Five Years’ Experience of Multidisciplinary Approach to Chronic Inflammatory Diseases by Rheumatology, Dermatology and Gastroenterology Departments

Year 2022, , 37 - 44, 29.01.2022

Burcu Yağız , Belkıs Nihan Coşkun , Tugba Ocak Altuğ Güner , Aslı Macunluoglu , Yavuz Pehlivan , Murat Kıyıcı Serkan Yazici , Emel Başkan , Hüseyin Ediz Dalkılıç

https://doi.org/10.46310/tjim.958247

Abstract

Introduction: Chronic inflammatory diseases (CIDs) are lifelong complex disorders that affect quality of life, and this study aimed to summarize 5 years of experience with a multidisciplinary approach for these complex diseases as a result of medical council meetings.
Methods: Hospital-based, medical records review study was conducted. A total of 45 monthly medical council meetings were held between 2014-2019 with the participation of the rheumatology, dermatology and gastroenterology departments of the same university. Patients with complex conditions that were seen in each department's own polyclinic composed the council. This study only included 308 patients referred by the rheumatology group.
Results: Females made up 66.5 % of the 308 patients. The median age was 45 (19-77). PsA (psoriatic arthritis) and other SPA (spondyloarthritis) patients composed 49.3% of the total. A total of 68.18% of the patients were presented only to consult with the dermatology department. The most common reason for presenting patients was to discuss options for treatment (41.5%). The diagnosis of psoriasis was confirmed in 48 of 67 (71.6%) patients who presented with a pre-diagnosis. The diagnosis was changed in 34.74% of the patients, whereas the diagnosis became completely different in 11.36% of the patients.
Conclusions: Many patients with challenging diagnosis and treatment processes are encountered in daily practice. The combination of different disciplines makes it possible to provide more rapid and effective solutions. In this study, we aimed to emphasize the increasing importance of such multidisciplinary approaches

Keywords

Chronic inflammatory diseases, dermatology, gastroenterology, multidisciplinary, rheumatology

References

• Daniel C Baumgart, William J Sandborn. Inflammatory bowel disease: clinical aspects and established and evolving therapies. Lancet. 2007;369(9573):1641-57. doi:10.1016/S0140- 6736(07)60751-X.
• Strober W, Fuss I, Mannon P. The fundamental basis of inflammatory bowel disease. J Clin Investig. 2007;117(3):514-21. doi: 10.1172/JCI30587.
• Andersen V, Holmskov U, Sørensen SB, Jawhara M, Andersen KW, Bygum A, et.al. A proposal for a study on treatment selection and lifestyle recommendations in chronic inflammatory diseases: A danish multidisciplinary collaboration on prognostic factors and personalized medicine. Nutrients. 2017 May 15;9(5):499. doi: 10.3390/nu9050499.
• Ibrahim G, Waxman R, Helliwell PS. The prevalence of psoriatic arthritis in people with psoriasis. Arthritis Rheum. 2009 Oct 15;61(10):1373-8. doi: 10.1002/ art.24608.
• Wilson FC, Icen M, Crowson CS, McEvoy MT, Gabriel SE, Kremers HM. Incidence and clinical predictors of psoriatic arthritis in patients with psoriasis: a populationbased study. Arthritis Rheum. 2009 Feb 15;61(2):233-9. doi: 10.1002/art.24172.
• Velez NF, Wei-Passanese EX, Husni ME, Mody EA, Qureshi AA. Management of psoriasis and psoriatic arthritis in a combined dermatology and rheumatology clinic. Arch Dermatol Res. 2012 Jan;304(1):7-13. doi:10.1007/s00403-011-1172-6.
• Gladman DD, Stafford-Brady F, Chang CH, Lewandowski K, Russell ML. Longitudinal study of clinical and radiological progression in psoriatic arthritis. J Rheumatol. 1990 Jun;17(6):809-12.
• Kane D, Stafford L, Bresnihan B, FitzGerald O. A prospective, clinical and radiological study of early psoriatic arthritis: an early synovitis clinic experience. Rheumatology (Oxford). 2003 Dec;42(12):1460-8. doi: 10.1093/rheumatology/keg384.
• McHugh NJ, Balachrishnan C, Jones SM. Progression of peripheral joint disease in psoriatic arthritis: a 5-yr prospective study. Rheumatology (Oxford). 2003 Jun;42(6):778-83. doi: 10.1093/rheumatology/keg217.
• Hindryckx P, Novak G, Costanzo A, Danese S. Disease-related and drug-induced skin manifestations in inflammatory bowel disease. Expert Review of Gastroenterology and Hepatology. 2017;11(3):203-214. doi: 10.1080/17474124.2017.1283985.
• Bansback NJ, Ara R, Barkham N, Brennan A, Fraser AD, Conway P, Reynolds A, Emery P. Estimating the cost and health status consequences of treatment with TNF antagonists in patients with psoriatic arthritis. Rheumatology (Oxford). 2006 Aug;45(8):1029-38. doi:10.1093/rheumatology/kel147.
• Fowler JF, Duh MS, Rovba L, Buteau S, Pinheiro L, Lobo F, Sung J, Doyle JJ, Swensen A, Mallett DA, Kosicki G. The impact of psoriasis on health care costs and patient work loss. J Am Acad Dermatol. 2008 Nov;59(5):772-80. doi: 10.1016/j.jaad.2008.06.043.
• Gottlieb AB, Dann F. Comorbidities in Patients with Psoriasis. Am J Med. 2009;122(12):1150. doi: 10.1016/j.amjmed.2009.06.021.
• Kurd SK, Troxel AB, Crits-Christoph P, Gelfand JM. The risk of depression, anxiety, and suicidality in patients with psoriasis: A population-based cohort study. Arch Dermatol. 2010;146(8):891-5. doi: 10.1001/archdermatol.2010.186.
• Prodanovich S, Kirsner RS, Kravetz JD, Ma F, Martinez L, Federman DG. Association of psoriasis with coronary artery, cerebrovascular, and peripheral vascular diseases and mortality. Arch Dermatol. 2009;145(6):700-3. doi: 10.1001/archdermatol.2009.94.
• Solomon DH, Love TJ, Canning C, Schneeweiss S. Risk of diabetes among patients with rheumatoid arthritis, psoriatic arthritis and psoriasis. Ann Rheum Dis. 2010;69(12):2114-7. doi: 10.1136/ard.2009.125476.
• Soltani-Arabshahi R, Wong B, Feng BJ, Goldgar DE, Duffin KC, Krueger GG. Obesity in early adulthood as a risk factor for psoriatic arthritis. Arch Dermatol. 2010;146(7):721-6. doi: 10.1001/archdermatol.2010.141.
• Felice C, Leccese P, Scudeller L, Lubrano E, Cantini F, Castiglione F, Gionchetti P, Orlando A, Salvarani C, Scarpa R, Vecchi M, Olivieri I, Armuzzi A; Italian SpAIBD Expert Panel Group. Red flags for appropriate referral to the gastroenterologist and the rheumatologist of patients with inflammatory bowel disease and spondyloarthritis. Clin Exp Immunol. 2019 Apr;196(1):123-38. doi: 10.1111/cei.13246.
• Kirkham B, de Vlam K, Li W, Boggs R, Mallbris L, Nab HW, Tarallo M. Early treatment of psoriatic arthritis is associated with improved patient-reported outcomes: findings from the etanercept PRESTA trial. Clin Exp Rheumatol. 2015 Jan-Feb;33(1):11-9.
• Boehncke WH, Anliker MD, Conrad C, Dudler J, Hasler F, Hasler P, Häusermann P, Kyburz D, Laffitte E, Michel BA, Möller B, Navarini AA, Villiger PM, Yawalkar N, Gabay C. The dermatologists’ role in managing psoriatic arthritis: results of a Swiss Delphi exercise intended to improve collaboration with rheumatologists. Dermatology. 2015;230(1):75-81. doi: 10.1159/000367688.
• Silverberg JI. Adult-Onset Atopic Dermatitis. J Allergy Clin Immunol Pract. 2019;7(1):28-33. doi: 10.1016/j. jaip.2018.09.029.
• Park JH, Park YJ, Kim SK, Kwon JE, Kang HY, Lee ES, Choi JH, Kim YC. Histopathological Differential Diagnosis of Psoriasis and Seborrheic Dermatitis of the Scalp. Ann Dermatol. 2016 Aug;28(4):427-32. doi:10.5021/ad.2016.28.4.427.
• Ghosh S. Multidisciplinary teams as standard of care in inflammatory bowel disease. Can J Gastroenterol. 2013 Apr;27(4):198. doi: 10.1155/2013/710671.
• Siebert U, Wurm J, Gothe RM, Arvandi M, Vavricka SR, von Känel R, Begré S, Sulz MC, Meyenberger C, Sagmeister M; Swiss IBD Cohort Study Group. Predictors of temporary and permanent work disability in patients with inflammatory bowel disease: results of the swiss inflammatory bowel disease cohort study. InflammBowel Dis. 2013 Mar-Apr;19(4):847-55. doi: 10.1097/MIB.0b013e31827f278e.
• Tung CH, Lai NS, Lu MC, Lee CC. Liver cirrhosis in selected autoimmune diseases: a nationwide cohort study in Taiwan. Rheumatol Int. 2016 Feb;36(2):199-205. doi:0.1007/s00296-015-3369-z.
• Abraham S, Begum S, Isenberg D. Hepatic manifestations of autoimmune rheumatic diseases. Ann Rheum Dis. 2004 Feb;63(2):123-9. doi: 10.1136/ard.2002.001826.