What Are Combined Dermatology-Rheumatology Clinics?

Dual Practice Clinic

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Dual dermatology-rheumatology practices combine rheumatology and dermatology care in one clinical setting. For people with certain conditions, the combination of these two specialties in one place can improve outcomes.

Psoriatic disease, a condition that includes features of skin psoriasis and psoriatic arthritis (PsA), necessitates care from both a rheumatologist and dermatologist. Lupus and dermatomyositis are examples of other conditions that can involve care from a dermatologist and a rheumatologist. With the help of dual dermatology-rheumatology clinics, coordination of care can be easier.

Read more about these combined practices, why they are necessary, their impact, and the advantages and disadvantages of these practices. 

Necessity

There are more than 8 million people in the United States affected by psoriasis, according to the National Psoriasis Foundation. And up to 30% of people with psoriasis—nearly 1 in 3—will eventually go on to develop psoriatic arthritis.

Psoriasis and PsA are both associated with an overactive immune system and chronic inflammation that attacks the skin and/or joints.

  • Skin psoriasis is known for causing a buildup of skin cells that can produce changes ranging from small, localized patches to diffuse, extensive skin involvement.
  • PsA causes inflammation in the joints—specifically in the locations where tendons and ligaments meet bone.

Neither condition is curable, but both are treatable—often with some of the same therapies.

When doctors from two different medical disciplines see the same patient at the same, the patient and both doctors can discuss all concerns and options together in one place. In addition to saving time, this combination helps different health providers stay on the same page when it comes to managing psoriatic disease.

One-Stop Experience

For someone living with both psoriasis and PsA, the combined clinic experience can be like one-stop shopping. This way you are not running around to multiple appointments, or having to take multiple days away from work or family (or looking for child care) to attend your medical appointments.

Overlap

Dermatology, the branch of medicine focused on the diagnosis and treatment of skin disorders, overlaps just about every medical specialty.

It has the strongest connection with rheumatology— a medical specialty focused on the diagnosis and management of autoimmune, inflammatory, or other musculoskeletal conditions, commonly known as rheumatic diseases.

Many types of skin problems can occur with rheumatic diseases like psoriatic arthritis (PsA) and rheumatoid arthritis (RA). RA is a chronic rheumatic disease that mainly affects joints, but it can also affect other body systems, including the eyes, skin, heart, and kidneys.

Many skin conditions share similar symptoms with rheumatic conditions. And a growing list of therapies that can treat both types of conditions is emerging—like disease-modifying anti-rheumatic drugs (DMARDs), biologic therapies, and biosimilar drugs.

With these overlaps, combined specialty practices provide an advantage. Many major medical centers in the United States are combining the process of diagnosis and treatment of PsA with that of other interconnected skin and musculoskeletal conditions.

Technology Enhancement

Many of the goals and practices of combined dermatology-rheumatology clinics can benefit from certain types of technology—like electronic health records and telemedicine.

These methods can make information sharing between the specialties easier, which can translate into improved patient outcomes, especially as it pertains to enhanced quality of life for people living with psoriasis, PsA or other overlapping skin and rheumatic diseases.

Impact

The effectiveness of dual joint dermatology-rheumatology clinics was demonstrated by researchers at a psoriasis and psoriatic arthritis clinic (PPAC) in Athens, Greece.

From December 2018 to January 2019, the doctors at the PPAC clinic saw 185 patients who had both psoriasis and PsA. The majority had severe psoriasis and were using biologic therapy treatment.

Among these patients, comorbidities (more than one disease in the same person) were high. Psoriasis and PsA are linked to many comorbidities, including heart disease, depression, and type 2 diabetes

Most of the patients at the PPAC reported being highly satisfied with the dual specialty practice compared to going to two separate clinics, and most agreed that the collaboration between dermatologists and rheumatologists was vital to their care. The doctors acknowledged the combined team approach improved patient care quality and clinical outcomes.

Another study, this one reported in 2018 in the journal Clinical Rheumatology aimed to determine whether integrated management for psoriatic disease could achieve certain goals, including early diagnosis, better outcomes for skin and musculoskeletal symptoms, and overall patient quality of life.

After a 48-week period, the researchers found the dual specialty practice could yield prompt diagnoses and best treatment approaches, which was evidenced by significant improvement of skin and joint symptoms and patient quality of life. 

Advantages and Disadvantages

Combined care clinics offer advantages to patient care and medical practice. They may also have disadvantages. 

Advantages

A 2012 report from a dual dermatology and rheumatology clinic in Vancouver, British Columbia reported on the doctor-patient combined practice experience. The report’s authors noted that the combination of specialists was helpful in evaluating patients with skin and multiple systemic symptoms, offering a comprehensive treatment approach for people with both psoriasis and PsA.

A 2015 systemic review of the literature on psoriasis and PsA found the effectiveness of therapy improved in combined dermatology-rheumatology clinics. Additionally, patient satisfaction was higher with the combined practice than with separate visits. 

Disadvantages

The downside—as reported by many of the study participants—was the scheduling wait time and the wait at the clinic to be seen. Only 41% of the patients were seen at their actual appointment time.

Productivity can be another challenge for dual practice clinics. For example, dermatologists are used to seeing multiple patients over a workday, while rheumatologists see about half that amount.

Cost is yet another concern. People who participate in combined clinics may see higher medical costs because their visits are more complex, or they may see two bills—one for each medical provider involved in their care.

It is possible that higher costs could be offset by the benefits of avoiding duplicative appointments, reduced miscommunication between departments, and timely access to specialist care.

Pediatric Dermatology-Rheumatology Clinics

Much like adult conditions, there can overlap in rheumatic and dermatologic conditions in children. Pediatric joint and skin conditions can be challenging to diagnose and treat, and may require the expertise of both rheumatologists and dermatologists.

With combined practices, doctors can provide optimized care and parent and child education at one location and at one time.

A retrospective analysis reported in 2018 in the journal Rheumatology aimed to analyze the quality of care given to pediatric patients seen in a combined dermatology-rheumatology practice.

The researchers looked at patient demographics, common diagnoses over a two-year period, and the benefits of having a combined treatment approach. For the analysis, researchers relied on care records and informal feedback from providers, parents, and their patients.

They were able to conclude that the combined dermatology-rheumatology experience was a more useful resource and experience compared to visiting multiple specialties. 

Benefits of the pediatric dermatology-rheumatology clinic experience included:

  • Quick access to rheumatologic and dermatologic care and diagnosis, and appropriate disease management
  • Reduced clinic visits and less time spent at appointments
  • Improved patient education and support

There is a critical shortage of pediatric rheumatologists in the United States, which means that parents of children with rheumatic conditions might need to travel to clinics that are far away—this can impose time burdens and high monetary costs on these families. And while telemedicine can help filter some of the cost and time burdens, it doesn’t tackle the need for in-person care.

With dual specialty practices, families can go to one appointment and have their healthcare needs met in one place, which might translate to better health outcomes for pediatric patients.

There are few combined pediatric dermatology-rheumatology practices in the United States, including one at Stanford University Health system in Palo Alto, California. This may change with changing needs and awareness.

 A Word From Verywell

Combined dermatology-rheumatology practices are not a new concept. In fact, you can find them at many major academic institutions in the United States and around the globe. And most have focused primarily on the treatment of psoriasis and psoriatic arthritis.

There are other types of combined clinics, including in functional medicine and complex medical care, in addition to rheumatology. They can be found at many medical institutions across the United States, including at the Cleveland Clinic in Cleveland, Ohio, and at Johns Hopkins Medical Center in Baltimore, Maryland. 

The benefits of using dermatology-rheumatology dual clinics are many, including the consistent dialogue between healthcare providers. But in the end, it will come down to you as the patient, or as a parent advocating for your child, being at the center of it all.

Do your research and advocate to get access to the best and most appropriate care in the way that it fits into your life—regardless of the structure of that care.

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