Management of psoriatic arthritis in rheumatology and dermatology settings: sub-analysis of the Italian population from the international LOOP study

Ennio Lubrano, Andrea Delle Sedie, Marco Romanelli, Maria Sole Chimenti, Luca Bianchi, Stefano Piaserico, Catia De Felice, Dario Graceffa, Maria Ilenia De Andres, Salvatore Curatolo, Rosa Daniela Grembiale, Stefano Dastoli, Chiara Arcuri, Rosa Giuseppa Angileri, Francesca Prignano, Francesca Bandinelli, Elena Baldissera, Santo Raffaele Mercuri, Chiara Franchi, Matteo LonghiAngela Patrì, Francesco Caso, Giuseppe Passiu, Maria Antonia Montesu, Simone Parisi, Elena Stroppiana, Genoveffa Scotto di Luzio, Giovanni Italiano, Sergio Di Nuzzo, Daniele Santilli, Laura Bigi, Federica Lumetti, Concetto Paolo Agnusdei, Maria Grazia Ferrucci, Giuliana Gualberti, Francesca Marando, Roberta Ramonda, Francesco Cusano

Research output: Contribution to journalArticlepeer-review


Psoriatic arthritis (PsA) patients are often treated by dermatology and rheumatology specialities and may receive different treatments. To evaluate the impact of dermatology/rheumatology specialist settings on diagnosis and therapeutic approach in PsA patients. This cross-sectional multicounty study in Italy involved twenty-eight rheumatology or dermatology clinics. Patients with suspected or confirmed PsA were examined by both a dermatologist and a rheumatologist. A total of 413 patients were enrolled and 347 (84%) were diagnosed with PsA. The majority of patients were enrolled from a rheumatology setting (N = 224, 64.6%). Patients with PsA in the dermatology settings had significantly higher disease activity, including skin involvement and musculoskeletal symptoms. Time from PsA onset to diagnosis was 22.3 ± 53.8 vs. 39.4 ± 77.5 months (p = 0.63) in rheumatology and dermatology settings; time from diagnosis to initiation of csDMARD was 7.3 ± 27.5 vs. 19.5 ± 50.6 months, respectively (p < 0.001). In contrast, time from diagnosis to bDMARD use was shorter in dermatology settings (54.9 ± 69 vs. 44.2 ± 65.6 months, p = 0.09, rheumatology vs. dermatology), similar to the time taken from first csDMARDs and bDMARDs (48.7 ± 67.9 vs. 35.3 ± 51.9 months, p = 0.34). The choice to visit a rheumatologist over a dermatologist was positively associated with female gender and swollen joints and negatively associated with delay in time from musculoskeletal symptom onset to PsA diagnosis. This study highlights a diagnostic delay emerging from both settings with significantly different therapeutic approaches. Our data reinforce the importance of implementing efficient strategies to improve early identification of PsA that can benefit from the integrated management of PsA patients.Key Points• A diagnostic delay was observed from both dermatology and rheumatology settings with significantly different therapeutic approaches.•Shared dermatology and rheumatology clinics offer the combined expertise to improve in the early identification and management of PsA.

Original languageEnglish
JournalClinical Rheumatology
Publication statusAccepted/In press - 2020


  • Biological drugs
  • Dermatology
  • Diagnosis
  • Management
  • Psoriatic arthritis
  • Rheumatology

ASJC Scopus subject areas

  • Rheumatology


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