Collaboration in 'specialized PsA center' significantly reduces time to diagnosis
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A university psoriatic arthritis center focusing on close collaboration between rheumatologists and dermatologists helped significantly decrease time to diagnosis, according to data published in BMC Rheumatology.
“It is estimated that 29% of psoriasis patients seen by dermatologists suffer from undiagnosed PsA,” Jana Ziob, DMSc, of the University Hospital of Bonn, in Germany, and colleagues wrote. “Alternatively, in 14% to 20% of PsA patients, arthritis can occur before or simultaneously with psoriasis.”
“Despite the assumed high importance of interdisciplinary collaboration in dermatology-rheumatology, the clear evidence for it has not been explored significantly yet,” they added. “Therefore, we designed a study at our University Hospital of Bonn to compare two specific periods, one before and one after the foundation of a specialized PsA center, enabling close dermatology-rheumatology cooperation.”
To analyze the center’s impact on the specialized management of patients with psoriasis and arthralgia who are suspected of having PsA, Ziob and colleagues conducted a retrospective cohort study of all dermatological-rheumatological consultations conducted before and after the center opened. A total of 404 consultations across the two time periods were included in the study. The time periods were defined as April 1, 2016, to Feb. 28, 2018, and March 1, 2018, to Jan. 31, 2020.
For each consultation, the researchers obtained and analyzed clinical data on patient characteristics, including psoriasis subtypes, as well as clinical symptoms and signs, disease activity scores, classification criteria and comorbidities, and patient journey.
According to the researchers, close collaboration in the PsA center led to a relevantly shortened patient journey regarding rheumatological complaints. The median patient journey lasted 36 months during the time prior to the center opening (interquartile range = 10-126), compared with 24 months (6-60) during the second period.
Established scores and classification criteria, such as GEPARD or CASPAR, were less helpful than expected in diagnosing PsA, the researchers wrote. Meanwhile, arthralgia (P=.0407), swollen joints (P=.0151), morning stiffness (P=.0451) and dactylitis (P=.0086) helped distinguish between osteoarthritis and PsA.
“The results of our study confirm the importance of a multidisciplinary university dermatological-rheumatological management in a specialized PsA center,” Ziob and colleagues wrote. “Time to rheumatological examination and time to diagnosis was significantly decreased. These data form the concept of a model that can enhance medical treatment through close interdisciplinary cooperation, which should be implemented nationally and globally. Further research showing the value of such a centered care in greater patient numbers is obligatory.”
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