Rheumatologists' recommendations on what to do in the dermatology office to evaluate and manage psoriasis patients' joint symptoms.
BACKGROUND
Psoriasis patients presenting to the dermatologist for skin disease management may have joint symptoms related to psoriatic arthritis. Dermatologists should ask psoriasis patients about these, yet may not be sure about how to best collaborate with rheumatologists in the management of these patients.


OBJECTIVE
To describe how rheumatologists view the role of dermatologists in addressing and identifying signs and symptoms of psoriatic arthritis in psoriasis patients.


METHODS
A questionnaire was developed concerning the evaluation and management of joint complaints in a dermatology setting. The survey was sent to rheumatologists interested in psoriatic arthritis.


RESULTS
Rheumatologists recommended dermatologists ask psoriasis patients about joint pain, stiffness, swelling, and fatigue to evaluate for psoriatic arthritis. Rheumatology referral was recommended if patients had signs of inflammatory joint disease that were unrelieved by non-prescription non-steroidal anti-inflammatory drugs (NSAIDs). Patients with disabling joint symptoms, no improvement on (disease-modifying antirheumatic drug; DMARD) therapy, or with other causes of joint pain should be referred to rheumatology. Rheumatologists recommended that dermatologists only provide DMARD therapy for joint symptoms if concomitant skin disease warrants such treatment.


CONCLUSIONS
Dermatologists play a pivotal role in preventing joint destruction in psoriasis patients by screening for signs of psoriatic arthritis, initiating treatment, and referring patients to a rheumatologist when appropriate.
Taylor
Sarah L
SL
Departments of Dermatology, Wake Forest University School of Medicine, Winston-Salem, NC 27157-1071, USA.
Petrie
Matthew
M
O'Rourke
Kenneth S
KS
Feldman
Steven R
SR
D000553:Ambulatory Care; D018501:Antirheumatic Agents / Q000627:therapeutic use; D018771:Arthralgia / Q000209:etiology; D015535:Arthritis, Psoriatic / Q000150:complications / Q000175:diagnosis* / Q000188:drug therapy; D003880:Dermatology; D042241:Early Diagnosis; D005221:Fatigue / Q000209:etiology; D006306:Health Surveys; D006801:Humans; D009819:Office Visits; D010819:Physician's Role; D012017:Referral and Consultation; D012216:Rheumatic Diseases / Q000188:drug therapy; D012219:Rheumatology; D011795:Surveys and Questionnaires
D018501:Antirheumatic Agents