**4. How could the cooperation between dermatologist and rheumatologist be set up?**

As described in the previous paragraphs screening of patients with Ps can easily be done by using the GEPARD patient self-administered questionnaire. In the case of equal or more than 4 positive answers in the questionnaire, the dermatologist may refer the patient to a cooperating rheumatologist. Since the end of the 90s most rheumatologists have set up an early arthritis schedule. With the GEPARD questionnaire the patient is already screened for arthritis and is more likely to have an arthritic manifestation. After the rheumatologic assessment the decision has to be made which discipline is advantageous to take the lead in guidance and treatment of the patient. Usually a cooperative way is chosen, taken into consideration that the general practitioner is the stearing physician for the other comorbid and social problems of the individual patient (figure 6).

Fig. 5. Distribution of arthritis, arthralgia and no complaints in percent of GEPARD patientquestionnaire early arthritis patients (≤ 4 years). According to the CASPAR classification

4%

16%

**4. How could the cooperation between dermatologist and rheumatologist be** 

As described in the previous paragraphs screening of patients with Ps can easily be done by using the GEPARD patient self-administered questionnaire. In the case of equal or more than 4 positive answers in the questionnaire, the dermatologist may refer the patient to a cooperating rheumatologist. Since the end of the 90s most rheumatologists have set up an early arthritis schedule. With the GEPARD questionnaire the patient is already screened for arthritis and is more likely to have an arthritic manifestation. After the rheumatologic assessment the decision has to be made which discipline is advantageous to take the lead in guidance and treatment of the patient. Usually a cooperative way is chosen, taken into consideration that the general practitioner is the stearing physician for the other comorbid

criteria, eighty percent were classified as having PsA.

80%

 Arthritis Arthralgia No complaints

and social problems of the individual patient (figure 6).

**set up?** 

In the case of leading arthritis, the consultation of the dermatologist is necessary to confirm the diagnosis of Ps by clinical means or by biopsy in unclear situations (figure 7). Furthermore, topical treatment may be instituted if systemic therapy of PsA does not lead to full treatment success of the skin. The same treatment cycle as described before is necessary in order to treat all facets of PsA.

Fig. 6. Flow chart of possible cooperation among the medical disciplines. Screening starts in the dermatology practice by using the GEPARD patient self-administered questionnaire.

Detecting Psoriasis Arthritis Early in the Disease Course – Why This

Fig. 8. Interdisciplinary, holistic view of Ps and PsA.

**6. References** 

2792.

*Dis* 14, pp. 339-340.

*Rheum Dis* 70(6), pp. 891-895.

is Important and How Dermatologists and Rheumatologists Can Successfully Cooperate? 75

Aletaha, D., Neogi, T., Silman, A. J., Funovits, J., Felson, D. T., Bingham, C. O., 3rd,

Aletaha, D., Smolen, J., & Ward, M. M. (2006). Measuring function in rheumatoid arthritis:

Blumberg, B., Bunim, J., & Calkins, E. (1964). Nomenclature and classification of arthritis

Cugno, M., Ingegnoli, F., Gualtierotti, R., & Fantini, F. (2010). Potential effect of anti-tumour

de Wit, M. P., Smolen, J. S., Gossec, L., & van der Heijde, D. M. (2011). Treating rheumatoid

Identifying reversible and irreversible components. *Arthritis Rheum* 54(9), pp. 2784-

and rheumatism accepted by the American Rheumatism Association. *Bull Rheum* 

necrosis factor-alpha treatment on reducing the cardiovascular risk related to

arthritis to target: the patient version of the international recommendations. *Ann* 

collaborative initiative. *Ann Rheum Dis* 69(9), pp. 1580-1588.

rheumatoid arthritis. *Curr Vasc Pharmacol* 8(2), pp. 285-292.

Bennet, R. M. (1979). Psoriasis Arthritis. Philadelphia, Lea & Febiger.

Birnbaum, N. S., Burmester, G. R., Bykerk, V. P., Cohen, M. D., Combe, B., Costenbader, K. H., Dougados, M., Emery, P., Ferraccioli, G., Hazes, J. M., Hobbs, K., Huizinga, T. W., Kavanaugh, A., Kay, J., Kvien, T. K., Laing, T., Mease, P., Menard, H. A., Moreland, L. W., Naden, R. L., Pincus, T., Smolen, J. S., Stanislawska-Biernat, E., Symmons, D., Tak, P. P., Upchurch, K. S., Vencovsky, J., Wolfe, F., & Hawker, G. (2010). 2010 rheumatoid arthritis classification criteria: an American College of Rheumatology/European League Against Rheumatism

Fig. 7. Flow chart of possible cooperation among the medical disciplines. In the case of suspected psoriatic manifestation or in the case of suboptimal treatment response of Ps by systemic therapy the rheumatologist confers the patient to the dermatologist for further evaluation.
