Background/Purpose: The current system of referral by Canadian dermatologists of patients who may have psoriatic arthritis (PsA) to rheumatologists is suboptimal. Hypothesizing that knowledge level, attitude and confidence in being able to refer appropriately impacts the ability of dermatologists to refer patients who may have PsA to a rheumatologist, we aimed to define their current awareness of, and practices relating to, the diagnosis and referral of PsA.

Methods: Based on recommendations from our advisory group comprising rheumatologists, dermatologists, methodologists and patient-partners, questions for structured interviews and focus groups with practicing dermatologists were developed. Dermatologists from across Canada at different stages of their career were recruited via electronic mail. Telephone or face-to-face interviews and focus groups were conducted by trained research associates. The interviews and focus groups were recorded, transcribed, and analyzed by 2 experts and key themes identified.

Results: 8 interviews and 2 focus groups involving a total of 20 dermatologists in community practice (10 males, mean years in practice 18.4) were conducted and data saturation reached. The following themes were identified- (1) Self-perceived knowledge of psoriasis and associated co-morbidities was fairly high [mean of 8.5 (out of 10) across the interviews and 7.1 across focus groups]. (2) The number of patients with psoriasis seen was quite variable, 30-50 weekly on average. Of these, the percentage with PsA or suspected PsA ranged from 5%-50%. (3) Co-morbidities, including PsA, diabetes, obesity, heart disease, depression, metabolic syndrome, and hypertension were consistently mentioned. (4) Red flags noted for PsA included morning stiffness and joint pain. Fewer mentioned nail lesions and joint swelling. (5) All dermatologists recognized the importance of identifying PsA early, both for the patient and for the broader healthcare system. (6) There was a notable divide between their perceived role in screening for PsA and in making the diagnosis. A minority of respondents felt comfortable managing PsA if it was mild without confirmation by a rheumatologist. (7) If arthritis is perceived to be mild, dermatologists perceive an ongoing role in patient management. Other aspects of the healthcare system that affected dermatologists’ perception included the nature of the local healthcare context, access to rheumatologists, and the role of primary care.

Conclusion: This qualitative study shows that dermatologists have high self-perceived knowledge of psoriasis, PsA and its associated comorbidities, and recognize the importance of identifying PsA early. However, the nature of the local healthcare context and access to rheumatologists are significant road blocks to appropriate referral.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/roadblocks-perceived-by-canadian-dermatologists-for-referring-patients-with-suspected-psoriatic-arthritis/