Rheumatology Department, Hospital Universitario Parc Taulí de Sabadell, I3PT, UAB, Parc Taulí, 1 Sabadell, Barcelona, Spain.
CIRI/Rheumatologie und Fraunhofer IME-Translationale Medizin und Pharmakologie, Goethe-Universität, Frankfurt am Main, Germany.
Joint Bone Spine. 2021 May;88(3):105175. doi: 10.1016/j.jbspin.2021.105175. Epub 2021 Mar 23.
Making a differential diagnosis of psoriatic arthritis (PsA) is not straightforward. This is partly because of its heterogeneous presentation and partly because many patients with PsA are initially diagnosed with psoriasis and treated in primary care or by dermatologists, with referral to rheumatologists being delayed. Once diagnosed, optimal disease control requires frequent specialist monitoring, adjustment or switching of therapies, and management of comorbidities and concomitant diseases, as well as attention to patients' overall well-being. Given the breadth of expertise that diagnosis and management of PsA requires, we sought to define a collaborative, structured framework that supports the optimisation of multidisciplinary care for patients with PsA in Europe.
An expert panel comprising four rheumatologists, three dermatologists, two specialist nurses and one psychologist-from Spain, the United Kingdom, The Netherlands, Germany, France and Italy-met face-to-face to take part in a modified Delphi exercise.
The result of this exercise is a set of recommendations that are based on combining published evidence with the panel's extensive clinical experience. Recommendations can be implemented in a number of ways, but the central call-to-action of this framework is the need for improved collaboration between dermatologists (or primary care physicians) and rheumatologists. This could occur in a variety of different formats: standard referral pathways, multidisciplinary physician meetings to discuss patient cases, or 'one stop', combined clinics.
We anticipate that when the majority of patients with PsA receive regular multidisciplinary care, improved patient outcomes will follow, although robust research is needed to explore this assumption.
银屑病关节炎（PsA）的鉴别诊断并不简单。这部分是因为其表现具有异质性，部分是因为许多 PsA 患者最初被诊断为银屑病，并在初级保健或皮肤科接受治疗，转诊给风湿病学家的时间被延迟。一旦确诊，为了实现疾病的最佳控制，需要频繁的专科监测、调整或转换治疗方案，并管理合并症和并存疾病，同时关注患者的整体健康状况。鉴于诊断和管理 PsA 需要广泛的专业知识，我们试图制定一个协作的、结构化的框架，以支持优化欧洲 PsA 患者的多学科护理。
一个由 4 名风湿病学家、3 名皮肤科医生、2 名专科护士和 1 名心理学家组成的专家小组在西班牙、英国、荷兰、德国、法国和意大利进行了面对面的会议，参与了一项修改后的 Delphi 研究。
这项研究的结果是一组建议，这些建议是基于结合已发表的证据和小组的广泛临床经验。建议可以通过多种方式实施，但该框架的核心行动呼吁是需要改善皮肤科医生（或初级保健医生）和风湿病学家之间的合作。这可以通过多种不同的形式发生：标准转诊途径、多学科医生会议以讨论患者病例，或“一站式”联合诊所。
我们预计，当大多数 PsA 患者接受定期的多学科护理时，患者的预后将会得到改善，尽管需要进行强有力的研究来探索这一假设。
