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Managing Psoriatic Arthritis with Multiple Doctors

How do you maintain continuity of care when you see more than one doctor for your psoriatic arthritis (PsA)?

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Psoriatic arthritis is considered a single disease, but in many respects it’s really two conditions. The arthritis causes swollen, painful joints, while the psoriasis produces skin plaques.

A condition that affects multiple body systems requires a multifaceted approach to care. “The rheumatologist, who is a joint specialist, helps provide particularly good care for pain or stiffness of the joints, and the dermatologist makes sure the skin is as clear as possible,” says David Rosmarin, MD, a dermatologist at Tufts Medical Center in Boston. And you’ll still need your primary care provider to oversee your general health.

These healthcare providers may prescribe similar treatments in some cases, for example, an anti-inflammatory medicine. Without coordination of care between your providers, you could get conflicting recommendations. Fortunately, you can synchronize care between all the doctors you see.

Who Should Lead Your Care?

When you see more than one doctor, which should take the lead in developing and managing your treatment plan?

A 2016 survey found that about 37% say a rheumatologist is their lead doctor. And about 25% of PsA patients see their primary care provider or dermatologist most often.

If you’re among the estimated 85% of people with PsA whose skin symptoms started first, you might lean on your dermatologist for the bulk of your care. Yet it’s important that you also get a rheumatologist involved. That specialist can help you recognize the warning signs of joint inflammation and work with you to develop a proactive plan to deal with joint stiffness and pain.

You don’t necessarily need one doctor to take the lead, provided that both doctors work together, Dr. Rosmarin says. If one symptom worsens or becomes more difficult to treat, then that specialist might temporarily spend more time with you.

Psoriatic Arthritis Care Team

A number of medical centers around the country – including NYU Langone Medical Center in New York, Brigham and Women’s Hospital in Boston and Cleveland Clinic – have streamlined psoriatic arthritis treatment by having dermatologists and rheumatologists together in the same clinic.

By having both specialties in the same network, it can be easier to share patient information, says Elaine Husni, MD, MPH, vice chair of rheumatology and director of the Arthritis and Musculoskeletal Center at Cleveland Clinic.

During your visits, each doctor records your symptoms, test results and medications they’ve prescribed. This information goes into your electronic medical record (EMR). Every doctor’s office on the same EMR system will then have access to your medical information.

Coordinating Care

If your dermatologist and rheumatologist are not part of the same network, it might not be easy for them to share notes on your care. This puts more of the burden on you to make sure your doctors communicate.

“Ask, ‘Can you get in touch with my doctor, or can she see your notes?’” Dr. Husni suggests. “You establish how they communicate.” Make sure your rheumatologist gets all the notes from your dermatologist visits, and vice versa.

You might want to get copies of all your tests, procedures and medications and carry the information to all appointments. An easy way to keep your medical information in one place is with a personal health record (PHR). A PHR is an app or a program that consolidates your medical records from your various doctors and lets you access the information online.

Psoriatic arthritis treatment relies on certain drugs to calm the immune response and reduce inflammation in your body. These medicines can be very effective at taming symptoms, but they can have side effects, and they may interact with other drugs you take. That’s why each doctor you see should know exactly what you’re taking.

“It’s important to go over your medicines at each visit, to make sure they aren’t duplicated and that there are no drug interactions,” Dr. Rosmarin says.

Also let each doctor know about any recent tests you’ve had. “It’s always good if you have recent laboratory work or imaging scans that you can bring, or sign a request form so the office can get them,” Dr. Husni says. Keeping up-to-date records can help you avoid undergoing the same test twice.

Both your dermatologist and rheumatologist should know about any tests and treatments you’ve undergone to manage other health conditions, such as heart disease or diabetes. Your primary care provider can help coordinate this information.

Finally, it’s important for you to maintain an open line of communication with your doctors. Keeping a record of symptoms can help you initiate discussions.

“I like my patients to keep a diary, so I know when their skin or joints flare,” Dr. Husni says.

In your diary, record your symptoms and how they affect your daily life. Some PHR programs will allow you to track daily symptoms and activities. This information will help ensure that all your doctors are on the same page regarding your care.

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