Assessing the role of rheumatology-dermatology clinics in facilitating diagnoses and optimizing patient care beyond psoriasis
J Am Acad Dermatol
Introduction: There is considerable overlap in the conditions that rheumatologists and dermatologists manage beyond psoriasis. However, the focus and insight about these conditions varies between the two fields. We present a retrospective review on our experience with a rheumatology-dermatology clinic in the management of rheumatologic disorders with cutaneous manifestations beyond psoriasis.
Design: We conducted a retrospective review of all the cases from our combined rheumatology and dermatology clinic (RD-Clinic), January 2014–July 2017. Established diagnoses of psoriasis were not included as these cases were directed to our multidisciplinary psoriasis clinic. Data included patient age, gender, pre-/post-RD-Clinic diagnosis, change in treatment and/or additional work-up. Disease activity was assessed from clinical documentation over the subsequent six-months.
Results: Of the 111 patients evaluated in the clinic, 81% were female and the average patient age was 51 (range 19-80). Most patients were African-American (58%) or Caucasian (34%). RD-Clinic recommendations included a different diagnosis in 34% of cases and modification to the treatment regimen in 69% of cases. Disease activity over the next six-months improved, remained stable, progressed, or was unclearly documented in 32%, 20%, 9%, and 2% of cases, respectively. No follow-up data were available for 37% of cases. Of those with follow-up data, disease activity improved, remained stable, progressed, or was unclearly documented in 51%, 31%, 14%, and 2% of cases, respectively. Of note, over 80% of those that improved during follow-up had their treatment plan changed. The main clinical diagnosis for each RD-Clinic encounter was: Fibrosing conditions (22% of cases, e.g., diffuse scleroderma and eosinophilic fasciitis), cutaneous lupus (19%), mixed connective tissue disease (9%), dermatitis (7%, e.g., chronic actinic dermatitis and atopic dermatitis), leukocytoclastic vasculitis (6%), dermatomyositis (5%), and pyoderma gangrenosum (5%). Other conditions, such as Behcet disease, sarcoidosis, Jessner’s, vitiligo, urticarial vasculitis, and recurrent HSV, also presented, but were less commonly seen.
Conclusion: With the diagnosis altered in one-third of cases and the treatment plan modified in the vast majority of those with reduced disease activity, our findings indicate both the need for this multispecialty collaboration and the positive role it may have in patient care.