Background/Purpose: Multidisciplinary clinics are becoming increasingly common as a way to bring together multiple specialists to care for patients with complex diseases.  While multidisciplinary clinics commonly involve pulmonologist and cardiologist for patients with pulmonary hypertension, rheumatology and dermatology combined clinic are thought to be less common.  Managing skin lesions in patients with known or possible autoimmune diseases can be a diagnostic and therapeutic challenge which often requires the combined expertise of dermatology and rheumatology.  Previous studies have shown the benefit of managing patients with psoriasis and psoriatic arthritis in a combined dermatology and rheumatology clinic but to our knowledge there have not been any studies reporting the experience of a general dermatology/rheumatology clinic.  We feel that our multidisciplinary clinic adds significant value to complex patients and this study sought to evaluate the clinical experience of a dermatology/rheumatology clinic.

Methods:  We performed a retrospective chart review of all patients presenting to our dermatology / rheumatology combined clinic between July 2008 to April 2014 at Dartmouth-Hitchcock Medical Center.  A total of 126 patients were seen over 158 visits.  We reviewed demographic data, initial diagnosis, treatment modalities including procedures like skin biopsy, change in initial diagnosis and treatment. 

Results: Of the 126 patients evaluated, 73% were referred by rheumatology and 27% by dermatology.  The majority of participants were females (75%) and the mean age of the patients was 52 years.  The average wait period to be seen in the clinic after the referral was made was 3.8 weeks.    A skin biopsy was done in 24% patients during the visit and 19% had a skin biopsy reviewed at the visit.  The most common initial diagnosis were connective tissue disease related rash (9.5%), SLE (9%) and vasculitis (9%).  This was followed by drug rash, psoriasis and psoriatic arthritis.  Seventy-seven patients (61%) had a change in diagnosis and treatment as a result of this combination clinic visit.  Of the 77 patients who had a treatment change, 18% received DMARD therapy and 8% received biologics.  On follow-up, 28.5% patients had significant or complete improvement, 43.5% patients had partial improvement, 12% reported no improvement at all and 16% were lost to follow up. 

Conclusion: This study shows that the majority of patients seen in our multidisciplinary clinic had a change in the diagnosis and/or treatment.  We believe that this clinic brings value to patients by simplifying the care of these complex patients by having multiple specialists in the same room with the patients.  This integrated care approach improves the quality of care for our patients with skin and musculoskeletal diseases.  Moreover this combined clinic increases access for these patients and as patients may receive appropriate treatment sooner, it may reduce the overall health care costs for these patients.

 

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/dermatologic-rheumatism-our-experience-with-a-multidisciplinary-dermatologyrheumatology-clinic/