By Dr Irwin Lim, Rheumatologist
As a gross generalisation, my Sydney dermatology colleagues are very busy, and have short consultation times. In these minutes, they'll undress the patient, have a look at the skin, & work out the management options. Since I'm being a little inflammatory (apologies in advance - my dermatology friends will forgive me), dermatologists only need to decide on 3 main options for the rash/skin lesion: let the passage of time pass & watch it, cut it out, or stick some steroid on it.
With regards Psoriasis, and in another gross generalisation (and this is unfortunately, probably accurate), many dermatologists will likely not have time to fully consider rheumatic manifestations. Up to 30% of patients with the autoimmune skin condition, psoriasis, will also have psoriatic arthritis.
While psoriatic arthritis can cause terrible joint deformity, in many, the symptoms and signs are much more subtle. Think tennis elbow or "heel spurs" or achilles pain (enthesopathy). Often, the problem is spinal pain that is instead attributed to "age" or some lifting injury. Or, the patient may have pain in the hands, feet or knees, often without obvious swelling.
The chance of psoriatic arthritis is higher when the patient with psoriasis has psoriatic nail disease. Typically, a very recognisable manifestation for the dermatologist.
How do we get dermatologists to pick up these manifestations and therefore direct their psoriasis patients to appropriate therapy for their joint, tendon, spine disease?
Improved awareness is one way. I've just returned from a combined dermatology & rheumatology weekend meeting. The meeting agenda was very good, with content relevant to both specialties. Importantly, there were combined sessions to highlight why our specialities need to work better together. Connected Care. Wouldn't that be good?
A practical measure is the use of questionnaires. These could be handed out to psoriasis patients waiting in dermatology clinics. Once filled, they can be presented to the dermatologist. If the questionnaire suggests psoriatic arthritis, the referral can then be made to a rheumatology service. Fast, easy, efficient.
Dr Irwin Lim is a rheumatologist and a director of BJC Health.
BJC Health provides a connected care multidisciplinary team philosophy to deliver positive lifestyle outcomes through a holistic approach to those with degenerative & inflammatory arthritis, tendon injury and lifestyle diseases. Our clinics are located in Parramatta, Chatswood and Brookvale. Contact us.
This blog focuses on arthritis-related diseases, healthcare in general, and our Connected Care philosophy.