Background Psoriatic arthritis (PsA) is a chronic arthritis, included in the spondyloarthritis group, characterized by the coexistence of skin and joint inflammation. The delayed diagnosis and therapy may result in an increased rate of progression of clinical damage, affecting significantly the quality of life (QoL) (1). An integrated clinical examination of PsA patients, carried out by the dermatologist and rheumatologist, is actually considered the optimal approach to manage the PsA disease.
Objectives Evaluation of the effect of the multidisciplinary integrated approach, performed by dermatologist and rheumatologist, in: a) the early diagnosis of PsA, and b) the quality of life before and after therapeutic integrated approach.
Methods Since January 2015, we examined 145 consecutive patients complaining articular symptoms and/or psoriasis in the outpatient clinics and in the clinical ward of the dermatology and internal medicine departments. Among them, 53 patients were diagnosed as PsA and 21 by psoriasis (Pso). At baseline, after collegial evaluation, the treatment strategy was planned depending on articular activity-involvement (peripheral or axial), systemic inflammation (C-reactive protein, CRP, and erythrocyte-sedimentation rate, ESR, levels), and skin involvement. Moreover, at baseline and after 12-weeks, articular disease was assessed by Ankylosing Spondylitis Disease Activity Score (ASDAS-CRP) and Bath Ankylosing Spondylitis Disease Activity Index (BASDAI), following ASAS (Assessment of SpondyloArthritis international Society) indications, and skin disease by the Psoriasis Area Severity Index (PASI). QoL was assessed using the Short Form-36 questionnaire (SF-36).
Results At baseline, QoL was significantly worse in PsA than Pso patients, as assessed by mean SF-36 (physical component score, PCS, and mental component score, MCS) (Fig.1A). Female patients had significantly worse SF-36 MCS than male patients globally considered (37.4±8.4 vs 46.1±12.3, p=0.03), also in the PsA patient's group alone (35.8±8.1 vs 44±13.7, p=0.01). After the integrated evaluation in: a) 33 PsA naïve patients a biological drug was prescribed; b) 3 patients switched to another biological drug; c) 11 patients assuming already a biological drug a synthetic DMARD was added; d) 6 a synthetic DMARD alone was prescribed (Fig. 1, Table I). At 12 weeks, 33 patients had been evaluated at follow-up. It was observed a significant improvement in articular disease as well as skin disease activity (Fig. 1). Consistently, a significant improvement was obtained also in QoL (Fig. 1) and a significant statistical correlation resulted between articular activity and QoL. In fact, a significant correlation between ASDAS-CRP and BASDAI with SF-36 PCS was observed (Fig. 1).
Conclusions In our work, we demonstrate that the multidisciplinary treatment and follow-up approach in patients with PsA has achieved a significant and, most importantly, fast improvement in disease activity and patient reported QoL after 12 weeks. Thus this reinforces the importance of a shared choice of the therapy and it encourages further studies to assess the long-term outcomes and feasibility.
Betteridge N. et al. JEADV, 16 Sep2015.
Disclosure of Interest None declared