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皮肤科和风湿科联合诊所中银屑病和银屑病关节炎的管理。

Management of psoriasis and psoriatic arthritis in a combined dermatology and rheumatology clinic.

机构信息

Department of Dermatology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA 02115, USA.

出版信息

Arch Dermatol Res. 2012 Jan;304(1):7-13. doi: 10.1007/s00403-011-1172-6.

Abstract

Psoriasis and psoriatic arthritis (PsA) are chronic systemic inflammatory disorders with wide spectrums of cutaneous and musculoskeletal presentations. Management of joint disease in this population can be challenging and often requires the expertise of rheumatology in conjunction with dermatology. A multidisciplinary clinic setting may benefit these patients, and in this study we sought to evaluate the experience of such a model. We performed a retrospective chart review of patients evaluated between October 2003 and October 2009 in the Center for Skin and Related Musculoskeletal Diseases (SARM) at Brigham and Women's Hospital, Boston, MA, USA, where patients are seen by both an attending rheumatologist and dermatologist. Main outcomes included the presence of comorbidities, accuracy of the initial diagnosis, and escalation of treatment modalities. Over the 6-year period, 510 patients were evaluated. Two hundred sixty-eight patients had psoriasis and/or PsA. The prevalence of comorbidities was high (45% hypertension, 46% hyperlipidemia, 19% diabetes, and 36% history of the past or current smoking). Visit in SARM resulted in a revised diagnosis that differed from the previous diagnosis at outside clinics in 46% of cases. Patients were more likely to receive a systemic medication after the evaluation in SARM as compared to before, 25 versus 15%, respectively, with an odds ratio of 5.1. Patients were also more likely to be treated with a biologic agent after the evaluation in SARM as compared to before, 37 versus 16%, respectively. Multidisciplinary care may facilitate the diagnosis of joint disease and offers a more comprehensive treatment approach for patients with both psoriasis and PsA. Our data can be used to support the efforts to provide integrated rheumatologic and dermatologic care for this population.

摘要

银屑病和银屑病关节炎(PsA)是慢性全身性炎症性疾病,具有广泛的皮肤和肌肉骨骼表现。此类人群的关节疾病的治疗可能具有挑战性,通常需要风湿病学与皮肤科的专业知识。多学科诊所环境可能使这些患者受益,在这项研究中,我们评估了这种模式的经验。我们对 2003 年 10 月至 2009 年 10 月期间在美国马萨诸塞州波士顿布莱根妇女医院皮肤及相关肌肉骨骼疾病中心(SARM)就诊的患者进行了回顾性图表审查,该中心由主治风湿病医生和皮肤科医生共同看诊。主要结果包括合并症的存在、初始诊断的准确性和治疗方式的升级。在 6 年期间,共评估了 510 例患者。268 例患者患有银屑病和/或 PsA。合并症的患病率很高(45%高血压、46%高血脂、19%糖尿病和 36%有过去或现在吸烟史)。在 SARM 的就诊导致了 46%的病例与之前在外部诊所的诊断不同的修订诊断。与之前相比,在 SARM 就诊后患者更有可能接受系统性药物治疗,分别为 25%和 15%,比值比为 5.1。与之前相比,在 SARM 就诊后患者也更有可能接受生物制剂治疗,分别为 37%和 16%。多学科护理可能有助于诊断关节疾病,并为同时患有银屑病和 PsA 的患者提供更全面的治疗方法。我们的数据可用于支持为这一人群提供综合风湿病和皮肤科护理的努力。

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