September 2020

Project Name: Joint Working Project to develop a new service model for the identification and diagnosis of PsA in PsO patients.

Joint Working Partner: Royal Wolverhampton NHS Trust Novartis UK

Project Summary: Clinical studies suggest that the incidence of PsA in PsO patients may be as high as 40%¹ although this figure varies between papers. There is a concern that some PsO patients within the dermatology service may have undiagnosed PsA and/or other undiagnosed rheumatic disease(s).  This is a particular concern for PsO patients who are not being currently treated with biologic therapy due to potential for irreparable joint damage caused by undiagnosed and untreated PsA.This project aims to develop a new service model for identifying and diagnosing PsA and PsO patients. A central database will be created and populated with details of non-biologic, systemic-treated PsO patients. The database will be used to identify patients who may not be receiving care in accordance with internal guidelines and relevant guidelines published by the National Institute for Health and Care Excellence. All non-biologic, systemic-treated PsO patients will be invited for an ultrasound assessment and  those identified as requiring further review or management will be invited to attend a treatment review clinic on the same day. The project outputs will be used to evaluate the service and review the use of routine ultrasound in PsO patients to support the diagnosis of PsA.

Expected Patient Benefits for this Project: 

• More patients will be under the care of a specialist Rheumatology and Dermatology team working to BAD, BSR, GRAPPA and NICE standards and guidelines 
• Patients will have access to the Rheumatology team following confirmation of a PsA diagnosis and be treated according to current BSR and NICE guidance
• Patients who have experienced joint symptoms or have concerns about their diagnosis will have the opportunity to discuss any worries with a specialist Rheumatologist and receive expert advice and support
• Patients who have severe PsO and are newly diagnosed with PsA may be eligible to attend a joint Dermatology/Rheumatology specialist clinic for additional support and advice
• Patients newly diagnosed with PsA will receive expert support from a leading edge team, including access to a helpline which is manned by specialist biologic nurses through the Trust’s existing Rheumatology Service
• Patients with PsA will be seen within an existing virtual biologics clinic service – which is not available to them under the Dermatology Service – reducing their waiting times and trips to clinic and access an appropriate biologic medicine more quickly due to the nature of a virtual service.  This service is offered through the Trust’s existing Rheumatology Service
• Patients will have a decision on their treatment made at the same time as the ultrasound results and be invited for education and started on biologic treatment within three weeks, through the Trust’s existing Rheumatology Service. This is significantly quicker than the Dermatology team is currently able to offer

Start Date & Duration: September 2020 for 20 months

References: Gladman DD, Antoni C, Mease P, Clegg DO, Nash P (2005) Psoriatic arthritis: epidemiology, clinical features, course, and outcome. Ann Rheum Dis 64(Suppl 2):ii14–ii17