Approaching Treatment for Patients With Psoriatic Arthritis



Mark Lebwohl, MD: Let me ask you for last words of advice to our colleagues about how can dermatologists and rheumatologists facilitate a comprehensive approach for helping patients manage and treat the disease.

Philip J. Mease, MD: I come back to the importance of evaluating each domain that the patient is presenting with, and not just focusing on the joints, in the case of the rheumatologist. In the case of the dermatologist, it is just on the skin. The disease is so much more than that, and it doesn’t take that much more time to quickly address the degree of enthesitis: Is there back pain? How is that doing? What’s the degree of nail disease? How severe is the psoriasis? Make sure no 1 of those domains is left behind when you’re approaching treatment. By addressing that each time, that teaches the patient to also be aware of the various domains, and they can comment to you when you’re on your virtual visits: “My back isn’t doing so well, although my joints are doing fine.” You can address each of those, and the patient is trusting that you are very comprehensive in your care. You are thinking about them, and to the extent that you can probe in a gentle manner about their emotional life, that goes a long way. It is just counseling people to be good doctors and take the time to do it. It’s extremely rewarding, especially these days when we have such a multitude of really effective medications that we can employ.

Mark Lebwohl, MD: I’ll throw in my 2 cents, which is that using a rheumatologist and a dermatologist together helps you get the right treatment for your patients in more ways than 1. When I went to medical school and I trained, I thought the best doctor was the guy who was not only dedicated to his patients, which most of us are, but who studied the most, learned the most, and knew the most.

That’s not true anymore. The best doctor is the guy who gets the best medicine and the right medicine for his patient. Sometimes, when you have a rheumatologist and dermatologist weighing in, as I alluded to earlier, you can get 2 drugs when you need them. If both of you have complained to the insurance company that they’re wrong—this is the right drug for the patient, not the 1 they’re telling me—and they hear it from 2 doctors, it helps the cause in getting the right treatment for your patient. I would use that as an advantage that many of us haven’t thought about but really is an advantage.

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Transcript Edited for Clarity

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