Supporting Combined Clinics to Improve PsA Care

PPACMAN is a non-profit organization with a mission to enhance comanagement of patients with psoriasis and PsA among rheumatologists and dermatologists and to improve early identification of PsA.


Figure. The PPACMAN board of directors, from left to right: vice president Jose U. Scher, MD, president Joseph F. Merola, MD, MMSc, treasurer Soumya M. Reddy, MD, secretary Alexis Ogdie-Beatty, MD, MSCE, Cheryl Rosen, MD (not shown), and Vinod Chandran, MD (not shown).

Psoriatic arthritis (PsA) is the major comorbidity of psoriasis, occurring in up to 30% of this patient population.1 Many gaps exist in the screening, diagnosis, and management of patients with PsA. Dermatologists are on the front lines of screening patients with psoriasis for PsA, and therefore can have the earliest impact by making a diagnosis in time to prevent potential joint damage. One way to bridge care gaps is through interdisciplinary care models that facilitate education and clinical care between dermatologists and rheumatologists, which is central to improving outcomes for patients with psoriasis/PsA.  

The Psoriasis and Psoriatic Arthritis Clinics Multicenter Advancement Network (PPACMAN) received 501c3 non-profit status in January 2018. The organization’s mission is to nucleate psoriatic disease combined clinics and centers to advance a multilevel approach to psoriatic patients, increase awareness, and accelerate management of the disease.

Why PPACMAN Was Formed

PsA results in functional disability, reduced quality of life, and joint deformities, which can occur early in the disease. Overall, 27% of patients have notable joint erosions within 5 months and 47% within 2 years of symptom onset.1 Early identification and treatment of PsA is key and has been shown to improve patient response to therapy and lessen disease progression.1-3 

However, PsA is often underdiagnosed or the diagnosis is delayed.4 Despite the development of several tools for PsA screening, the use of these instruments in clinical practice has not been widely adopted.5,6 The critical barrier to improving early diagnosis is that we do not know how to get physicians to actually screen patients. Many dermatologists do not inquire about musculoskeletal symptoms. In an unpublished study presented at the American Academy of Dermatology meeting on PsA screening, many dermatologists who participated in a traditional didactic intervention did not change their behavior post-intervention. 

Innovative approaches to improve screening and early detection of PsA are needed. We created PPACMAN to improve partnerships between dermatologists and rheumatologists and believe this will expedite more accurate and timely diagnosis of PsA and lead to earlier initiation of appropriate therapy. Also, we think that dermatologists can be trained in a basic screening musculoskeletal exam to detect early signs and symptoms of PsA. We have had several initiatives that trained dermatologists in the basics of hands-on physical joint exams of patients with psoriasis.  

The Benefits of Combining Clinical Care

There are numerous benefits to dermatology and rheumatology partnerships. Dermatologists and rheumatologists each play a key role in the diagnosis and management of PsA. While existing therapies have substantially improved the management of this disease, less than 20% of patients reach remission and, most often, 1 or more aspects of PsA (eg, psoriasis, nail disease, peripheral arthritis, enthesitis, etc) remain active while patients are on therapy.6 It is in these scenarios that dual management is most critical. 

Furthermore, while practitioners often work within “silos” of their own specialty, expanding opportunities for collaborative care increases physicians’ continuing education, professional development, and professional satisfaction while simultaneously improving care for patients and earlier recognition of musculoskeletal symptoms.7 Despite the fact that collaborative care is recognized as valuable, little is known about the logistics, benefits, and challenges of dual specialty clinics within academic medical centers. 

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