Skip to main content

Multidisciplinary Management of Psoriatic Arthritis: The Benefits of a Comprehensive Approach

Advances in Therapy volume 36, pages 806–816 (2019)Cite this article

Abstract

Psoriatic arthritis (PsA) is a lifelong disease associated with extra-articular manifestations and several comorbidities, as well as reduced quality of life and psychosocial burden. Diagnostic delay is associated with poorer outcomes, while a short delay between symptom onset and diagnosis is linked with preservation of function. Overcoming the barriers to early diagnosis of PsA is often difficult to achieve in the absence of well-characterized disease markers and/or a definitive screening procedure. Once a diagnosis is made, approaches to care may differ between countries, but a treat-to-target approach can be advocated, with constant patient follow-up visits and specialist monitoring and treatment of comorbidities. Adequately addressing all aspects of care can help to drive patient-centered care and encourage better adherence. Given the mounting number of therapeutic options and the complexity of management of PsA, the disease can be optimally treated by a multidisciplinary approach, and a collaborative approach between rheumatologists and dermatologists can be advocated. The need for multidisciplinary management is reinforced by consensus among experts. Patient satisfaction has emerged as a central indicator of quality, and patient-centered care must remain a central goal for the care of patients with PsA. Definition of a minimum set of standards for care will help to achieve the goal of multidisciplinary care for patients with PsA. Optimal care of PsA and greater collaboration among clinicians should always be encouraged so that patients can receive the best possible quality of care.

Funding: Pfizer Italy.

This is a preview of subscription content, access via your institution.

Access options

Buy single article

Instant access to the full article PDF.

USD 39.95

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Fig. 1
Fig. 2
Fig. 3

References

  1. Van den Bosch F, Coates L. Clinical management of psoriatic arthritis. Lancet. 2018;391(10136):2285–94.

    Article  PubMed  Google Scholar 

  2. Reich K, Kruger K, Mossner R, Augustin M. Epidemiology and clinical pattern of psoriatic arthritis in Germany: a prospective interdisciplinary epidemiological study of 1511 patients with plaque-type psoriasis. Br J Dermatol. 2009;160(5):1040–7.

    Article  CAS  PubMed  Google Scholar 

  3. Husted JA, Thavaneswaran A, Chandran V, et al. Cardiovascular and other comorbidities in patients with psoriatic arthritis: a comparison with patients with psoriasis. Arthritis Care Res (Hoboken). 2011;63(12):1729–35.

    Article  Google Scholar 

  4. Jamnitski A, Symmons D, Peters MJ, et al. Cardiovascular comorbidities in patients with psoriatic arthritis: a systematic review. Ann Rheum Dis. 2013;72(2):211–6.

    Article  Google Scholar 

  5. Husted JA, Gladman DD, Farewell VT, Cook RJ. Health-related quality of life of patients with psoriatic arthritis: a comparison with patients with rheumatoid arthritis. Arthritis Rheum. 2001;45(2):151–8.

    Article  CAS  PubMed  Google Scholar 

  6. Gladman DD, Antoni C, Mease P, Clegg DO, Nash P. Psoriatic arthritis: epidemiology, clinical features, course, and outcome. Ann Rheum Dis. 2005;64(Suppl 2):ii14–7.

  7. Kavanaugh A, Helliwell P, Ritchlin CT. Psoriatic arthritis and burden of disease: patient perspectives from the population-based Multinational Assessment of Psoriasis and Psoriatic Arthritis (MAPP) survey. Rheumatol Ther. 2016;3(1):91–102.

    Article  PubMed  PubMed Central  Google Scholar 

  8. Husni ME, Merola JF, Davin S. The psychosocial burden of psoriatic arthritis. Semin Arthritis Rheum. 2017;47(3):351–60.

    Article  PubMed  Google Scholar 

  9. Helliwell PS, Ruderman EM. Natural history, prognosis, and socioeconomic aspects of psoriatic arthritis. Rheum Dis Clin North Am. 2015;41(4):581–91.

    Article  PubMed  Google Scholar 

  10. Husted JA, Tom BD, Farewell VT, Schentag CT, Gladman DD. A longitudinal study of the effect of disease activity and clinical damage on physical function over the course of psoriatic arthritis: Does the effect change over time? Arthritis Rheum. 2007;56(3):840–9.

    Article  PubMed  Google Scholar 

  11. Husted JA, Tom BD, Farewell VT, Schentag CT, Gladman DD. Description and prediction of physical functional disability in psoriatic arthritis: a longitudinal analysis using a Markov model approach. Arthritis Rheum. 2005;53(3):404–9.

    Article  PubMed  Google Scholar 

  12. Haroon M, Gallagher P, FitzGerald O. Diagnostic delay of more than 6 months contributes to poor radiographic and functional outcome in psoriatic arthritis. Ann Rheum Dis. 2015;74(6):1045–50.

    Article  CAS  PubMed  Google Scholar 

  13. Tillett W, Jadon D, Shaddick G, et al. Smoking and delay to diagnosis are associated with poorer functional outcome in psoriatic arthritis. Ann Rheum Dis. 2013;72(8):1358–61.

    Article  PubMed  Google Scholar 

  14. Theander E, Husmark T, Alenius GM, et al. 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. 2014;73(2):407–13.

  15. Lebwohl MG, Kavanaugh A, Armstrong AW, Van Voorhees AS. US perspectives in the management of psoriasis and psoriatic arthritis: patient and physician results from the population-based Multinational Assessment of Psoriasis and Psoriatic Arthritis (MAPP) survey. Am J Clin Dermatol. 2016;17(1):87–97.

    Article  PubMed  Google Scholar 

  16. Betteridge N, Boehncke WH, Bundy C, et al. Promoting patient-centred care in psoriatic arthritis: a multidisciplinary European perspective on improving the patient experience. J Eur Acad Dermatol Venereol. 2016;30(4):576–85.

    Article  CAS  PubMed  Google Scholar 

  17. Gladman DD, Poulin Y, Adams K, et al. Treating psoriasis and psoriatic arthritis: position paper on applying the treat-to-target concept to Canadian daily practice. J Rheumatol. 2017;44(4):519–34.

    Article  PubMed  Google Scholar 

  18. Kavanaugh A. Psoriatic arthritis: treat-to-target. Clin Exp Rheumatol. 2012;30(4 Suppl 73):S123–S125125.

    PubMed  Google Scholar 

  19. Tucker LJ, Ye W, Coates LC. Novel concepts in psoriatic arthritis management: can we treat to target? Curr Rheumatol Rep. 2018;20(11):71.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  20. Coates LC, Moverley AR, McParland L, et al. Effect of tight control of inflammation in early psoriatic arthritis (TICOPA): a UK multicentre, open-label, randomised controlled trial. Lancet. 2015;386(10012):2489–98.

    Article  PubMed  PubMed Central  Google Scholar 

  21. Campbell NKJ, Saadeldin K, De Vera MA. The duality of economic issues with medication non-adherence in patients with inflammatory arthritis. Curr Rheumatol Rep. 2017;19(10):66.

    Article  PubMed  Google Scholar 

  22. Giacomelli R, Gorla R, Trotta F, et al. Quality of life and unmet needs in patients with inflammatory arthropathies: results from the multicentre, observational RAPSODIA study. Rheumatology (Oxford). 2015;54(5):792–7.

    Article  Google Scholar 

  23. Queiro R, Coto P. Multidisciplinary care for psoriatic disease: where we are and where we need to go. Rheumatology (Oxford). 2017;56(11):1829–31.

    Google Scholar 

  24. Husni ME. Comorbidities in psoriatic arthritis. Rheum Dis Clin North Am. 2015;41(4):677–98.

    Article  PubMed  Google Scholar 

  25. Ogdie A, Schwartzman S, Husni ME. Recognizing and managing comorbidities in psoriatic arthritis. Curr Opin Rheumatol. 2015;27(2):118–26.

    Article  PubMed  Google Scholar 

  26. Queiro R, Coto P, Rodriguez J, et al. Multidisciplinary care models for patients with psoriatic arthritis. Reumatol Clin. 2017;13(2):85–90.

    Article  PubMed  Google Scholar 

  27. Cobo-Ibanez T, Villaverde V, Seoane-Mato D, et al. Multidisciplinary dermatology-rheumatology management for patients with moderate-to-severe psoriasis and psoriatic arthritis: a systematic review. Rheumatol Int. 2016;36(2):221–9.

    Article  PubMed  Google Scholar 

  28. Urruticoechea-Arana A, Serra Torres M, Hergueta Diaz M, et al. Experience and satisfaction with a multidisciplinary care unit for patients with psoriasis and psoriatic arthritis. Reumatol Clin. 2017. https://doi.org/10.1016/j.reuma.2017.07.007.

  29. Soleymani T, Reddy SM, Cohen JM, Neimann AL. Early recognition and treatment heralds optimal outcomes: the benefits of combined rheumatology-dermatology clinics and integrative care of psoriasis and psoriatic arthritis patients. Curr Rheumatol Rep. 2017;20(1):1.

    Article  CAS  PubMed  Google Scholar 

  30. Luchetti MM, Benfaremo D, Campanati A, et al. Clinical outcomes and feasibility of the multidisciplinary management of patients with psoriatic arthritis: two-year clinical experience of a dermo-rheumatologic clinic. Clin Rheumatol. 2018;37(10):2741–9.

    Article  PubMed  Google Scholar 

  31. Gratacos J, Luelmo J, Rodriguez J, et al. Standards of care and quality indicators for multidisciplinary care models for psoriatic arthritis in Spain. Rheumatol Int. 2018;38(6):1115–24.

    Article  PubMed  Google Scholar 

  32. Gossec L, Smolen JS, Ramiro S, et al. European League Against Rheumatism (EULAR) recommendations for the management of psoriatic arthritis with pharmacological therapies: 2015 update. Ann Rheum Dis. 2016;75(3):499–510.

    Article  CAS  PubMed  Google Scholar 

  33. Gratacos-Masmitja J, Luelmo-Aguilar J, Zarco-Montejo P, et al. Points to consider in the foundation of multidisciplinary units for psoriatic arthritis: a Delphi study and a systematic review of the literature. Adv Ther. 2017;33(12):2150–9.

    Article  PubMed  Google Scholar 

  34. Rizzello F, Olivieri I, Armuzzi A, et al. Multidisciplinary management of spondyloarthritis-related immune-mediated inflammatory disease. Adv Ther. 2018;35(4):545–62.

    Article  PubMed  PubMed Central  Google Scholar 

  35. Li TH, Liao HT, Huang YF, et al. The current status and unmet needs in the management of psoriatic arthritis: viewpoint from physicians in Taiwan. J Formos Med Assoc. 2018;117(5):404–12.

    Article  PubMed  Google Scholar 

Download references

Acknowledgements

Funding

This review and article processing charges were funded by Pfizer Italy.

Medical Writing and Editorial Assistance

The authors thank Dr. Patrick Moore, an independent medical writer, who provided editorial and medical writing support on behalf of Health Publishing & Services (HPS) Srl, Milan, Italy. This support was funded by Pfizer Italy.

Authorship

All named authors meet the International Committee of Medical Journal Editors (ICMJE) criteria for authorship for this article, take responsibility for the integrity of the work as a whole, and have given their approval for this version to be published.

Disclosures

Natascia Crispino is a Pfizer employee. Rosario Foti received an honorarium from Pfizer in connection with the development of this manuscript. Elisa Visalli did not receive an honorarium from Pfizer in connection with the development of this manuscript and declares that she has no relevant disclosures.

Compliance with Ethics Guidelines

This article is based on previously conducted studies and does not directly contain any studies with human participants or animals performed by any of the authors.

Data Availability

Data sharing is not applicable to this article as no datasets were generated or analyzed during the current study.

Author information

Authors and Affiliations

  1. Rheumatology Unit A. O. U. Policlinico Vittorio Emanuele, Catania, Italy

    Elisa Visalli & Rosario Foti

  2. Medical Department, Pfizer Italy, Rome, Italy

    Natascia Crispino

Authors
  1. Elisa Visalli
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Natascia Crispino
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Rosario Foti
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Elisa Visalli.

Additional information

Enhanced Digital Features

To view enhanced digital features for this article go to https://doi.org/10.6084/m9.figshare.7655546.

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Visalli, E., Crispino, N. & Foti, R. Multidisciplinary Management of Psoriatic Arthritis: The Benefits of a Comprehensive Approach. Adv Ther 36, 806–816 (2019). https://doi.org/10.1007/s12325-019-00901-0

Download citation

  • Received:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s12325-019-00901-0

Keywords

  • Management
  • Multidisciplinary
  • Pathway
  • Psoriatic arthritis