Dipartimento di Medicina e Scienze della Salute "Vincenzo Tiberio", Università degli Studi del Molise, Via Giovanni Paolo II, C/da Tappino, 86100, Campobasso, Italy.
Rheumatology Unit, University of Pisa, Pisa, Italy.
Clin Rheumatol. 2021 Jun;40(6):2251-2262. doi: 10.1007/s10067-020-05482-w. Epub 2020 Nov 6.
Psoriatic arthritis (PsA) patients are often treated by dermatology and rheumatology specialities and may receive different treatments. To evaluate the impact of dermatology/rheumatology specialist settings on diagnosis and therapeutic approach in PsA patients. This cross-sectional multicounty study in Italy involved twenty-eight rheumatology or dermatology clinics. Patients with suspected or confirmed PsA were examined by both a dermatologist and a rheumatologist. A total of 413 patients were enrolled and 347 (84%) were diagnosed with PsA. The majority of patients were enrolled from a rheumatology setting (N = 224, 64.6%). Patients with PsA in the dermatology settings had significantly higher disease activity, including skin involvement and musculoskeletal symptoms. Time from PsA onset to diagnosis was 22.3 ± 53.8 vs. 39.4 ± 77.5 months (p = 0.63) in rheumatology and dermatology settings; time from diagnosis to initiation of csDMARD was 7.3 ± 27.5 vs. 19.5 ± 50.6 months, respectively (p < 0.001). In contrast, time from diagnosis to bDMARD use was shorter in dermatology settings (54.9 ± 69 vs. 44.2 ± 65.6 months, p = 0.09, rheumatology vs. dermatology), similar to the time taken from first csDMARDs and bDMARDs (48.7 ± 67.9 vs. 35.3 ± 51.9 months, p = 0.34). The choice to visit a rheumatologist over a dermatologist was positively associated with female gender and swollen joints and negatively associated with delay in time from musculoskeletal symptom onset to PsA diagnosis. This study highlights a diagnostic delay emerging from both settings with significantly different therapeutic approaches. Our data reinforce the importance of implementing efficient strategies to improve early identification of PsA that can benefit from the integrated management of PsA patients. Key Points • A diagnostic delay was observed from both dermatology and rheumatology settings with significantly different therapeutic approaches. • Shared dermatology and rheumatology clinics offer the combined expertise to improve in the early identification and management of PsA.
银屑病关节炎（PsA）患者通常由皮肤科和风湿病学专科治疗，可能接受不同的治疗。评估皮肤科/风湿病学专科设置对银屑病关节炎患者诊断和治疗方法的影响。本研究为意大利多县的横断面研究，纳入了 28 个风湿病或皮肤科诊所。由皮肤科医生和风湿病医生对疑似或确诊的银屑病关节炎患者进行检查。共纳入 413 例患者，其中 347 例（84%）诊断为银屑病关节炎。大多数患者来自风湿病科（N=224，64.6%）。皮肤科就诊的银屑病关节炎患者的疾病活动度显著更高，包括皮肤受累和肌肉骨骼症状。从银屑病关节炎发病到诊断的时间在风湿病科和皮肤科分别为 22.3±53.8 个月和 39.4±77.5 个月（p=0.63）；从诊断到开始使用 csDMARD 的时间分别为 7.3±27.5 个月和 19.5±50.6 个月（p<0.001）。相反，皮肤科就诊的患者从诊断到使用生物制剂的时间更短（54.9±69 个月比 44.2±65.6 个月，p=0.09，风湿病科比皮肤科），与首次使用 csDMARD 和生物制剂的时间相似（48.7±67.9 个月比 35.3±51.9 个月，p=0.34）。选择看风湿病医生而不是皮肤科医生与女性性别和关节肿胀有关，与肌肉骨骼症状出现到银屑病关节炎诊断的时间延迟呈负相关。本研究强调了两种设置都存在诊断延迟，且治疗方法明显不同。我们的数据证实了实施有效策略的重要性，以改善对银屑病关节炎的早期识别，使患者受益于银屑病关节炎的综合管理。重点 • 在皮肤科和风湿病学设置中都观察到诊断延迟，且治疗方法明显不同。 • 共享的皮肤科和风湿病学诊所提供了综合专业知识，以改善对银屑病关节炎的早期识别和管理。
