Identifying Breakthroughs for Autoimmune Diseases

Joel Gelfand, MD, MSCE, is professor of dermatology and epidemiology, vice chair of clinical research, and medical director of the Dermatology Clinical Studies Unit, and director of the psoriasis and phototherapy center at the University of Pennsylvania, Perelman School of Medicine in Philadelphia.

He recently discussed the latest breakthroughs in managing autoimmune diseases with us.

When did you become interested in autoimmune diseases and multidisciplinary research?

I've always been interested in multidisciplinary research since my days in medical school. I always have felt that diseases don't respect the boundaries of specialties, and I often think that the most interesting things can be learned at the intersection of our various specialties of medicine.

What are some of the exciting breakthroughs in your field for autoimmune diseases, such as psoriasis and psoriatic arthritis?

There have been a number of important breakthroughs in the field of psoriasis and psoriatic arthritis.

I'd say, first of all, probably the biggest breakthroughs have been in the area of both genetics and treatments, where through identifying the path of physiology of disease, identifying genes that make people susceptible to psoriasis, they're then rushed with designed targeted therapies that have been brought to bear in this disease, that are highly effective and often highly safe. That's been a major advance in the disease state.

Another major advance has been better understanding of the natural history of psoriasis and psoriatic arthritis. These are common occurring diseases that people live with for decades, yet previously, it wasn't well-understood what other health problems people would encounter related to having psoriasis.

It was thought to be a mild disease just of your skin, and now it's more felt to be a systemic inflammatory disease of which the skin is one of the manifestations. We know that people who have more extensive disease involvement, they're more prone to things like diabetes, cardiovascular diseases, even mortality.

That's been recognized recently in both the AAD guidelines for psoriasis and the AHA/ACC guidelines for cholesterol management, and which both groups, the cardiology community and the dermatology community recognize that psoriasis is a disease that needs to be targeted for screening of traditional cardiovascular risk factors.

In many cases, having a more aggressive management of these cardiovascular risk factors such as earlier use of statins in people found to be at higher risk of cardiovascular diseases.

What are some of the challenges for collaboration between these for both research and patient care?

One of the biggest challenges is the structural issues in healthcare that make it difficult for physicians to work in a team environment. For example, at the University of Pennsylvania, I'm fortunate to work with outstanding rheumatologists, both in the research arena but also clinically.

It's difficult for us to be able to see patients on the exact same day and have insurance be worked out in a straightforward manner for our patients.

If you're a patient, who has psoriasis and psoriatic arthritis, it would be nice to be able to see both the dermatologist and the rheumatologist in the same room, at the same time, instead of having to have multiple different appointments and multiple different copays.

Our systems really haven't evolved yet to recognize the benefits of team-based care for people with complex inflammatory conditions.