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Collaboration between dermatologists and internal medicine clinicians reduced psoriasis severity, improved QOL, and lowered patients’ risk of CV events.

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New findings suggest that a holistic, multidisciplinary approach involving dermatologists and internal medicine clinicians reduced the severity of psoriasis and patients’ risk for comorbid cardiovascular (CV) events.

A study published in the Journal of Clinical Medicine involved an observational, prospective, single-center, case-control investigation into the benefits of multidisciplinary care. Researchers examined 52 patients with psoriatic disease who underwent follow-up at a combined dermatology and internal medicine clinic or received standard dermatologic care.

“The care of [patients with psoriasis] requires a multidisciplinary approach that addresses not only skin involvement but also CV risk factors and other comorbidities,” explained Ana Julia García-Malinis, MD, PhD, and coauthors. “Coordination between dermatology and internal medicine departments during the management of patients with psoriasis, with a specific focus on treatment and long-term follow-up, can substantially improve the course of disease and its associated complications, as well as patient QOL.”

A Holistic Approach

The study participants received treatment in San Jorge University Hospital’s dermatology department. The control group included 25 mostly male patients (72%) with an average age of 56.76 ±14.42 years (range, 25-78). Patients received care from their dermatologist and PCP.

The case group included 27 patients and primarily comprised men (81.5%) with an average age of 54.19 ±12.88 years (range, 16-82). The most common metabolic comorbidities in this group were dyslipidemia (88.9%), hypertension (55.6%), and diabetes (25.9%). A dermatologist and an internal medicine specialist simultaneously examined patients each month, with follow-up visits every three or six months based on patients’ needs.

In addition to addressing psoriatic disease, clinicians assessed the case group’s weight, BP, waist circumference, BMI, and Systemic Coronary Risk Evaluation (SCORE). They also conducted blood tests to evaluate patients’ lipid levels, liver and kidney profile, glycosylated hemoglobin, C-reactive protein, and erythrocyte sedimentation rate. The multidisciplinary exams also accounted for lifestyle factors such as patient diet, exercise, smoking status, and alcohol consumption.

The researchers analyzed patients’ medical records between October 2016 and December 2019 and compared data at baseline, 12-18 months after baseline visit, and 12-18 months after intermediate visit.

Disease Severity and Risk Reduction

The case group saw improvements in disease severity (as measured by psoriasis area and severity index [PASI] and body surface area [BSA] scores), QOL, blood test parameters, and CV event risk. By contrast, the control group had improvements only in PASI and BSA scores.

Multidisciplinary care reduced the mean Dermatology Life Quality Index score from 4.04 (SD, 5.85) to 2.83 (SD, 3.38) (P=0.936) and raised the mean Psoriasis Quality of Life score from 69.7 (SD, 26.5) to 84.6 (SD, 11.8; P=0.070).

Patients receiving multidisciplinary care also experienced reductions in insulin (P=0.042) and improved lipid profiles. Compared with controls, the case group had lower vitamin D levels at baseline but higher levels at the end of follow-up (P>0.05).

Researchers noted a decrease in average SCORE values among patients treated at the multidisciplinary clinic, from 2.62 (SD, 1.96) at baseline to 1.89 (SD, 1.05) at the end of follow-up. By comparison, the control group had a smaller decrease, from 2.88 (SD, 3.30) at the second time interval to 2.83 (SD, 3.34) at the end of the study.

The following patient characteristics were associated with an increased 10-year risk for CV events:

• age (OR, 1.33; 95% CI, 1.21–1.50; P<0.001);
• smoking (OR, 5.05; 95% CI, 1.07–27.37; P=0.047);
• PASI (OR, 7.98; 95% CI, 2.32–35.86; P=0.003);
• BSA (OR, 1.22; 95% CI, 1.01–1.49; P=0.044); and
• being in the control group (OR, 3.26; 95% CI, 0.84–13.56; P=0.029).

The control group experienced greater reductions in PASI and BSA scores, which could have been due to higher rates of obesity and smoking in the case group.

Surveys indicated that participation in the multidisciplinary clinic increased patient awareness of psoriasis and its associated comorbidities.

The study was limited by its small sample size and relatively short follow-up period. In addition, some patients in the control group lacked baseline data for certain metabolic variables, and it was impossible to randomize the participants. Most patients in both groups had low baseline PASI and BSA scores, but conclusions related to disease severity may be biased since most patients were on systemic therapy when the study began. However, “a key strength of the study is that it is one of very few to evaluate the effects of co-management of patients with psoriasis by a multidisciplinary team,” Dr. García-Malinis and coauthors said.

“Together with overall satisfaction with the multidisciplinary approach, reported by participating patients and professionals, these results support the establishment of similar [multidisciplinary] units to ensure better disease management via a more holistic approach,” researchers concluded.