Work with both a Derm and Rheum?

Is it in my best interest to work with both a Dermatologist and Rheumatologist to manage this disease?

I want to know what is effective.

You may have to. It is not uncommon to need a team. For example, in addition to my rheumy, I need to see the eye doctor twice a year, in order to keep an eye out for plaquenil toxicity. I see the podiatrist for orthotics, to help out with my feet. I’m a frequent flyer with the physical therapist, and have now added a hand therapist to the mix. Oh, and let’s not forget the hand surgeon.

Personally, my actual psoriasis is very minimum, so I don’t need to see the dermatologist. But if you have more psoriasis, then yes, it would certainly be appropriate to see the dermatologist. A lot of the psoriasis may clear up with proper treatment of the disease.

Its not a bad thing to work with both while keeping the rheumy in charge of you meds. keeping the derm in you back pocket can be helpful. Your rheumy for example might have a problem (with the insurance company) going to twice weekly Enbrel, weekly Humira etc. but those are acceptable frequencies for psoriasis, In fact depending on your insurance a lot of their "requirements" can be skipped (number of joints involved facet joint involvement etc) and go right to a biological. Stelera is becoming a popular choice along with some of the other new biologicals. Stelera although approved in Europe for PsA for several years and being found to work when other biologicals won't is at least a year away from approval in the states. Insurance companies won't generally approve any off label use. BUT if your derm prescribes it ((or its prescribed for p) no problem.

Then the is the other little matter that while many PsA drugs control the PsA very well the P lingers on and on for many. there is still the need for lotions and potions, UV treatments etc.

My psoriasis has been very well-controlled since I've been on methotrexate- am I in the minority? Luckily, I have never had much of it. Where I live, finding a dermatologist who accepts both new patients and insurance is almost impossible. My PCP has been writing the prescription for the steroid ointment I use for my skin.

I've used steroid ointments on my hands (where most of my P is) for 33 years. My skin is no thinner than anyone else's.

Lovemydogs said:

Not that your PCP isn't taking good care of you but a dermatologist likely wouldn't keep you on a steroid ointment for too long cuz it thins your skin...