Approximately 70% of cases of skin involvement APs precedes the onset of symptoms. Because of its association with psoriasis since it precedes the occurrence of the APs, in most cases the key query is Dermatology for early detection. Therefore, early diagnosis of PsA and prompt referral to Rheumatology is a major challenge in the management of these patients, since there is evidence that early management can slow the progression of joint damage and the number of affected joints. Hence the importance of a multidisciplinary management between the two specialties.
With this intention had been held in Madrid on 1 and 2 February, the International Symposium "Shedding light on Psoriatic Arthritis and Psoriasis" scientific interest declared by the Spanish Society of Rheumatology (SER), Grappa (Group for Research and Assessment of 'm Psoriasis Psoriatic Arthritis) and the Spanish Association of Dermatology and Venereology (AEDV) with the support of the biomedical company Pfizer. Intended for rheumatologists and dermatologists, the meeting brought together the most renowned international experts in order to put the focus of attention of both specialists on the APs and highlight the key role of the rheumatologist, dermatologist collaboration for better management of this disease.
And is that the whole approach is still very widespread in Spain, something that would not only improve medical care to those affected, but it would optimize available resources. "This will achieve a saving in diagnostic tests, better use of treatment resources and greater patient satisfaction, and lay the foundation for a common language that will address cross-cutting research projects," said Dr. Lluís Puig, coordinator Psoriasis Group of AEDV, director of the Dermatology Department of the Hospital Santa Creu i Sant Pau, Barcelona and member of the Scientific Committee of the symposium.
An important practical aspect in this regard is the organization of interdisciplinary units. Although there are some units with excellent interaction between the two specialties in our country today it is certain that this joint approach is not widespread.
"One of the objectives of this meeting has been laying the groundwork to prepare guidelines interdisciplinary joint management of psoriasis and psoriatic arthritis, from a discussion based on the results presented at this meeting," said Dr. Puig.
A successful experience
On these results spoke Dr. Jordi Gratacós, Rheumatology Service Parc Taulí Hospital de Sabadell, founder of Gresser (Group for the Study of spondyloarthritis the Spanish Society of Rheumatology) and member of the Scientific Committee of the symposium, who participated with the paper "The experience at the Hospital de Sabadell Taulí Parc" on multidisciplinary units for patients with PsA.
"This is a pioneering experience in our country, because although collaboration between rheumatologist and dermatologist has been done in many hospitals, it is a volunteer collaboration of sympathy and / or proximity. Unlike this from the Department of Dermatology and Rheumatology, University Hospital of Sabadell Taulí Parc (with doctors and Gratacós as responsible Luelmo respective project) has created a multidisciplinary unit with the aim of improving the management of psoriatic disease high degree of complexity. To do this, we designed a strategy to sensitize both services the existence of this new tool for the management of psoriasis, consensuamos bypass criteria, we established a set visitation schedule (once a month) and, finally, create a unit accredited teaching around this project, "he said.
Today, with over 3 years of experience have shown the efficiency of the unit from the point of view of care and training (already created two similar units in other hospitals with peers who have attended one of our courses accredited) "The bottom line is that it is an efficient unit and exportable to other hospitals and clinical situations of our country," said Dr. Gratacós.
Genetic studies of diagnostic and prognostic
PHC is a very heterogeneous disease clinically (patients have many clinical differences among themselves), which poses challenges in interpreting genetic studies, measure disease activity, make a prognosis or treatment.
Therefore, the meeting also discussed the latest results from genome studies, taking into account the different clinical symptoms or phenotypes (psoriasis vulgaris, psoriatic arthritis with enthesitis, spondylitis, etc..), Which provides information about genes and predominantly inflammatory pathways in each of the clinical phenotypes of these diseases. This is important to understand the differences in level of pathophysiological mechanisms and may be useful for optimizing the diagnosis, prognosis and treatment.
"Biomarkers for the diagnosis and prognosis report about those genetic data, epidemiological or biological that can help identify patients with psoriasis will develop PsA, and the severity of the APs. The goal is to prevent or treat the disease early and more personalized, "said Dr. Juan Cañete, Arthritis Unit of Rheumatology at Hospital Clínic of Barcelona and member of the Scientific Committee of the symposium.
Dr. Cañete made a presentation on "common pathophysiological pathways of the skin and joints," in which he talked about biological therapies directed at specific targets, which stressed that "the effectiveness of these therapies both diseases shows that TNFalpha , and probably also the cytokines IL-17/IL-23 pathway are shared. However there are also differences in the response to anti-T cell therapies between psoriasis and psoriatic arthritis, suggesting that psoriasis have a higher autoimmune component psoriatic arthritis. "
Among the various anti-TNF biologic therapies currently available for this condition, there are differences in the mechanism of action, half-life, the safety profile and immunogenicity, which must be taken into account for an appropriate and individualized management of both the psoriasis as psoriatic arthritis.
Finally, Dr. Puig, who acted as moderator at the table "Therapeutic approach: optimization criteria, objectives and results" of psoriasis and PsA, emphasized common production mechanisms of the disease, early diagnosis elements of rheumatological manifestations of psoriasis and optimization approach based therapeutics whole problem of the patient, taking into account the different domains (skin disease, nail, axial and peripheral arthritis, enthesitis, dactylitis, psychological effects and other comorbidities) of disease.
Image By Arnavaz at fr.wikipedia [Public domain], from Wikimedia Commons