Multidisciplinary working in the management of axial and peripheral spondyloarthritis

Abstract

Multidisciplinary (MD) care is essential in the management of patients with spondyloarthritis (SpA) and is one of the main pillars of disease management and patient care. However, evidence supporting the effectiveness and benefits of this strategy in SpA is scarce. In this review we discuss the three types of MD care models: (i) combined clinics (MD units), including 'face to face', 'parallel' and 'circuit approach' clinics; (ii) MD team meetings; (iii) group consultations. The most frequently used model in SpA studies has been the 'parallel' combined clinic and usually encompasses a rheumatologist and another specialist, most commonly a dermatologist or a gastroenterologist, that work in tandem according to predefined referral criteria and treatment algorithms. MD working seems to improve the care of patients with SpA by a better identification and diagnosis of the disease, an earlier and more comprehensive treatment approach, and better outcomes for patients in terms of disease activity, physical function, quality of life and patient satisfaction. Nevertheless, challenges remain. Data on effectiveness and feasibility are scarce and are mostly derived from studies with design issues and often without a unidisciplinary care comparator arm. Although patient centricity is one of the core values of patient care and MD setting in SpA, the patient often does not play an active role in most of the MD settings studied or in common clinical practice. Further efforts should be made so that MD care reflects patients' expectations and needs. Overcoming these limits will help to implement successfully SpA MD care in daily clinical practice and subsequently to achieve a higher quality of care for our patients.

Keywords: combined clinics; multidisciplinary team meetings; multidisciplinary working; spondyloarthritis.

Figure 1.

Types of multidisciplinary care models (original). There are three main MD models currently used in the management of patients with spondyloarthritis: MD care units (combined clinics), MDT meetings and group consultations. This figure depicts the advantages and disadvantages, as well as how each model is organised and how patients and health professionals interact within the model. MD, multidisciplinary; MDT, multidisciplinary team.

Figure 2.

Collection of cases of patients with spondyloarthritis that have benefited from an MDT input. All cases were discussed in one of the MDT meetings taking place in the rheumatology department at Addenbrooke’s Hospital, Cambridge, UK. DMARD, disease-modifying antirheumatic drug; HBV, hepatitis B virus; IL, interleukin; MDT, multidisciplinary team; PsA, psoriatic arthritis; TNF, tumour necrosis factor.