Dermatology PAs and Rheum PAs Working Together for Better Outcomes
1 Big Thing: The recent conference highlighted the importance of collaboration between dermatology PAs and rheumatology PAs to enhance patient outcomes.
Why it matters: Interdisciplinary cooperation between these specialties ensures comprehensive care for patients with underlying connective tissue disease in both common and rare rheumatologic disorders.
Between the lines: Effective communication and shared expertise between dermatology and rheumatology PAs can lead to earlier diagnoses, better treatment plans, and improved quality of life for patients.
Go deeper: Collaboration Between Specialties
The session, presented by Jeannette Hart, PA-C, MCHS, MHA, of Providence Health Systems, and Amanda Mixon, PA-C, of UCHealth Rheumatology Clinic, underscored the importance of dermatology and rheumatology PAs working together. Effective collaboration between these specialties is crucial in managing diseases that have both skin and joint manifestations. The speakers emphasized that dermatology PAs should not hesitate to consult with their rheumatology counterparts, as even informal consultations can significantly benefit patient care. Sharing clinical images and discussing unusual cases can provide valuable insights and lead to better management strategies.
Coverage: SDPA Annual Summer Dermatology Conference, June 5-9, 2024, in San Diego, California
Managing Psoriatic Arthritis
One of the critical discussions centered around the management of psoriatic arthritis. The speakers highlighted the complexity of treating patients who might experience joint improvement while simultaneously dealing with skin flare-ups. They stressed that psoriatic arthritis patients should be referred to rheumatologists, but dermatology PAs play a vital role in managing skin symptoms and performing regular skin cancer screenings, especially considering the increased risks associated with biologic treatments.
Laboratory Tests and Referrals
The session also addressed the protocol for lab tests before referring patients with abnormal nailfold capillaries. The speakers recommended basic laboratory tests such as antinuclear antibody (ANA), complete blood count (CBC), comprehensive metabolic panel (CMP), and inflammatory markers. Conducting these tests beforehand can streamline the referral process, providing rheumatologists with essential data for a more effective follow-up.
Malignancy Screening in Connective Tissue Diseases
A significant point of discussion was the increased risk of malignancies in patients with connective tissue diseases. The speakers advocated for comprehensive cancer screenings for conditions like myositis, which have higher malignancy risks. Recommended screenings include CT scans, mammograms, and colonoscopies, particularly during the initial years following diagnosis. Dermatology PAs can play a pivotal role in identifying suspicious skin lesions and ensuring timely referrals for appropriate cancer screenings.
Role of CRP in Diagnosing Autoimmune Diseases
The session also explored the role of C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR) in diagnosing and monitoring autoimmune diseases. CRP is more indicative of acute inflammation, while ESR reflects longer-term inflammatory activity. The speakers emphasized that both markers, combined with clinical history and examination, are crucial for a comprehensive assessment. Dermatology PAs should be aware of these markers’ significance and collaborate with rheumatology PAs to interpret results accurately.
Treatment of Rheumatoid Nodules
Addressing the treatment of rheumatoid nodules, the speakers advised against their physical removal unless absolutely necessary, due to the high risk of infection and recurrence. They suggested alternative treatments, such as injecting triamcinolone, which can effectively reduce nodule size and discomfort without the complications associated with surgical removal. Dermatology PAs can provide valuable support in managing these treatments and monitoring patient outcomes.
Final Thoughts and Encouragement
The session concluded with a strong emphasis on the value of interdisciplinary collaboration and continuous communication between dermatology and rheumatology PAs. By leveraging each other’s expertise, these healthcare providers can ensure that patients receive the most comprehensive and effective care possible. The speakers encouraged PAs to actively seek opportunities for collaboration, share knowledge, and work together to improve patient outcomes.
Byline: Michael Rubio, MPAS, PA-C