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Management of psoriatic arthritis in rheumatology and dermatology settings: sub-analysis of the Italian population from the international LOOP study

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Abstract

Psoriatic arthritis (PsA) patients are often treated by dermatology and rheumatology specialities and may receive different treatments. To evaluate the impact of dermatology/rheumatology specialist settings on diagnosis and therapeutic approach in PsA patients. This cross-sectional multicounty study in Italy involved twenty-eight rheumatology or dermatology clinics. Patients with suspected or confirmed PsA were examined by both a dermatologist and a rheumatologist. A total of 413 patients were enrolled and 347 (84%) were diagnosed with PsA. The majority of patients were enrolled from a rheumatology setting (N = 224, 64.6%). Patients with PsA in the dermatology settings had significantly higher disease activity, including skin involvement and musculoskeletal symptoms. Time from PsA onset to diagnosis was 22.3 ± 53.8 vs. 39.4 ± 77.5 months (p = 0.63) in rheumatology and dermatology settings; time from diagnosis to initiation of csDMARD was 7.3 ± 27.5 vs. 19.5 ± 50.6 months, respectively (p < 0.001). In contrast, time from diagnosis to bDMARD use was shorter in dermatology settings (54.9 ± 69 vs. 44.2 ± 65.6 months, p = 0.09, rheumatology vs. dermatology), similar to the time taken from first csDMARDs and bDMARDs (48.7 ± 67.9 vs. 35.3 ± 51.9 months, p = 0.34). The choice to visit a rheumatologist over a dermatologist was positively associated with female gender and swollen joints and negatively associated with delay in time from musculoskeletal symptom onset to PsA diagnosis. This study highlights a diagnostic delay emerging from both settings with significantly different therapeutic approaches. Our data reinforce the importance of implementing efficient strategies to improve early identification of PsA that can benefit from the integrated management of PsA patients.

Key Points

• A diagnostic delay was observed from both dermatology and rheumatology settings with significantly different therapeutic approaches.

• Shared dermatology and rheumatology clinics offer the combined expertise to improve in the early identification and management of PsA.

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Acknowledgments

Medical writing support and editorial assistance were provided by Colin Gerard Egan, PhD (CE Medical Writing, Pisa, Italy).

Funding

AbbVie Srl, Italy, sponsored this study and editorial assistance for the writing of the manuscript. AbbVie participated in the study design, interpretation of data, and writing of the publication.

Author information

Authors and Affiliations

  1. Dipartimento di Medicina e Scienze della Salute “Vincenzo Tiberio”, Università degli Studi del Molise, Via Giovanni Paolo II, C/da Tappino, 86100, Campobasso, Italy

    Ennio Lubrano

  2. Rheumatology Unit, University of Pisa, Pisa, Italy

    Andrea Delle Sedie

  3. Department of Dermatology, University of Pisa, Pisa, Italy

    Marco Romanelli

  4. Rheumatology, Allergology and Clinical Immunology, Department of “Medicina dei Sistemi”, University of Rome Tor Vergata, Rome, Italy

    Maria Sole Chimenti

  5. Dermatology, Department of Systems Medicine, Tor Vergata University of Rome, Rome, Italy

    Luca Bianchi

  6. Dermatology Unit, Department of Medicine, University of Padova, Padova, Italy

    Stefano Piaserico

  7. Department of Clinical Dermatology, San Gallicano Dermatological Institute IRCCS, Rome, Italy

    Catia De Felice & Dario Graceffa

  8. ARNAS Garibaldi UO Department of Rheumatology, Catania, Italy

    Maria Ilenia De Andres

  9. ARNAS Garibaldi UO Department of Dermatology, Catania, Italy

    Salvatore Curatolo

  10. Rheumatology Research Unit, Department of Health Sciences, “Magna Graecia” University, Catanzaro, Italy

    Rosa Daniela Grembiale

  11. Dermatology Unit, Department of Health Sciences, “Magna Graecia” University, Catanzaro, Italy

    Stefano Dastoli

  12. ARNAS Civico Di Palermo, UOC Reumatologia, Palermo, Italy

    Chiara Arcuri

  13. ARNAS Civico Di Palermo, UOC Dermatologia, Palermo, Italy

    Rosa Giuseppa Angileri

  14. Dermatology Clinic – ASF, Department of Health Sciences, University of Florence, Florence, Italy

    Francesca Prignano

  15. Rheumatology Unit, San Giovanni di Dio Hospital, Florence, Italy

    Francesca Bandinelli

  16. Unit of Immunology, Rheumatology, Allergy and Rare Diseases, IRCCS San Raffaele Hospital, Vita-Salute, Milan, Italy

    Elena Baldissera

  17. Unit of Dermatology and Cosmetology, IRCCS University San Raffaele, Vita-Salute, Milan, Italy

    Santo Raffaele Mercuri

  18. UO Dermatologia, IRCCS Galeazzi, Milan, Italy

    Chiara Franchi

  19. UO Reumatologia, IRCCS Galeazzi, Milan, Italy

    Matteo Longhi

  20. Department of Dermatology, University of Naples Federico II, Naples, Italy

    Angela Patrì

  21. Rheumatology Unit, Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples, Italy

    Francesco Caso

  22. Rheumatology Unit, Department of Clinical and Experimental Medicine, University of Sassari, Sassari, Italy

    Giuseppe Passiu

  23. Department of Surgical, Microsurgical and Medical Sciences, Dermatology, University of Sassari, Sassari, Italy

    Maria Antonia Montesu

  24. Rheumatology Unit, Azienda Ospedaliera Città della Salute e della Scienza di Torino, Turin, Italy

    Simone Parisi

  25. Dermatology Unit, A.O.U Città della Salute e della Scienza di Torino, Turin, Italy

    Elena Stroppiana

  26. AO Caserta San Sebastiano e Sant Anna UOS Di Dermatologia, Caserta, Italy

    Genoveffa Scotto di Luzio

  27. AO Caserta San Sebastiano e Sant Anna UOS Medicina Interna, Caserta, Italy

    Giovanni Italiano

  28. Department of Medicine and Surgery (DiMeC), University of Parma, Parma, Italy

    Sergio Di Nuzzo

  29. Department of General and Specialist Medicine, Internal Medicine and Rheumatology Unit, Azienda Ospedaliero-Universitaria di Parma, Parma, Italy

    Daniele Santilli

  30. Dermatology Unit, Azienda Ospedaliero-Universitaria Policlinico di Modena, Modena, Italy

    Laura Bigi

  31. Rheumatology Unit, Azienda Ospedaliero-Universitaria di Modena, University of Modena and Reggio Emilia, Modena, Italy

    Federica Lumetti

  32. Azienda Sanitaria Regionale Molise, OO.CC. Cardarelli, UO Dermatologia, Campobasso, Italy

    Concetto Paolo Agnusdei

  33. Department of Rheumatology, AO San Pio, Benevento, Italy

    Maria Grazia Ferrucci

  34. AbbVie SrL, Rome, Italy

    Giuliana Gualberti & Francesca Marando

  35. Rheumatology Unit, Department of Medicine – DIMED, University of Padua, Padua, Italy

    Roberta Ramonda

  36. UOC di Dermatologia, AO San Pio di Benevento, Benevento, Italy

    Francesco Cusano

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  1. Ennio Lubrano
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  2. Andrea Delle Sedie
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  3. Marco Romanelli
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  4. Maria Sole Chimenti
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  5. Luca Bianchi
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  6. Stefano Piaserico
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  7. Catia De Felice
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  9. Maria Ilenia De Andres
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  10. Salvatore Curatolo
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  11. Rosa Daniela Grembiale
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  14. Rosa Giuseppa Angileri
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  15. Francesca Prignano
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  16. Francesca Bandinelli
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  17. Elena Baldissera
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  18. Santo Raffaele Mercuri
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  19. Chiara Franchi
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  20. Matteo Longhi
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  21. Angela Patrì
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  22. Francesco Caso
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  23. Giuseppe Passiu
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  24. Maria Antonia Montesu
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  25. Simone Parisi
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  26. Elena Stroppiana
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  27. Genoveffa Scotto di Luzio
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  28. Giovanni Italiano
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  29. Sergio Di Nuzzo
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  30. Daniele Santilli
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  31. Laura Bigi
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  32. Federica Lumetti
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  33. Concetto Paolo Agnusdei
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  34. Maria Grazia Ferrucci
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  35. Giuliana Gualberti
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  36. Francesca Marando
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  37. Roberta Ramonda
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  38. Francesco Cusano
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Contributions

All authors contributed to data acquisition and interpretation of results. All authors were involved in drafting the article or revising it critically for important intellectual content. All authors approved the final version to be submitted for publication.

Corresponding author

Correspondence to Ennio Lubrano.

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Conflict of interest

G Gualberti and F Marando are AbbVie employees and may own AbbVie stocks and options.

A Delle Sedie received honoraria for invited talks, board, and meetings from Abbvie, Celgene, Lilly, Novartis; Sanofi. D Santilli declares fees for Advisory Boards or Talks from Abbvie, Abiogen, GSK, Novartis; Roche. F Cusano declares fees for Advisory Boards or Talks from Abbvie. F Prignano has been consultant, adviser, and clinical study investigator for Eli-Lilly, Abbvie, Novartis, Leo-Pharma, Abiogen-Pharma, Celgene, Janssen-Cilag, Biogen, Admirall. S Piaserico declares fees for Advisory Boards or Talks from Almirall, Lilly, Abbvie, UCB, Janssen, and Novartis. The following authors declare no conflicts of interests: R Ramonda, L Bianchi, E Baldissera, S Di Nuzzo, S. Parisi, F Lumetti, L Bigi, S Curatolo, F Caso, C Franchi, C Arcuri, RG Angileri, C De Felice, F Bandinelli, S Dastoli, G Italiano, M Romanelli, G Scotto di Luzio, A Patrì, MA Montesu, E Stroppiana, G Passiu, RD Grembiale, I De Andres, MG Ferrucci, E Lubrano, MS Chimenti, D Graceffa, P Agnusdei, SR Mercuri, M Longhi.

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Lubrano, E., Delle Sedie, A., Romanelli, M. et al. Management of psoriatic arthritis in rheumatology and dermatology settings: sub-analysis of the Italian population from the international LOOP study. Clin Rheumatol 40, 2251–2262 (2021). https://doi.org/10.1007/s10067-020-05482-w

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