Rapid access clinic model suggested for psoriasis care

Dermatologists in the UK are advocating an “early access clinic” model of care for psoriasis patients similar to those used to enable prompt diagnosis and intervention in other immune-mediated inflammatory diseases such as IBD.

The pilot Psoriasis Rapid Access Clinic was a community-based multidisciplinary clinic involving specialist dermatologists and health psychologists. It aimed to recruit patients who were ≥ 16 years old, systemic treatment naive and had developed psoriasis within the previous 2 years.

A research letter in the British Journal of Dermatology reported the median age was 34 years and disease duration was 21 months at recruitment in the 39 eligible patients seen before the onset of the COVID-19 pandemic.

“The mean Psoriasis Area and Severity Index was 64 (SD 45) and 90% had psoriasis affecting a high-impact site,” it said.

“Screening for comorbidities revealed hypertension (blood pressure ≥ 140/90 mmHg) in 36% (14 of 39), total cholesterol > 5 mmol L1 in 50% (17 of 34) and glycated haemoglobin > 41 mmol mol1 (high risk of developing diabetes) in 6% (two of 34).”

“Hospital Anxiety and Depression Scale scores ≥ 8, consistent with possible mental health impairment, were reported by 36% (14 of 39) for anxiety and 23% (nine of 39) for depression. Overall, 18% (seven of 39) had a Psoriasis Epidemiology Screening Tool score ≥ 3 when screened, warranting investigation for psoriatic arthritis.”

“Most demonstrated high disease burden and considerable comorbidity risk, making them suitable for early and more effective therapies such as systemic treatment and illness prevention behavioural support to minimise long-term psychological and physical consequences of psoriasis.”

The study is yet to report on longer-term outcomes of clinic attendees and the results of a psychoeducational intervention.

The investigators said there was an urgent need to identify vulnerable patients and escalate care, “while integrating primary and secondary care services to optimise disease management for individual patients.”

“Although to the best of our knowledge this is a world-first multidisciplinary early access clinic for psoriasis, the benefits of early intervention are well established for other immune-mediated inflammatory diseases such as rheumatoid arthritis and Crohn disease, for which early targeted treatment can potentially modify the disease course,” the study said.

Meanwhile a Danish psoriasis study, also published in the British Journal of Dermatology, has confirmed lengthy diagnostic delays are associated with poorer quality of life.

The study of more than 2,000 patients found the mean diagnostic delay for female patients with dermatologist-verified psoriasis was 2.7 years and 3.9 years for men (P < 0.001).

Nearly half of patients (43.5%) had a diagnostic delay of < 1 year; 22.1% waited 1–2 years to see a dermatologist, 17% waited 2-5 years, 7% waited 5-10 years, 6% waited 10-20 years and 4.3% waited >20 years.

“Furthermore, those having a longer diagnostic delay also had a higher current Dermatology Life Quality Index (DLQI, P < 0001),” it said.

The authors said the findings suggested that patients who remain untreated or undiagnosed for a longer time may be more affected by the disease later in life.

“Even though some cases may be successfully managed by GPs, early dermatologist assessment of psoriasis would ensure that the most appropriate treatment was prescribed early in the disease course.”

They noted early detection of psoriasis could help reduce psychological sequelae including stress, anxiety and depression as well as play a part in early detection of and intervention in psoriatic arthritis.


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