dermatologists and 42.9% of rheumatologists. Dermatologists indicated they were solely responsible for prescribing decisions in 23.6% of their PsA patients. In 30.8%, they were primarily responsible for prescribing decisions but patients were monitored by a rheumatologist for joint symptoms, and in 44.8%, rheumatologists made prescribing decisions but the responding dermatologist monitored skin symptoms. While rheumatologists indicated they were solely responsible for prescribing decisions in 66.1% of their PsA patients, 34.2% might also be monitored by a dermatologist for skin symptoms and in 8.7% of patients, the dermatologist made primary prescribing decisions, whereas joint symptoms were monitored by the rheumatologist. physician estimates of the current treatment utilization by patients with moderate-to-severe psoriasis or PsA in their practice. Dermatologists reported that 74.9% of their psoriasis patients were receiving topical therapy, 19.5% were receiving conventional oral disease-modifying antirheumatic drug (DMARD) therapy and 19.6% were receiving biologics. PsA patients were more often receiving oral therapy when treated by rheumatologists (63.4%) vs. dermatologists (35.2%), whereas dermatologists and rheumatologists both reported that approximately 30% of their PsA patients were receiving biologics.Physician attitudes: patient management and treatment goals The top goal for dermatologists treating psoriasis patients was keeping signs/symptoms at bay (52.5%), followed by improving normal functional activities (22.3%) and improving patient self-esteem (10.7%). Dermatologists reported feeling optimistic (45.2%) and/or hopeful (35.3%) about managing a new patient with moderate-to-severe psoriasis. However, approximately one in five felt that managing such a patient was time-consuming (19.8%) and complicated (18.6%). Approximately, 60% of dermatologists felt that psoriasis patients require more time and support than their other patients and that the current structure of the healthcare system does not allow them adequate time for their care. Dermatologists cited affordability and long-term safety risks with current medications as the greatest challenges in managing psoriasis patients When treating PsA patients, dermatologists and rheumatologists reported the top goals were to reduce joint pain and stiffness (33.8% and 36.2% respectively), improve normal functional activities (28.4% and 23.6%) and keep symptoms at bay (25.3% and 23.6%). Dermatologists reported feeling optimistic (30.9%) or hopeful (29.7%) about managing PsA patients with active disease, 26.5% felt it would be complicated and 15.4% said it was time-consuming; 17.4% thought they would need to refer to or involve other specialists. Rheumatologists reported feeling optimistic (61.3%) or hopeful (37.2%) about managing a PsA patient with active disease; 29.5% agreed that PsA patients require more time and support than their other patients. Dermatologists most often cited differentiating PsA from other arthritic diseases as the greatest challenge (24.6%), whereas rheumatologists most often cited delayed referral (31.0%) (Fig. 2b).Physician attitudes: treatment options In all, 53.5% of dermatologists said they would prescribe topical therapies as monotherapy for their moderate-to-severe psoriasis patients. Dermatologists most commonly identified the primary challenge with topical therapies as lack of, partial or waning response (25.1%); compliance (18.4%); patient complaints of inconvenience/mess (18.2%); and inability to cover the entire surface area (17.9%).Dermatologists (47.6%) most commonly felt they were comfortable, but conservative, with the use of conventional oral DMARD therapy, or reported using it sparingly (20.5%), whereas most rheumatologists (68.5%) reported that they felt conventional oral therapy provided benefit and used it broadly and only 9.0% used it sparingly. Reasons for not initiating (Fig. 3a) or continuing (Fig. 3b) oral therapy were often related to long-term safety and tolerability concerns. In addition, 18.7% of dermatologists and 16.1% of rheumatologists said patient contraindications were a main factor in preventing greater use of conventional oral therapies. Rheumatologists commonly cited lack of response as a limitation to continuing therapy (35.4%). For dermatologists and rheumatologists who held back prescribing oral therapy because of patient refusal or concerns, the most common reasons were related to tolerability, long-term safety, lifestyle modifications and lack or loss of response (Fig. 3c).Top five most commonly cited limitations for initiating conventional oral therapy (a), continuing conventional oral therapy (b) and patient concerns regarding the use of conventional oral therapy (c). Approximately 40% of