Background/Purpose: Many autoimmune diseases have both musculoskeletal and cutaneous manifestations, which historically have been managed separately by rheumatologists and dermatologists. Given the complex presentation of autoimmune dermatologic and rheumatologic diseases, new tools are now available for proper workup and diagnosis, and access to a wide array of novel targeted therapies, combined Rheumatology-Dermatology clinics have been developed across the country. These clinics are unique in that both rheumatologists and dermatologists work together to provide multi-disciplinary care for patients with skin and musculoskeletal diseases. In this study, we retrospectively reviewed the records from a our combined Rheumatology-Dermatology clinic at Rhode Island Hospital, a tertiary care medical center in the Northeast.

Methods: We conducted a retrospective chart review of 324 patient visits to the newly formed Rhode Island Hospital Center for Skin and Musculoskeletal Diseases during the period from July 2014 to February 2016. A total of 167 new patients were identified. We collected data on patient demographics, past medical history, family history, referring physician, presenting diagnoses, change in diagnoses, escalation or reduction of pharmacologic management including biologic medication use, and development of adverse events

Results:

Of 167 new patients seen in the combined Rheumatology-Dermatology Clinic between July 2014 and February 2016, 105 (63%) were female and the average age was 50 years. The average number of visits per patient over this period was 2.5. The majority (68%) of patients were referred by either dermatology or rheumatology for further evaluation and management. The most frequent diagnosis referred to the clinic was psoriasis, comprising 60% of referrals. Other diagnoses seen in the clinic included psoriatic arthritis, systemic lupus erythematosus, cutaneous lupus, dermatomyositis, scleroderma, vasculitis, pyoderma gangrenosum, and mixed connective tissue disease. 44 (26%) patients reported a history of a co-morbid autoimmune condition such as inflammatory bowel disease (IBD), thyroid disease, or pernicious anemia. 118 (71%) patients denied a family history of similar autoimmune condition. As a result of their consultation in the combined dermatology-rheumatology clinic, 55 (37%) patients received a change in diagnosis. One fifth of patients presenting with psoriasis were diagnosed with concomitant psoriatic arthritis. Treatment was changed in 94 (56%) patients overall. 68 (41%) patients had escalation of treatment, while 12 (7%) had treatment reduction. A small minority of patients 18 (11%) experienced adverse events from these treatments.

Conclusion: This study provides evidence to support improved patient outcomes by evaluation in a unique combined rheumatology-dermatology multidisciplinary setting. Patients with complex autoimmune diseases, including those with psoriasis and psoriatic arthritis, experienced benefits from co-management of their condition.

References: 1. Cobo-Ibanez T, et al. Rheumatol Int. 2016 Jul;36(2):221-9. 2. Mody E, et al. Br J Dermatol. 2007 Nov;157(5):1050-1. 3. Velez NF, et al. Arch Dermatol Res. 2012 Jan;304(1):7-13.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/patient-outcomes-from-a-tertiary-center-combined-rheumatology-dermatology-clinic/