Combined Clinics for Management of Psoriatic Disease Take Many Forms

摘要

In this issue of Healio Psoriatic Disease, we focus on the advent of combined dermatology-rheumatology clinics for the management of patients with psoriatic disease. A critical motivating factor for these initiatives is that psoriasis is a systemic and dynamic chronic inflammatory disease. Invariably most clinicians will need the expertise of others to successfully manage patients with psoriasis long term. Most combined clinics focus on the intersection of the skin and the joints, but it is important to emphasize that comor-bid mood disorders and cardiometabolic disease are also highly prevalent in patients with psoriatic disease and that major cardiovascular events are the leading cause of excess premature mortality in patients with psoriasis. As a result, clinicians who manage psoriasis should have a plan in place for comanagement of these patients. This plan may mean having the patient seen by multiple specialists at once, as is done in the Rochester model exemplified by Ritchlin and Tausk, or it can be a virtual approach in which the clinician establishes relationships with relevant specialists for the management of psoriatic disease and has pathways available that allow for good communication and rapid consultation. In my academic practice at Penn, our “combined” clinic is virtual. We have an established group of expert dermatologists who specialize in psoriasis, rheumatologists who specialize in psoriatic arthritis, and internists who specialize in preventive cardiology and are knowledgeable about the impact psoriasis has on cardiovascular risk. Our communications and referrals are aided tremendously by the electronic medical record we share. As a dermatologist, I screen all patients with psoriasis regularly for signs and symptoms of inflammatory arthritis.