Rheumatologists Are the Primary Specialists for Managing Psoriatic Arthritis
Rheumatologists should primarily care for patients with psoriatic arthritis (PsA), with dermatologist collaboration when clinically relevant skin involvement is present. 1
Specialist Roles in PsA Management
Rheumatologist's Role
Rheumatologists possess optimal expertise in:
- Diagnosing and managing musculoskeletal manifestations of PsA
- Assessing disease activity and structural damage
- Managing disease-modifying antirheumatic drugs (DMARDs)
- Monitoring treatment response
- Evaluating safety considerations and comorbidities 1
Responsible for managing all musculoskeletal manifestations:
- Peripheral arthritis
- Axial disease
- Enthesitis
- Dactylitis 1
Collaborative Care
- When clinically relevant skin involvement is present, a collaborative approach between rheumatologist and dermatologist is recommended 1, 2
- The 2023 EULAR guidelines specifically updated terminology from "clinically significant" to "clinically relevant" skin involvement to maintain consistency with other recommendations 1
- Other specialists may be involved based on specific manifestations:
- Ophthalmologists for uveitis or eye manifestations
- Gastroenterologists for inflammatory bowel disease 2
Evidence Supporting Rheumatologist-Led Care
The 2023 EULAR recommendations explicitly state that "rheumatology experts provide the best care for patients with PsA" due to their:
- Experience with medications used to treat rheumatic and musculoskeletal diseases
- Knowledge of safety considerations
- Understanding of relevant comorbidities 1
This recommendation has remained unchanged across multiple guideline updates, demonstrating strong consensus among experts 1.
Benefits of Collaborative Care
Research shows that multidisciplinary care can improve outcomes:
- A study of a combined dermatology-rheumatology clinic found that 46% of patients received a revised diagnosis that differed from previous diagnoses 3
- Patients were 5 times more likely to receive appropriate systemic medication after evaluation in a combined clinic 3
- Early referral to a rheumatologist is crucial for timely diagnosis and treatment to prevent structural damage 2
Common Pitfalls in PsA Management
- Delayed diagnosis: Rheumatologists estimate time to diagnosis as four times shorter than what patients actually experience 4
- Discordance in symptom perception: Patients perceive joint pain as their most severe symptom, while rheumatologists often presume skin appearance is most concerning 4
- Residual disease activity: One-third of PsA patients considered to have "acceptable disease state" by rheumatologists still have residual disease activity that negatively impacts quality of life 5
- Lack of patient involvement: Almost half of patients report having no input into the development of their treatment goals 4
Conclusion
For optimal management of morbidity, mortality, and quality of life in PsA, rheumatologists should serve as the primary specialists managing the condition. When skin manifestations are clinically relevant, a collaborative approach with dermatologists ensures comprehensive care addressing all disease domains.