That advice holds true for rheumatologists, because many patients with rheumatic diseases also suffer from skin diseases. In fact, Dr. Siegel says the treat-to-target approach is based on a similar strategy taken for psoriatic arthritis and championed by Laura Coates, MBChB, MRCP, PhD, of Britain’s National Institute for Health Research.4
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“A rheumatologist [may not be] an expert in treating skin disease, but knowing that there is something out there, I think, can really help [the rheumatologist] interact with patients with psoriatic arthritis who are more often than not suffering from skin symptoms, as well,” Dr. Siegel says. “Maybe if you’re not reaching the different levels of skin clearance while managing your joint disease, [patients] should be changing the dialogue with [their] dermatologist, thinking about different things. This [strategy] is about bringing [all those aspects] into the conversation so every contact point for that patient in the healthcare system will, hopefully, be helping them work toward those treatment targets.”
The advice is particularly helpful for rheumatologists, because the nexus of psoriasis and psoriatic arthritis is one they commonly deal with. Dr. Siegel says that many rural rheumatologists, in addition to their day jobs, are treating patients with dermatologic issues and the new BSA guidelines can be a needed push to more aggressively treat patients.
“If a patient has access to only one healthcare provider,” Dr. Siegel adds, “there are some really serious limitations for them to go and see the appropriate specialist. We hope, whoever they’re seeing, can be best equipped to help that patient.”
Richard Quinn is a freelance writer in New Jersey.
- American Academy of Dermatology. Conditions: Psoriasis. 2017
- American College of Rheumatology. Diseases and conditions: Psoriatic arthritis. 2017
- Armstrong AW, Siegel MP, Bagel J, et al. From the medical board of the National Psoriasis Foundation: Treatment targets for plaque psoriasis. J Am Acad Dermatol. 2017 Feb;76(2):290–298. doi: 10.1016/j.jaad.2016.10.017. Epub 2016 Nov 28.
- Coates LC, Helliwell PS. Treating to target in psoriatic arthritis: How to implement in clinical practice. Ann Rheum Dis. 2016 Apr;75(4):640–643. doi: 10.1136/annrheumdis-2015-208617. Epub 2015 Dec 15.