Autoimmune Diseases

WASHINGTON – The recombinant fusion protein atacicept, which targets B-cell stimulating factors BLyS and APRIL, had a favorable safety profile and showed some evidence of efficacy in systemic lupus erythematosus patients – particularly those with high disease activity and serologically active disease – in the randomized, phase IIb ADDRESS II study.

Although the primary endpoint of the study – percentage of patients achieving SLE responder index-4 (SRI-4) response at 24 weeks – was not met, a reduction in both disease activity and severe flares was observed in patients in the multicenter study who received atacicept vs. placebo, Joan T. Merrill, MD, of the Oklahoma Medical Research Foundation, Oklahoma City, reported in a late-breaking poster at the annual meeting of the American College of Rheumatology.

sworcester@frontlinemedcom.com

WASHINGTON – The recombinant fusion protein atacicept, which targets B-cell stimulating factors BLyS and APRIL, had a favorable safety profile and showed some evidence of efficacy in systemic lupus erythematosus patients – particularly those with high disease activity and serologically active disease – in the randomized, phase IIb ADDRESS II study.

Although the primary endpoint of the study – percentage of patients achieving SLE responder index-4 (SRI-4) response at 24 weeks – was not met, a reduction in both disease activity and severe flares was observed in patients in the multicenter study who received atacicept vs. placebo, Joan T. Merrill, MD, of the Oklahoma Medical Research Foundation, Oklahoma City, reported in a late-breaking poster at the annual meeting of the American College of Rheumatology.

sworcester@frontlinemedcom.com

WASHINGTON – The recombinant fusion protein atacicept, which targets B-cell stimulating factors BLyS and APRIL, had a favorable safety profile and showed some evidence of efficacy in systemic lupus erythematosus patients – particularly those with high disease activity and serologically active disease – in the randomized, phase IIb ADDRESS II study.

Although the primary endpoint of the study – percentage of patients achieving SLE responder index-4 (SRI-4) response at 24 weeks – was not met, a reduction in both disease activity and severe flares was observed in patients in the multicenter study who received atacicept vs. placebo, Joan T. Merrill, MD, of the Oklahoma Medical Research Foundation, Oklahoma City, reported in a late-breaking poster at the annual meeting of the American College of Rheumatology.

sworcester@frontlinemedcom.com

NEWPORT BEACH, CALIF. – Cutaneous lupus erythematosus and dermatomyositis look identical on histology, so the diagnosis boils down to your clinical exam.

At the annual meeting of the Pacific Dermatologic Association, Nicole Fett, MD, provided clinical pearls on how to differentiate between the two conditions. She began by discussing the case of a 28-year-old female who presents with fatigue, arthralgias, myalgias, photosensitivity, and erythematous scaling papules coalescing into plaques on the face (sparing the nasolabial folds), neck, chest, and bilateral arms and hands (sparing the dorsal hand joints). Earlier in the week, she saw her primary care physician, who ordered an antinuclear antibody test, which was positive at 1:640.

This patient, who was previously healthy, has no known allergies, is on a prenatal vitamin, does not use any drugs or alcohol, is a nonsmoker, and has a family history of autoimmunity, said Dr. Fett, of the department of dermatology at Oregon Health and Science University, Portland. The woman’s clinical findings were most consistent with acute cutaneous lupus erythematosus (CLE).

“Acute CLE spares the nasolabial folds, whereas patients who have dermatomyositis have involvement of the nasolabial folds,” she noted. Examining the hands can also provide clues, as patients with CLE have involvement of the interjoint spaces and sparing of the joints, while patients with dermatomyositis have involvement of the joints and sparing of the interjoint spaces. In addition, patients with dermatomyositis are more likely to have lower extremity involvement, compared with patients who have CLE. “Patients with dermatomyositis will tend to have diffuse scalp involvement that is itchy,” Dr. Fett added. “That is not something you commonly see in cutaneous lupus.”

Other common features of CLE include concomitant discoid lupus erythematosus or another lupus subtype, and mucosal ulcerations, while other common features of dermatomyositis include the Shawl sign and poikiloderma.

The recommended review of systems and exams to assess for systemic lupus erythematosus in CLE patients include asking about photosensitivity, looking for mucosal ulcers, assessing for arthritis, asking about a history of pericarditis or pleuritis, as well as asking about a history of low blood counts, kidney disease, seizures, and malar rash. On cutaneous exam, look for signs of concomitant CLE subtypes, assess for nonspecific cutaneous lupus findings, and evaluate the mucosa. Recommended labs include a complete blood count and an additional workup for anemia, complete metabolic panel, urinalysis, erythrocyte sedimentation rate, C-reactive protein, antinuclear antibody, complement C3 and C4, and antiphospholipid and anticardiolipin antibodies.

The recommended review of systems and exams in patients with dermatomyositis, she said, include assessing for dysphonia/dysphagia, weakness with overhead tasks, weakness when climbing stairs or standing from a seated position, cough, shortness of breath, or dyspnea on exertion, fever, weight loss, night sweats, and pruritus. “When I think about the dermatomyositis patient I think not only about their skin, but about their muscles, lungs and risk of malignancy,” Dr. Fett said. “They have a high risk for developing interstitial lung disease, and about 25% of adult patients are going to have an underlying malignancy.”

She reported having no financial disclosures.

dbrunk@frontlinemedcom.com

NEWPORT BEACH, CALIF. – Cutaneous lupus erythematosus and dermatomyositis look identical on histology, so the diagnosis boils down to your clinical exam.

At the annual meeting of the Pacific Dermatologic Association, Nicole Fett, MD, provided clinical pearls on how to differentiate between the two conditions. She began by discussing the case of a 28-year-old female who presents with fatigue, arthralgias, myalgias, photosensitivity, and erythematous scaling papules coalescing into plaques on the face (sparing the nasolabial folds), neck, chest, and bilateral arms and hands (sparing the dorsal hand joints). Earlier in the week, she saw her primary care physician, who ordered an antinuclear antibody test, which was positive at 1:640.

This patient, who was previously healthy, has no known allergies, is on a prenatal vitamin, does not use any drugs or alcohol, is a nonsmoker, and has a family history of autoimmunity, said Dr. Fett, of the department of dermatology at Oregon Health and Science University, Portland. The woman’s clinical findings were most consistent with acute cutaneous lupus erythematosus (CLE).

“Acute CLE spares the nasolabial folds, whereas patients who have dermatomyositis have involvement of the nasolabial folds,” she noted. Examining the hands can also provide clues, as patients with CLE have involvement of the interjoint spaces and sparing of the joints, while patients with dermatomyositis have involvement of the joints and sparing of the interjoint spaces. In addition, patients with dermatomyositis are more likely to have lower extremity involvement, compared with patients who have CLE. “Patients with dermatomyositis will tend to have diffuse scalp involvement that is itchy,” Dr. Fett added. “That is not something you commonly see in cutaneous lupus.”

Other common features of CLE include concomitant discoid lupus erythematosus or another lupus subtype, and mucosal ulcerations, while other common features of dermatomyositis include the Shawl sign and poikiloderma.

The recommended review of systems and exams to assess for systemic lupus erythematosus in CLE patients include asking about photosensitivity, looking for mucosal ulcers, assessing for arthritis, asking about a history of pericarditis or pleuritis, as well as asking about a history of low blood counts, kidney disease, seizures, and malar rash. On cutaneous exam, look for signs of concomitant CLE subtypes, assess for nonspecific cutaneous lupus findings, and evaluate the mucosa. Recommended labs include a complete blood count and an additional workup for anemia, complete metabolic panel, urinalysis, erythrocyte sedimentation rate, C-reactive protein, antinuclear antibody, complement C3 and C4, and antiphospholipid and anticardiolipin antibodies.

The recommended review of systems and exams in patients with dermatomyositis, she said, include assessing for dysphonia/dysphagia, weakness with overhead tasks, weakness when climbing stairs or standing from a seated position, cough, shortness of breath, or dyspnea on exertion, fever, weight loss, night sweats, and pruritus. “When I think about the dermatomyositis patient I think not only about their skin, but about their muscles, lungs and risk of malignancy,” Dr. Fett said. “They have a high risk for developing interstitial lung disease, and about 25% of adult patients are going to have an underlying malignancy.”

She reported having no financial disclosures.

dbrunk@frontlinemedcom.com

NEWPORT BEACH, CALIF. – Cutaneous lupus erythematosus and dermatomyositis look identical on histology, so the diagnosis boils down to your clinical exam.

At the annual meeting of the Pacific Dermatologic Association, Nicole Fett, MD, provided clinical pearls on how to differentiate between the two conditions. She began by discussing the case of a 28-year-old female who presents with fatigue, arthralgias, myalgias, photosensitivity, and erythematous scaling papules coalescing into plaques on the face (sparing the nasolabial folds), neck, chest, and bilateral arms and hands (sparing the dorsal hand joints). Earlier in the week, she saw her primary care physician, who ordered an antinuclear antibody test, which was positive at 1:640.

This patient, who was previously healthy, has no known allergies, is on a prenatal vitamin, does not use any drugs or alcohol, is a nonsmoker, and has a family history of autoimmunity, said Dr. Fett, of the department of dermatology at Oregon Health and Science University, Portland. The woman’s clinical findings were most consistent with acute cutaneous lupus erythematosus (CLE).

“Acute CLE spares the nasolabial folds, whereas patients who have dermatomyositis have involvement of the nasolabial folds,” she noted. Examining the hands can also provide clues, as patients with CLE have involvement of the interjoint spaces and sparing of the joints, while patients with dermatomyositis have involvement of the joints and sparing of the interjoint spaces. In addition, patients with dermatomyositis are more likely to have lower extremity involvement, compared with patients who have CLE. “Patients with dermatomyositis will tend to have diffuse scalp involvement that is itchy,” Dr. Fett added. “That is not something you commonly see in cutaneous lupus.”

Other common features of CLE include concomitant discoid lupus erythematosus or another lupus subtype, and mucosal ulcerations, while other common features of dermatomyositis include the Shawl sign and poikiloderma.

The recommended review of systems and exams to assess for systemic lupus erythematosus in CLE patients include asking about photosensitivity, looking for mucosal ulcers, assessing for arthritis, asking about a history of pericarditis or pleuritis, as well as asking about a history of low blood counts, kidney disease, seizures, and malar rash. On cutaneous exam, look for signs of concomitant CLE subtypes, assess for nonspecific cutaneous lupus findings, and evaluate the mucosa. Recommended labs include a complete blood count and an additional workup for anemia, complete metabolic panel, urinalysis, erythrocyte sedimentation rate, C-reactive protein, antinuclear antibody, complement C3 and C4, and antiphospholipid and anticardiolipin antibodies.

The recommended review of systems and exams in patients with dermatomyositis, she said, include assessing for dysphonia/dysphagia, weakness with overhead tasks, weakness when climbing stairs or standing from a seated position, cough, shortness of breath, or dyspnea on exertion, fever, weight loss, night sweats, and pruritus. “When I think about the dermatomyositis patient I think not only about their skin, but about their muscles, lungs and risk of malignancy,” Dr. Fett said. “They have a high risk for developing interstitial lung disease, and about 25% of adult patients are going to have an underlying malignancy.”

She reported having no financial disclosures.

dbrunk@frontlinemedcom.com

MIAMI – Combined rheumatology-dermatology clinics to help people with psoriasis, psoriatic arthritis, and other relevant overlapping conditions continue to evolve, with evidence suggesting advantages and challenges for both patients and physicians.

Physicians like the improved communication and greater collaboration but still have reservations about billing and scheduling, according to preliminary results of a survey conducted by the Psoriasis and Psoriatic Arthritis Clinic Multicenter Advancement Network (PPACMAN). For patients, the advantages go beyond convenience, according to a 1-year study of outcomes at a Rhode Island Hospital–Brown University combined clinic in Providence.

“The goal of the combined clinics survey is to gauge strengths, barriers, and challenges to creating these models, to learn from one another to improve current clinical care, and to support propagation of these models,” said Joseph F. Merola, MD, at the annual meeting of the Group for Research and Assessment of Psoriasis and Psoriatic Arthritis.

Multiple clinic models

The clinic setups differ. In those settings where rheumatologists and dermatologists see patients on the same day, approximately three-quarters provide care together in the same room. The remaining clinics see patients through serial visits. Another 30% of respondents said dermatologists and rheumatologists generally see patients in a combined clinic on different days.

Jay Omobono

“Rheumatologists said it is a satisfying and rewarding endeavor, they form closer ties with colleagues, and it allows early, improved communication,” said Dr. Merola, a rheumatologist and dermatologist who is co-director of the Center for Skin and Related Musculoskeletal Diseases, a combined clinic at Brigham and Women’s Hospital in Boston.

Some common benefits, each cited by more than 80% of respondents, include a prompt and accurate diagnosis of psoriatic arthritis, the ability of physicians to learn from each other, and multiple training opportunities for residents and fellows. In fact, 72% said their combined clinic has rheumatology fellows, 82% have dermatology residents, and 27% incorporate internal medicine trainees.

Other than rheumatologists and dermatologists, 31% said their clinic has dedicated nursing, 15% have a cardiologist, and 15% have a psychiatrist.

A majority of physicians (92%) said they bill through their own department. At a subsequent roundtable discussion, Dr. Merola noted that patients pay separate copays at the combined clinic. “We’ve had some complaints from patients. They don’t like having two copayments.”

“You have to tell patients in advance,” suggested Soumya M. Reddy, MD, a rheumatologist at NYU Langone Medical Center in New York and co-director of its Psoriasis and Psoriatic Arthritis Center.

Common conditions and challenges

Not surprisingly, psoriasis and psoriatic arthritis are the most common conditions treated in these clinics, followed by lupus and dermatomyositis. Most clinics see patients either once weekly or once monthly.

A major concern expressed by 75% surrounds scheduling. More than half, 58%, worry about demonstrating value to their institution. Only a minority, 17%, responded that achieving consensus on patient management is a challenge.

In general, rheumatology evaluations take more time than dermatology assessments, presenting a challenge for scheduling and maximizing physician time. “You don’t really want the dermatologist sitting there for 20 minutes not really doing a lot,” said Alison Ehrlich, MD, professor and chair of dermatology at George Washington University in Washington.

The solution at Brigham and Women’s Hospital is to staff the clinic with two dermatologists and one rheumatologist. The two dermatologists see about 20 patients each in a half-day; the rheumatologist probably treats about 6 to 8 of those 40 patients, Dr. Merola said. At George Washington, Dr. Ehrlich sees patients along with the rheumatologist, leaves the room to treat other patients, later consults with her colleague, and they go back in together as necessary.

“The patients are incredibly appreciative” of the combined clinic, Dr. Ehrlich said. “They really love it.”

The survey is ongoing. The preliminary responses above are based on 17 responses, a 52% response rate. Of the respondents, 10 are dermatologists, 6 are rheumatologists, and 1 is dual trained. Since the meeting, Dr. Merola indicated that another two dermatologists and three rheumatologists have responded to the survey.

The Brown University experience

Charis Gn, MD, and colleagues studied outcomes for 167 patients treated at a combined clinic at Rhode Island Hospital. The ultimate goal of the clinic is “to identify patients with psoriatic arthritis early on,” Dr. Gn said at a poster presentation at the GRAPPA annual meeting. “We wanted to see what kind of outcomes [we get] for patients who see rheumatology and dermatology.”

About one-third of patients left the clinic with changes in diagnosis. About 1 in 5 patients with psoriasis were diagnosed with psoriatic arthritis as well. For the psoriasis patients newly diagnosed with psoriatic arthritis, 80% had an escalation in treatment, said Dr. Gn, an internal medicine resident.

Of the 41 patients with psoriasis, 17 (41%) had a treatment escalation. The same was true for 15 (79%) of the 19 patients with psoriatic arthritis post-evaluation.

Regarding the combined clinic, “it’s shown to be very beneficial for patients with psoriatic arthritis,” Dr. Gn said.

The record review from July 2014 to February 2016 shows the clinic also serves patients with cutaneous lupus, dermatomyositis, pyoderma gangrenosum, vasculitis, and rheumatoid arthritis, among others.

The presenters had no relevant disclosures.

MIAMI – Combined rheumatology-dermatology clinics to help people with psoriasis, psoriatic arthritis, and other relevant overlapping conditions continue to evolve, with evidence suggesting advantages and challenges for both patients and physicians.

Physicians like the improved communication and greater collaboration but still have reservations about billing and scheduling, according to preliminary results of a survey conducted by the Psoriasis and Psoriatic Arthritis Clinic Multicenter Advancement Network (PPACMAN). For patients, the advantages go beyond convenience, according to a 1-year study of outcomes at a Rhode Island Hospital–Brown University combined clinic in Providence.

“The goal of the combined clinics survey is to gauge strengths, barriers, and challenges to creating these models, to learn from one another to improve current clinical care, and to support propagation of these models,” said Joseph F. Merola, MD, at the annual meeting of the Group for Research and Assessment of Psoriasis and Psoriatic Arthritis.

Multiple clinic models

The clinic setups differ. In those settings where rheumatologists and dermatologists see patients on the same day, approximately three-quarters provide care together in the same room. The remaining clinics see patients through serial visits. Another 30% of respondents said dermatologists and rheumatologists generally see patients in a combined clinic on different days.

Jay Omobono

“Rheumatologists said it is a satisfying and rewarding endeavor, they form closer ties with colleagues, and it allows early, improved communication,” said Dr. Merola, a rheumatologist and dermatologist who is co-director of the Center for Skin and Related Musculoskeletal Diseases, a combined clinic at Brigham and Women’s Hospital in Boston.

Some common benefits, each cited by more than 80% of respondents, include a prompt and accurate diagnosis of psoriatic arthritis, the ability of physicians to learn from each other, and multiple training opportunities for residents and fellows. In fact, 72% said their combined clinic has rheumatology fellows, 82% have dermatology residents, and 27% incorporate internal medicine trainees.

Other than rheumatologists and dermatologists, 31% said their clinic has dedicated nursing, 15% have a cardiologist, and 15% have a psychiatrist.

A majority of physicians (92%) said they bill through their own department. At a subsequent roundtable discussion, Dr. Merola noted that patients pay separate copays at the combined clinic. “We’ve had some complaints from patients. They don’t like having two copayments.”

“You have to tell patients in advance,” suggested Soumya M. Reddy, MD, a rheumatologist at NYU Langone Medical Center in New York and co-director of its Psoriasis and Psoriatic Arthritis Center.

Common conditions and challenges

Not surprisingly, psoriasis and psoriatic arthritis are the most common conditions treated in these clinics, followed by lupus and dermatomyositis. Most clinics see patients either once weekly or once monthly.

A major concern expressed by 75% surrounds scheduling. More than half, 58%, worry about demonstrating value to their institution. Only a minority, 17%, responded that achieving consensus on patient management is a challenge.

In general, rheumatology evaluations take more time than dermatology assessments, presenting a challenge for scheduling and maximizing physician time. “You don’t really want the dermatologist sitting there for 20 minutes not really doing a lot,” said Alison Ehrlich, MD, professor and chair of dermatology at George Washington University in Washington.

The solution at Brigham and Women’s Hospital is to staff the clinic with two dermatologists and one rheumatologist. The two dermatologists see about 20 patients each in a half-day; the rheumatologist probably treats about 6 to 8 of those 40 patients, Dr. Merola said. At George Washington, Dr. Ehrlich sees patients along with the rheumatologist, leaves the room to treat other patients, later consults with her colleague, and they go back in together as necessary.

“The patients are incredibly appreciative” of the combined clinic, Dr. Ehrlich said. “They really love it.”

The survey is ongoing. The preliminary responses above are based on 17 responses, a 52% response rate. Of the respondents, 10 are dermatologists, 6 are rheumatologists, and 1 is dual trained. Since the meeting, Dr. Merola indicated that another two dermatologists and three rheumatologists have responded to the survey.

The Brown University experience

Charis Gn, MD, and colleagues studied outcomes for 167 patients treated at a combined clinic at Rhode Island Hospital. The ultimate goal of the clinic is “to identify patients with psoriatic arthritis early on,” Dr. Gn said at a poster presentation at the GRAPPA annual meeting. “We wanted to see what kind of outcomes [we get] for patients who see rheumatology and dermatology.”

About one-third of patients left the clinic with changes in diagnosis. About 1 in 5 patients with psoriasis were diagnosed with psoriatic arthritis as well. For the psoriasis patients newly diagnosed with psoriatic arthritis, 80% had an escalation in treatment, said Dr. Gn, an internal medicine resident.

Of the 41 patients with psoriasis, 17 (41%) had a treatment escalation. The same was true for 15 (79%) of the 19 patients with psoriatic arthritis post-evaluation.

Regarding the combined clinic, “it’s shown to be very beneficial for patients with psoriatic arthritis,” Dr. Gn said.

The record review from July 2014 to February 2016 shows the clinic also serves patients with cutaneous lupus, dermatomyositis, pyoderma gangrenosum, vasculitis, and rheumatoid arthritis, among others.

The presenters had no relevant disclosures.

MIAMI – Combined rheumatology-dermatology clinics to help people with psoriasis, psoriatic arthritis, and other relevant overlapping conditions continue to evolve, with evidence suggesting advantages and challenges for both patients and physicians.

Physicians like the improved communication and greater collaboration but still have reservations about billing and scheduling, according to preliminary results of a survey conducted by the Psoriasis and Psoriatic Arthritis Clinic Multicenter Advancement Network (PPACMAN). For patients, the advantages go beyond convenience, according to a 1-year study of outcomes at a Rhode Island Hospital–Brown University combined clinic in Providence.

“The goal of the combined clinics survey is to gauge strengths, barriers, and challenges to creating these models, to learn from one another to improve current clinical care, and to support propagation of these models,” said Joseph F. Merola, MD, at the annual meeting of the Group for Research and Assessment of Psoriasis and Psoriatic Arthritis.

Multiple clinic models

The clinic setups differ. In those settings where rheumatologists and dermatologists see patients on the same day, approximately three-quarters provide care together in the same room. The remaining clinics see patients through serial visits. Another 30% of respondents said dermatologists and rheumatologists generally see patients in a combined clinic on different days.

Jay Omobono

“Rheumatologists said it is a satisfying and rewarding endeavor, they form closer ties with colleagues, and it allows early, improved communication,” said Dr. Merola, a rheumatologist and dermatologist who is co-director of the Center for Skin and Related Musculoskeletal Diseases, a combined clinic at Brigham and Women’s Hospital in Boston.

Some common benefits, each cited by more than 80% of respondents, include a prompt and accurate diagnosis of psoriatic arthritis, the ability of physicians to learn from each other, and multiple training opportunities for residents and fellows. In fact, 72% said their combined clinic has rheumatology fellows, 82% have dermatology residents, and 27% incorporate internal medicine trainees.

Other than rheumatologists and dermatologists, 31% said their clinic has dedicated nursing, 15% have a cardiologist, and 15% have a psychiatrist.

A majority of physicians (92%) said they bill through their own department. At a subsequent roundtable discussion, Dr. Merola noted that patients pay separate copays at the combined clinic. “We’ve had some complaints from patients. They don’t like having two copayments.”

“You have to tell patients in advance,” suggested Soumya M. Reddy, MD, a rheumatologist at NYU Langone Medical Center in New York and co-director of its Psoriasis and Psoriatic Arthritis Center.

Common conditions and challenges

Not surprisingly, psoriasis and psoriatic arthritis are the most common conditions treated in these clinics, followed by lupus and dermatomyositis. Most clinics see patients either once weekly or once monthly.

A major concern expressed by 75% surrounds scheduling. More than half, 58%, worry about demonstrating value to their institution. Only a minority, 17%, responded that achieving consensus on patient management is a challenge.

In general, rheumatology evaluations take more time than dermatology assessments, presenting a challenge for scheduling and maximizing physician time. “You don’t really want the dermatologist sitting there for 20 minutes not really doing a lot,” said Alison Ehrlich, MD, professor and chair of dermatology at George Washington University in Washington.

The solution at Brigham and Women’s Hospital is to staff the clinic with two dermatologists and one rheumatologist. The two dermatologists see about 20 patients each in a half-day; the rheumatologist probably treats about 6 to 8 of those 40 patients, Dr. Merola said. At George Washington, Dr. Ehrlich sees patients along with the rheumatologist, leaves the room to treat other patients, later consults with her colleague, and they go back in together as necessary.

“The patients are incredibly appreciative” of the combined clinic, Dr. Ehrlich said. “They really love it.”

The survey is ongoing. The preliminary responses above are based on 17 responses, a 52% response rate. Of the respondents, 10 are dermatologists, 6 are rheumatologists, and 1 is dual trained. Since the meeting, Dr. Merola indicated that another two dermatologists and three rheumatologists have responded to the survey.

The Brown University experience

Charis Gn, MD, and colleagues studied outcomes for 167 patients treated at a combined clinic at Rhode Island Hospital. The ultimate goal of the clinic is “to identify patients with psoriatic arthritis early on,” Dr. Gn said at a poster presentation at the GRAPPA annual meeting. “We wanted to see what kind of outcomes [we get] for patients who see rheumatology and dermatology.”

About one-third of patients left the clinic with changes in diagnosis. About 1 in 5 patients with psoriasis were diagnosed with psoriatic arthritis as well. For the psoriasis patients newly diagnosed with psoriatic arthritis, 80% had an escalation in treatment, said Dr. Gn, an internal medicine resident.

Of the 41 patients with psoriasis, 17 (41%) had a treatment escalation. The same was true for 15 (79%) of the 19 patients with psoriatic arthritis post-evaluation.

Regarding the combined clinic, “it’s shown to be very beneficial for patients with psoriatic arthritis,” Dr. Gn said.

The record review from July 2014 to February 2016 shows the clinic also serves patients with cutaneous lupus, dermatomyositis, pyoderma gangrenosum, vasculitis, and rheumatoid arthritis, among others.

The presenters had no relevant disclosures.