Connective Tissue Disease Brings Dermatology & Rheumatology Together

Connective tissue diseases may be the most common syndrome among all patients—an amalgamation of conditions including rheumatoid arthritis (RA), scleroderma, systemic lupus erythematosus (SLE), and approximately 200 other disorders. While the complexities of each intricate disease requires an individual care plan, there is a consistent trend of specialists encountering and managing factions of the disease course every time.

Central to those care teams are rheumatologists and dermatologists—a pair of specialists whose patient populations and available pharmaceutical treatment options are increasingly overlapping. But how well are the 2 group working together?

In an interview with HCPLive during the Society for Dermatology Physician Assistants (SDPA) 2024 Summer Meeting, Amanda Mixon, PA-C, physician assistant at UCHealth Rheumatology Clinic, discussed her session presentation on connective tissue diseases and the evolving care team managing them. As Mixon noted, dermatologists are often encountering new diagnoses, due to the common trend of skin manifestations.

“Oftentimes a patient may start noticing a sun-exposed rash, for example, that they didn't have before. So, they'll go to see their dermatology provider as a first step,” Mixon said. “That, I think, is where the very first interaction can happen. Oftentimes, when they get to rheumatology, it's pretty incredible how many different specialists this person has seen often before they even get to us.”

It’s critical dermatologists are helping to minimize the referral process for such patients, working deliberate to gauge patients on relevant symptoms, potentially ordering labs, and connecting with colleagues in rheumatology for a full evaluation. Unfortunately, the burden is on such specialists to adequately form and utilize appropriate networks in an era of shrinking care teams.

“I think first and foremost, there's just not enough rheumatologists and dermatologists,” Mixon said. “I mean, I think that's really where APPs thrive—we're kind of fitting and filling that gap.”

Mixon counts herself among her peers who are well-networked across specialties and are able to work expeditiously and confidently to refer connective tissue disease patients to others when necessary. She knows that is not the norm, unfortunately; patient wait times between specialists can last months—all the while their diseases are progressing.

“And we always say in the rheumatology world: time is tissue, time is organ. And so, if there's this huge delay in getting a patient seen, obviously that is detrimental to the patient's health,” Mixon said. “I think prioritizing open communication between specialties, networking between specialties, is absolutely crucial so that when you do have that patient that can't wait 6 months, you can pick up the phone and say, 'Hey, I have this presentation. Are you or one of your colleagues able to get this patient in the next couple of weeks? Because we really need to get this figured out.’”

In the case when referrals are more effectively, though, dermatologists and rheumatologists benefit from a similar armamentarium of biologic therapies. Mixon recalled beginning her career 2 decades ago, at time when most conditions that fall under the connective tissue disease umbrella had no such targeted, small molecule agents. For all the challenges that remain in bridging rheumatologists and dermatologists, breakthroughs in pharmacotherapy have made a significant difference for their shared patients.

“I mean, there's so many things that are in the pipeline, and oftentimes, we will be co-managing between rheumatology and dermatology with the same medication, because it treats multiple domains of the same disease,” Mixon said. “It's so exciting.”