Rheumatology International

, Volume 36, Issue 2, pp 221–229 | Cite as

Multidisciplinary dermatology–rheumatology management for patients with moderate-to-severe psoriasis and psoriatic arthritis: a systematic review

  • Tatiana Cobo-Ibáñez
  • Virginia Villaverde
  • Daniel Seoane-Mato
  • Santiago Muñoz-Fernández
  • Mercedes Guerra
  • Petra Díaz del Campo
  • Juan D. Cañete
Original Article - Health Services Research


The aim of the study was to analyze the efficacy and satisfaction of multidisciplinary dermatology–rheumatology management for patients with moderate-to-severe psoriasis and psoriatic arthritis (PsA). We conducted a systematic literature search in MEDLINE, EMBASE, and Cochrane Library up to September 2015. Selection criteria include (1) adult patients with moderate-to-severe psoriasis and PsA, (2) assessed in a multidisciplinary consultation, (3) comparison with routine separate consultations, and (4) outcome measures to evaluate efficacy and/or satisfaction. Meta-analyses, systematic reviews, clinical trials, cohort studies, and case series were included. The quality of the studies included was graded according to the Oxford Level of Evidence scale. Of 195 articles, three studies complied with the inclusion criteria: two case series and one descriptive study in which 506 patients were evaluated. Patients were referred to the multidisciplinary consultation from dermatology and rheumatology consultations in all but one study, in which primary care was also involved. The reason for the referral was to confirm the diagnosis and/or treatment. Patients were evaluated on a weekly and monthly basis in two and one study, respectively. The evidence obtained is scarce but suggests the efficacy of multidisciplinary consultations in terms of improved skin and joint symptoms after changing treatment (82–56 %), showing higher scores for this type of consultation compared to the usual [4.91 vs. 2.85 (0–5)] and a high level of satisfaction among patients (94 % “very satisfied”). However, waiting times were higher. With the limited evidence found, multidisciplinary management seems to be more effective and more satisfactory for patients with moderate-to-severe psoriasis and PsA than conventional consultations, though this could not be conclusively demonstrated. The results of this review support the benefit of implementing this type of consultation.


Systematic review Psoriatic arthritis Psoriasis Management Multidisciplinary Consultations 

Supplementary material

296_2015_3377_MOESM1_ESM.docx (14 kb)
Supplementary material 1 (DOCX 14 kb)


  1. 1.
    Haroon M, Kirby B, FitzGerald O (2013) High prevalence of psoriatic arthritis in patients with severe psoriasis with suboptimal performance of screening questionnaires. Ann Rheum Dis 72:736–740CrossRefPubMedGoogle Scholar
  2. 2.
    De Marco G, Cattaneo A, Battafarano N, Lubrano E, Carrera CG, Marchesoni A (2012) Not simply a matter of psoriatic arthritis: epidemiology of rheumatic diseases in psoriatic patients. Arch Dermatol Res 304:719–726CrossRefPubMedGoogle Scholar
  3. 3.
    Mease PJ, Gladman DD, Papp KA, Khraishi MM, Thaçi D, Behrens F et al (2013) Prevalence of rheumatologist-diagnosed psoriatic arthritis in patients with psoriasis in European/North American dermatology clinics. J Am Acad Dermatol 69:729–735CrossRefPubMedGoogle Scholar
  4. 4.
    Theander E, Husmark T, Alenius GM, Larsson PT, Teleman A, Geijer M et al (2014) Early psoriatic arthritis: short symptom duration, male gender and preserved physical functioning at presentation predict favourable outcome at 5-year follow-up. Results from the Swedish Early Psoriatic Arthritis Register (SwePsA). Ann Rheum Dis 73:407–413CrossRefPubMedGoogle Scholar
  5. 5.
    Kirkham B, de Vlam K, Li W, Boggs R, Mallbris L, Nab HW et al (2015) Early treatment of psoriatic arthritis is associated with improved patient-reported outcomes: findings from the etanercept PRESTA trial. Clin Exp Rheumatol 33:11–19PubMedGoogle Scholar
  6. 6.
    Richard MA, Barnetche T, Rouzaud M, Sevrain M, Villani AP, Aractingi S et al (2014) Evidence-based recommendations on the role of dermatologists in the diagnosis and management of psoriatic arthritis: systematic review and expert opinion. J Eur Acad Dermatol Venereol 28(Suppl 5):3–12CrossRefPubMedGoogle Scholar
  7. 7.
    Canete JD, Dauden E, Queiro R, Aguilar MD, Sanchez-Carazo JL, Carrascosa JM et al (2014) Recommendations for the coordinated management of psoriatic arthritis by rheumatologists and dermatologists: a Delphi study. Actas Dermosifiliogr 105:216–232CrossRefPubMedGoogle Scholar
  8. 8.
    Villani AP, Rouzaud M, Sevrain M, Barnetche T, Paul C, Richard MA et al (2014) Symptoms dermatologists should look for in daily practice to improve detection of psoriatic arthritis in psoriasis patients: an expert group consensus. J Eur Acad Dermatol Venereol 28:27–32CrossRefPubMedGoogle Scholar
  9. 9.
    Husni ME, Meyer KH, Cohen DS, Mody E, Qureshi AA (2007) The PASE questionnaire: pilot-testing a psoriatic arthritis screening and evaluation tool. J Am Acad Dermatol 57:581–587CrossRefPubMedGoogle Scholar
  10. 10.
    Ibrahim GH, Buch MH, Lawson C, Waxman R, Helliwell PS (2009) Evaluation of an existing screening tool for psoriatic arthritis in people with psoriasis and the development of a new instrument: the Psoriasis Epidemiology Screening Tool (PEST) questionnaire. Clin Exp Rheumatol 27:469–474PubMedGoogle Scholar
  11. 11.
    Gladman DD, Schentag CT, Tom BD, Chandran V, Brockbank J, Rosen C et al (2009) Development and initial validation of a screening questionnaire for psoriatic arthritis: the Toronto Psoriatic Arthritis Screen (TOPAS). Ann Rheum Dis 68:497–501CrossRefPubMedGoogle Scholar
  12. 12.
    Peloso PM, Behl M, Hull P, Reeder B (1997) The Psoriasis Arthritis Questionnaire (PAQ) in detection of arthritis among patients with psoriasis. Arthritis Rheum 40(Suppl 9):S64Google Scholar
  13. 13.
    Tinazzi I, Adami S, Zanolin EM, Caimmi C, Confente S, Girolomoni G et al (2012) The early psoriatic arthritis screening questionnaire: a simple and fast method for the identification of arthritis in patients with psoriasis. Rheumatology 51:2058–2063CrossRefPubMedGoogle Scholar
  14. 14.
    Luelmo J, Gratacos J, Moreno Martinez-Losa M, Ribera M, Romani J, Calvet J et al (2014) A report of 4 years of experience of a multidisciplinary unit of psoriasis and psoriatic arthritis. Reumatol Clin 10:141–146CrossRefPubMedGoogle Scholar
  15. 15.
    Cañete JD, Puig L (2014) Multidisciplinary teams for psoriatic arthritis: on aims and approaches. Actas Dermosifiliogr 105:325–327CrossRefPubMedGoogle Scholar
  16. 16.
    Bañares A, Jover JA, Fernández-Gutiérrez B, Benítez del Castillo JM, García J, Vargas E et al (1997) Patterns of uveitis as a guide in making rheumatologic and immunologic diagnoses. Arthritis Rheum 40:358–370CrossRefPubMedGoogle Scholar
  17. 17.
    Muñoz-Fernández S, Martín-Mola E (2006) Uveitis. Best Pract Res Clin Rheumatol 20:487–505CrossRefPubMedGoogle Scholar
  18. 18.
    Phillips B, Ball C, Sackett D, Badenoch D, Straus S, Haynes B et al Oxford Centre for evidence-based medicine levels of evidence. http://www.cebm.net/index.aspx?o=1025. Accessed 16 Jun 2015
  19. 19.
    Barnes L (2014) Rheumatic skin disorders. Rheumatology (United Kingdom) 53:i13Google Scholar
  20. 20.
    Wajed J, Gadsby K, Helliwell P, Korendowych E, Oliver S, Parrish L et al (2012) Facilitating a modular approach to the assessment of psoriatic arthritis. Ann Rheum Dis 71(Suppl3):571CrossRefGoogle Scholar
  21. 21.
    De Marco G, Cattaneo A, Carrera C, Tavecchio S, Ricci M, Fracchiolla C et al (2011) Epidemiologic results of early rheumatologic evaluations in a cohort of psoriatic patients complaining of musculo-skeletal symptoms. Arthritis Rheum 63(Suppl 10):S506Google Scholar
  22. 22.
    Mody E, Husni ME, Schur P, Qureshi AA (2007) Multidisciplinary evaluation of patients with psoriasis presenting with musculoskeletal pain: a dermatology: rheumatology clinic experience. Br J Dermatol 157:1050–1051CrossRefPubMedGoogle Scholar
  23. 23.
    Velez NF, Wei-Passanese EX, Husni ME, Mody EA, Qureshi AA (2012) Management of psoriasis and psoriatic arthritis in a combined dermatology and rheumatology clinic. Arch Dermatol Res 304:7–13CrossRefPubMedGoogle Scholar
  24. 24.
    Pérez-Barrio S, Galindez E, Alzaga JMC, Garcia-Vivar ML, Urigoitia P, Belloso RI (2014) Psoriasis and psoriatic arthropathy multidisciplinary clinic at Basurto University Hospital: 2 years of experience. J Am Acad Dermatol 70(5):AB180Google Scholar
  25. 25.
    Foulkes A, Chinoy H, Warren RB (2012) High degree of patient satisfaction and exceptional feedback in a specialist combined dermatology and rheumatology clinic. Br J Dermatol 167:38Google Scholar
  26. 26.
    Wajed J, Helliwell P, Korendowych E, Gadsby K, Oliver S, Parrish L et al (2014) Disease assessment in psoriatic spectrum: a modular approach for use in routine clinical practice. Ann Rheum Dis 73:318–319CrossRefPubMedGoogle Scholar
  27. 27.
    Wiles KS, Bramham K, Vais A, Harding KR, Chowdhury P, Taylor CJ et al (2015) Pre-pregnancy counselling for women with chronic kidney disease: a retrospective analysis of nine years’ experience. BMC Nephrol 16:28. doi:10.1186/s12882-015-0024-6 PubMedCentralCrossRefPubMedGoogle Scholar
  28. 28.
    Soh MC, Nelson-Piercy C (2015) High-risk pregnancy and the rheumatologist. Rheumatology (Oxford) 54:572–587CrossRefGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 2015

Authors and Affiliations

  • Tatiana Cobo-Ibáñez
    • 1
  • Virginia Villaverde
    • 2
  • Daniel Seoane-Mato
    • 3
  • Santiago Muñoz-Fernández
    • 1
  • Mercedes Guerra
    • 3
  • Petra Díaz del Campo
    • 3
  • Juan D. Cañete
    • 4
  1. 1.Rheumatology DepartmentHospital Universitario Infanta SofíaSan Sebastián de Los ReyesSpain
  2. 2.Rheumatology DepartmentHospital Universitario de MóstolesMóstolesSpain
  3. 3.Research UnitSpanish Society of RheumatologyMadridSpain
  4. 4.Rheumatology DepartmentHospital Clinic de Barcelona e IDIBAPSBarcelonaSpain

Personalised recommendations