questionnaire that rheumatologists can give to their patients.
When overlapping diagnoses of IBD and AS are made, close collaboration between gastroenterology and rheumatology remains vital. As outlined in the cover story, certain AS treatments may actually lead to worsening of IBD, certain IBD therapies have unknown or limited efficacy in the treatment of AS and some therapies are known to have efficacy in both conditions. In addition, placing patients on separate medications for IBD and AS when one could be sufficient increases the risk for possible complications that otherwise might have been avoided. Therefore, rheumatologists and gastroenterologists must work together closely in order to select a medication regimen that has the highest likelihood of successfully treating both conditions.
In large tertiary care centers, this can be streamlined through the creation of multidisciplinary gastroenterology and rheumatology clinics. As Seyedehsan Navabi, MD, points out, collaboration can be more challenging in other practice environments, particularly those that are more resource-limited. The goal, however, is still achievable if providers are willing to establish relationships with other specialists in their communities and work closely together, or use virtual clinics as piloted in the so-called “medical neighborhoods.” This integrated multidisciplinary approach to care can be rewarding for patients and providers alike.
- For more information:
- Katherine Falloon, MD, and Florian Rieder, MD, from the Department of Gastroenterology, Hepatology and Nutrition, Digestive Disease & Surgery Institute at the Cleveland Clinic.
Collapse
Read more about
Click Here to Manage Email Alerts