Initial Results from a Combined Rheumatology /Dermatology Connective Tissue Disease Clinic in Belfast
L McDonald, M McCarron, C McCourt, D O’Kane, C Riddell, E Ball
Comprehensive management of Connective Tissue Disease (CTD) often requires both dermatological and rheumatological input, and successful management of complex cases often requires a holistic, multi-disciplinary approach.
Combined clinics offer the opportunity for immediate clinician interaction and improved standards of care, while avoiding duplication of clinic appointments and enhancing inter-disciplinary co-operation.
A total of 20 patients were identified to attend three separate pilot clinics in October 2014, January and June 2015. Suitability was determined by the presence of a dermatological issue in the context of a possible or known diagnosis of SLE/CTD. For each patient clinical, immunological and previous treatment data was collated prior to assessment. At each clinic two consultant rheumatologists and two consultant dermatologists were in attendance and an agreed combined management plan formulated. Patients were given anonymised patient satisfaction questionnaires.
8/20 (40%) of patients had an established diagnosis of SLE/CTD overlap syndrome or discoid lupus. The remaining 12/20 (60%) patients had suspected diagnoses of SLE/CTD (9/20 (45%)) or SLE/dermatomyositis (3/20 (15%)). Median (range) disease duration was 4 (0.5, 15) years.
Over half (11/20 (55%)) of patients received a new dermatological diagnosis following attendance. 3/20 (15%) had a suspected diagnosis of SLE/CTD/dermatomyositis confirmed. 2/20 (10%) had an unclear aetiology but a CT rash was excluded.
5/20 (25%) commenced new treatment for their disease following combined assessment. 3/20 (15%) were teaching cases demonstrating treatment side effects or variants of cutaneous lupus. 5/20 (25%) of patients were awaiting Dermatology review at the time of clinic assessment, 8/20 (40%) were known to a Dermatologist, 3/20 (15%) were being considered for referral. Following joint assessment 10/20 (50%) required ongoing Dermatological follow-up. 5/20 patients (25%) avoided an unnecessary Dermatological referral.
In terms of patient satisfaction, 100 % of responders rated the helpfulness of combined assessment 5 or above (1=not helpful and 7 =very helpful) and 71% found it ‘very helpful’.
Although these initial numbers are small we anticipate that future continued collaboration with our dermatology colleagues will generate robust data to justify the establishment of a more permanent model of combined care for CTD patients within the Belfast Trust.