Working with dermatologists, orthopedists, and other specialists, rheumatologist Dr. Elaine Husni has pioneered an interdisciplinary approach to caring for patients with psoriatic disease. Interdisciplinary, also known as cross-disciplinary, care brings different kinds of doctors together to treat all of the problems a patient is experiencing. It can be particularly useful in treating psoriatic disease patients who have both skin and joint symptoms.
After starting the first combined clinic for dermatology and rheumatology at Boston’s Brigham and Women’s Hospital, Dr. Husni moved to Cleveland, Ohio, where she directs the Cleveland Clinic’s Arthritis and Musculoskeletal Treatment Center. Dr. Husni is also a member of the National Psoriasis Foundation Medical Board, and the cochair of July’s NPF Research Symposium. Here, Dr. Husni talks about why she thinks it’s so important to treat the whole patient, and what she finds most rewarding about caring for people with psoriatic disease.
Q: How did you become interested in studying psoriatic disease?
A: I’ve had a longstanding interest in working in an interdisciplinary setting. I enjoy working collaboratively with other disciplines. […] I direct the Arthritis Center here at the Cleveland Clinic. We are a center that sees patients with orthopedists, rheumatologists, and physical medicine and rehab physicians. We also liaison with the musculoskeletal radiologists and physical therapy. This whole team is able to address many different types of joint problems and the spectrum of joint problems, anywhere from rehabilitation to diagnosis and treatment, but in an interdisciplinary setting.
I work alongside a dermatologist. […] We actually go into the room and see the patient together, we produce two separate notes. I focus on joint symptoms, and they focus on the derm symptoms, and we come up with a comanagement plan. It’s very interesting and novel. Most health care is siloed, meaning you go to see your derm, and they create a plan, then you go to see your rheumatologist and they create a plan. You hope that they talk maybe after the visit, and the patient can help translate back and forth. Sometimes that works well, but many times […] we find that that kind of communication can get a little bit difficult. We take care of patients that may have more atypical issues, [like] problems with medication, and we can troubleshoot because we’re both in the room.
Q: Could you describe some of your research projects you’re working on?
A: We are so grateful for the NPF because they have funded me to do a very exciting area of research looking at subclinical atherosclerosis [hardening of the arteries] in patients with psoriatic disease. […] In addition to treating skin and joints of these patients, I’m interested in associated conditions. One of the most prominent associated conditions is cardiovascular disease. We know patients with both psoriasis and psoriatic arthritis have more cardiovascular complications than those without. The question is, why should that be? What role does inflammation play in this? It’s a very hot topic.
Q: What will you be talking about at the Research Symposium?
A: One of my goals for getting involved is to bring interdisciplinary research. We have very little opportunity for cross-disciplinary research. I have lots of opportunities as a rheumatologist to go to my major meetings, and dermatology has major meetings. But at these meetings, we don’t necessarily invite the other discipline. […] What I love about this conference and why I want to get involved is it really gives a chance for this cross-disciplinary research to occur.
Q: What really drives you and motivates you in your work?
A: For us, now, at least in psoriatic arthritis, we have so many more treatments than when I was in medical school. It’s so rewarding because I can help [my patients], because we have different drugs that are available. When I started medical school it was like, methotrexate.
Q: And that was it?
A: Enbrel [etanercept] wasn’t even developed until the late 90s. For me, it’s been really transformative, because I’ve watched it. I’ve seen both sides, so it’s been really great to be able to have all these tools in my toolkit to use more individualized treatments. For me, it’s even more rewarding now because we have so many more treatments that are really working well, and allowing people to go back to their jobs, allowing people to go back to their family. […] Unfortunately we still have a certain percentage who don’t respond to our current therapy, so that’s why we’re trying to develop new drugs. But at the same time, I think our understanding of comorbidities is so much better that we’re able to not only take care of the skin and joints, but really address all the other issues in a more timely matter, which then leaves [the patient] a fuller life.
Driving discovery, creating community
For more than 50 years, we’ve been driving efforts to cure psoriatic disease and improve the lives of those affected. But there’s still plenty to do! Learn how you can help our advocacy team shape the laws and policies that affect people with psoriasis and psoriatic arthritis – in your state and across the country. Help us raise funds to support research by joining Team NPF, where you can walk, run, cycle, play bingo or create your own fundraising event. If you or someone you love needs free, personalized support for living a healthier life with psoriatic disease, contact our Patient Navigation Center. And keep the National Psoriasis Foundation going strong by making a donation today. Together, we will find a cure.