Royal Wolverhampton NHS Trust Novartis UK

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

UK | September | COS20-C073a

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

Outcomes Summary

Completion Date: October 2021

Outcome Summary:

Implementing a new service model brings opportunities in clinical and technological advances, providing patients more options, generating collaboration for the NHS and leading to commercial research development and clinical improvements for PsA.

Key Project Outcomes Data:

Creation and population of a central database for non-biologic, systemic-treated PsO patients.

76% of Total Number of Psoriasis patients referred by the Dermatology service had features of inflammatory arthritis on Ultrasound Scan (USS).

52% of PsO patients identified through the project required a clinical intervention.

Outcomes:

Closer interaction and relationships between rheumatology and dermatology departments including establishing virtual MDT discussions of mutual patients.
Enhanced understanding of the features seen on musculoskeletal ultrasound typical of PsA
Design and establish a new PsA treatment to target (TTT) clinic, with the integration of musculoskeletal ultrasound that serves newly diagnosed patients
Established a database for patients with new diagnosis of PsA for further service development and evaluation
Further interesting data has been elicited, including approximately three quarters of PsO patients not on biologic treatment and under routine dermatology follow up have features of inflammatory arthritis on ultrasound; further publication(s) may ensue.

Conclusion:

This joint working project has been extremely successful on moving the dial on difficult to achieve aspects in the rheumatology field.

Additional Content:

Posters have been presented. Peer reviewed definitive paper should be available by the end of the year.

UK2204119689

Completion Date: October 2021