Collaborative systemic sclerosis care comes with challenges, but improves outcomes
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ORLANDO, Fla. — Including multiple specialists to treat the various facets of systemic sclerosis improves outcomes but can have its own challenges, according to a presenter at the 2024 Rheumatology Nurses Society annual conference.
“Systemic sclerosis can affect so many different organ systems, so having the various specialists all on board can be helpful,” Chad A. Hille, MD, a rheumatologist at Ochsner Health, in Louisiana, told attendees. “Coordinating care does lead to better outcomes.”
This multidisciplinary group may consist of a “core team” specializing in rheumatology, pulmonology, cardiology and nephrology, backed up by ancillary support teams of physical occupational therapists, psychologists, social workers and dietitians, Hille said.
In one example case of diffuse cutaneous SSc, Hille described a rheumatologist prescribing disease-modifying treatment, a pulmonologist managing interstitial lung disease with antifibrotic agents, a cardiologist monitoring for pulmonary arterial hypertension, and a gastroenterologist managing esophageal dysmotility. In another case of limited cutaneous SSc, a nephrologist managed renal crisis with ACE inhibitors, a dermatologist treated skin ulcers and calcinosis, and a physical therapist helped with mobility exercises and pain management.
However, Hille acknowledged that implementing such a coordinated care plan “can be easier said than done.”
He suggested that a team meet regularly and assess the effectiveness of its care plan, making any necessary adjustments. He also encouraged providers to “engage the patients and help them to be involved in shared decision-making.”
At the end of Hille’s talk, an audience member asked what they should do if including other specialists takes substantial time. He acknowledged the situation can be “a little bit tricky” and suggested taking a proactive approach.
“I think sometimes we have to start ordering things that maybe we wouldn’t necessarily order,” he said. “Ideally, we would like the pulmonologist to do the pulmonary function tests, but sometimes we just end up doing it ourselves.”
Fostering good relationships with other specialties can ease the situation, Hille added.
“If you have a patient that really needs to be seen, then you can have somebody that you have a connection with that you can reach out to,” he said. “Trying to establish good relationships with the other specialists, I think, can sort of facilitate having the patients get seen when they need to.”
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Hille C. Systemic Sclerosis: Optimizing Care Across the Disease Course. Presented at: Rheumatology Nurses Society annual conference; July 17-20, 2024, in Orlando, Florida (hybrid meeting).
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