title: Multidisciplinary dermatology-rheumatology management for patients with moderate-to-severe psoriasis and psoriatic arthritis: a systematic review.
abstract: The aim of the study was to analyze the efficacy and satisfaction of multidisciplinary dermatology-rheumatology management for patients with moderate-to-severe psoriasis and psoriatic arthritis (PsA). We conducted a systematic literature search in MEDLINE, EMBASE, and Cochrane Library up to September 2015. Selection criteria include (1) adult patients with moderate-to-severe psoriasis and PsA, (2) assessed in a multidisciplinary consultation, (3) comparison with routine separate consultations, and (4) outcome measures to evaluate efficacy and/or satisfaction. Meta-analyses, systematic reviews, clinical trials, cohort studies, and case series were included. The quality of the studies included was graded according to the Oxford Level of Evidence scale. Of 195 articles, three studies complied with the inclusion criteria: two case series and one descriptive study in which 506 patients were evaluated. Patients were referred to the multidisciplinary consultation from dermatology and rheumatology consultations in all but one study, in which primary care was also involved. The reason for the referral was to confirm the diagnosis and/or treatment. Patients were evaluated on a weekly and monthly basis in two and one study, respectively. The evidence obtained is scarce but suggests the efficacy of multidisciplinary consultations in terms of improved skin and joint symptoms after changing treatment (82-56 %), showing higher scores for this type of consultation compared to the usual [4.91 vs. 2.85 (0-5)] and a high level of satisfaction among patients (94 % "very satisfied"). However, waiting times were higher. With the limited evidence found, multidisciplinary management seems to be more effective and more satisfactory for patients with moderate-to-severe psoriasis and PsA than conventional consultations, though this could not be conclusively demonstrated. The results of this review support the benefit of implementing this type of consultation.
authors.affiliation: Rheumatology Department, Hospital Universitario Infanta Sofía, Paseo de Europa 34, 28702, San Sebastián de Los Reyes, Madrid, Spain. mtcoboiba@yahoo.es.
authors.forename: Tatiana
authors.initials: T
authors.lastname: Cobo-Ibáñez
authors.affiliation: Rheumatology Department, Hospital Universitario de Móstoles, Río Júcar s/n, 28935, Móstoles, Madrid, Spain. virginia.villaverde@yahoo.es.
authors.forename: Virginia
authors.initials: V
authors.lastname: Villaverde
authors.affiliation: Research Unit, Spanish Society of Rheumatology, Marqués de Duero 5, 1º, 28001, Madrid, Spain. daniel.seoane@ser.es.
authors.forename: Daniel
authors.initials: D
authors.lastname: Seoane-Mato
authors.affiliation: Rheumatology Department, Hospital Universitario Infanta Sofía, Paseo de Europa 34, 28702, San Sebastián de Los Reyes, Madrid, Spain. Santiago.munoz@salud.madrid.org.
authors.forename: Santiago
authors.initials: S
authors.lastname: Muñoz-Fernández
authors.affiliation: Research Unit, Spanish Society of Rheumatology, Marqués de Duero 5, 1º, 28001, Madrid, Spain. mercedes.guerra@ser.es.
authors.forename: Mercedes
authors.initials: M
authors.lastname: Guerra
authors.affiliation: Research Unit, Spanish Society of Rheumatology, Marqués de Duero 5, 1º, 28001, Madrid, Spain. petra.diaz@ser.es.
authors.forename: Petra Díaz
authors.initials: PD
authors.lastname: Del Campo
authors.affiliation: Rheumatology Department, Hospital Clinic de Barcelona e IDIBAPS, Calle Villarroel 170, 08036, Barcelona, Spain. jcanete@clinic.ub.es.
authors.forename: Juan D
authors.initials: JD
authors.lastname: Cañete
mesh_terms: D015535:Arthritis, Psoriatic / Q000175:diagnosis / Q000628:therapy*; D003880:Dermatology; D006801:Humans; D033183:Interdisciplinary Communication; D010348:Patient Care Team; D017060:Patient Satisfaction; D011565:Psoriasis / Q000175:diagnosis / Q000628:therapy*; D012017:Referral and Consultation; D012074:Remission Induction; D012219:Rheumatology; D012720:Severity of Illness Index; D013997:Time Factors; D016896:Treatment Outcome; D014850:Waiting Lists
keywords: Consultations; Management; Multidisciplinary; Psoriasis; Psoriatic arthritis; Systematic review