Coordinating Care Between Your Rheumatologist and Dermatologist
During rheumatology training, we had a special clinic called the “Rheum-Derm” clinic. Once a month, rheumatologists and dermatologists would huddle together in the same office space to put our heads together on mutual patients.
Even with both specialties crowded together in the same patient room, it was still a challenge sometimes to decide on a diagnosis and plan of care that we all agreed on. It was helpful to see the dermatologists’ point of view on plaque psoriasis and psoriatic arthritis during that shared time together.
The gap between different branches of medicine can be quite wide.
I saw that although we have access to the same treatments and biologics, the approach to using those medications can be quite different between specialties. Fast forward to being alone in private practice after medical training, I see that the challenges of teamwork and coordinating care with other specialists are even greater.
The gap between different branches of medicine can be quite wide. and my patients often lament that they feel like they are seeing too many different specialists and that none of their doctors are really communicating with each other. Here are a few reasons why a fragmentation of care could be occurring:
Different training approaches
Rheumatologists are often trained to use DMARD medications first, such as methotrexate, leflunomide, or sulfasalazine. Our first-line medications are often older medications that have been shown to have efficacy in reducing joint pain, swelling, rash, and other manifestations of plaque psoriasis and psoriatic arthritis.
On the other hand, dermatologists may be more likely to skip the DMARD tablets and go straight to an injectable biologic for the treatment of psoriasis. They might feel that the biologics are a better fit for their patients with psoriasis.
Different areas of focus
Rheumatologists are more concerned with the reduction of joint pain, stiffness, swelling, and other musculoskeletal symptoms in psoriatic arthritis, whereas dermatologists are more concerned with reducing the body surface area that is affected by psoriasis.
Certain treatments may have more of an advantage in reducing the joint symptoms but have less of an effect on the skin rash. The opposite is also true—some medications really reduce the severity of the skin rash but don’t help as much with joint pain and swelling.
It can be a struggle at times to find the right treatment that offers the right balance between living with less pain and also with clear skin!
Sometimes my patients can be confused because they don’t know whether they are supposed to be following up with both their rheumatologist and dermatologist or just one out of the two. It can get confusing who is prescribing their medications or sending refills. Clerical issues can occur, such as sharing lab results or clinical notes between two different offices.
How can communication between the two be strengthened?
Rheumatologists and dermatologists work best together when they are within the same hospital system, share the same electronic medical record, and can see each other’s clinical notes and lab results on the computer.
I consider myself lucky because the dermatologist I work with is just down the hall, and it’s very easy to talk to her about my patients with psoriatic arthritis and refer patients to her if I’m not sure what a rash really is. Being in close proximity with a dermatologist that I trust and share the same philosophy with definitely facilitates better care for my patients with psoriatic arthritis.
Finding a rheumatologist and dermatologist who work well together, share the same approaches, and communicate easily with one another will lead to better patient outcomes and satisfaction.
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