Ann Miller O’Keefe has lived in the Bronx her whole life. Already a grandmother of six, she is expecting her seventh in April 2026, all of them also in the Bronx. Now in her early 70s, she first experienced psoriasis when she was 20 years old. While this often painful condition can show up in a number of ways, it generally involves thickened patches of rough, red, and itchy skin. “It felt like somebody had scraped my skin across the pavement,” she says now.

An auto-immune disorder, where the body’s own defenses get turned on and cause severe inflammation, psoriasis can be difficult to diagnose and treat. When O’Keefe first became aware of her illness, there weren’t great treatment options available. “Nobody in my family ever had it,” she says. “And back then there were no injections for it. It was so itchy, and at that time all they had were skin creams that didn't help at all.”

O’Keefe worked at schools, serving lunch to the students. “I used to always wear long sleeves because I didn't want the kids seeing my psoriasis. It was very embarrassing. I loved my job and didn’t want to stop working, so I covered it up.”

About 20 to 30 percent of patients with psoriasis also have psoriatic arthritis, where the immune system causes painful damage to joints. Thanks to newer treatment options for psoriasis, O’Keefe was able to get relief for her skin symptoms. But she was also having joint pain. “A few years ago, when I woke up most mornings, I couldn't even stand up,” she says. “I'd have to slowly get all the kinks and cracks out of my body. It was so painful. Not only did I have no energy, but it was making me feel down in the dumps.”

By this time O’Keefe had found her way to dermatologist Shira Wieder, MD. “I fell in love with her right away,” says O’Keefe. “She's so helpful, she explains everything to you. I feel very comfortable with her.”

Dr. Wieder got her skin symptoms under control with a biologic, now the frontline treatment for both psoriasis and psoriatic arthritis. But the joint pain was a different story. “I began working with her to find the best plan to get rid of this arthritis that was bothering me a lot,” says O’Keefe. “The psoriasis was going away, but the arthritis kept coming back.”

At that time, Dr. Wieder was in private practice, but she knew that O’Keefe lived in the Bronx and saw several physicians at Montefiore Einstein. She ended up connecting with rheumatologist Anand Kumthekar, MD, and asked if he would see O’Keefe.

Their discussion about her care was the beginning of what grew into Montefiore Einstein’s combined Psoriasis and Psoriatic Arthritis Clinic, and a thriving clinical partnership and collaboration. “They worked to get me a medication that would control the arthritis,” says O’Keefe. “Now Dr. Wieder thanks me all the time for bringing the two of them together.”

Dr. Wieder found the collaboration with Dr. Kumthekar so professionally fulfilling that she joined Montefiore Einstein in late 2024. She and Dr. Kumthekar now see patients together, at the same visit, one Thursday every month at Montefiore’s Hutchinson campus, at Waters Place, and hope to expand to more times and locations in the future. “Dr. Kumthekar is a wonderful doctor and such a kind man,” says O’Keefe. “Dr. Wieder is very glad to be at Montefiore. I see them every three months on Thursdays and they have just helped me tremendously. When I go to see them, I'm happy.”

“I had been trying to find a dermatologist who has an interest in psoriasis since I started at Montefiore in 2018,” Dr. Kumthekar. “I’m grateful that Dr. Wieder chose to come practice here, and I get to learn so much from her.”

In addition to clear skin, O’Keefe is now free from her crippling joint pain. She enjoys dancing along to the movie K-Pop Demon Hunters with her oldest granddaughter.

“I just feel wonderful all the time now,” she says. “I really do. I used to only go to the beach far from my home where I wouldn’t see anyone I knew, I wouldn’t join any of the neighborhood pools. Now I wear short sleeves all the time. I go everywhere now, I go in the ocean, I go in the pool. I get to play with my grandkids. I’m enjoying life.”

It Takes Two

Long before she connected with Dr. Kumthekar, Dr. Wieder had felt the need for a co-management approach to her patients with psoriasis. “We know that as many as 30 percent of patients who have psoriasis will have psoriatic arthritis, and it's important to screen these patients,” she says. “We would tell them, ‘It would be a good idea for you to see a rheumatologist. You have these vague joint complaints. You don't necessarily meet criteria for psoriatic arthritis based on what you're telling me, but the complaints are enough that you should get checked out.’”

She continues, “What I kept finding is that they never ended up seeing a rheumatologist. And the question for me always was, is how much psoriatic arthritis are we missing in our clinic?”

In addition to causing pain in the immediate term, when left untreated, psoriatic arthritis can cause permanent damage to joints. Pain caused by this type of long-term damage doesn’t recede with biologic medications, which instead target active inflammation caused by the disease.

There is also evidence that the chronic inflammation caused by psoriatic arthritis puts patients at higher risk for heart disease. “When it’s not treated, it’s as bad as having diabetes in terms of risk factors for heart disease,” says Dr. Kumthekar. “Catching it early and treating it aggressively is really important, because it improves outcomes. And for so many patients, getting separate appointments to see both a dermatologist and rheumatologist is difficult.”

All of this underscores the need for the multidisciplinary approach offered at Montefiore Einstein. On their first visit, patients see both Dr. Wieder and Dr. Kumthekar. The two physicians discuss the case before going back to the patient together with their recommendations and treatment options.

“It's good for the patient because they can see two people at the same time, and it's good for us too, because we can bounce ideas off each other and come up with the right treatment,” says Dr. Kumthekar. Adds Dr. Wieder, “It's much more convenient, and they get a more comprehensive diagnosis, faster.”

Putting the pieces together

Both psoriasis and psoriatic arthritis can be tricky to diagnose. Some types of eczema, for instance, can mimic psoriasis. Even a biopsy does not always yield definitive results, depending on the exact type of disease. Finding the right treatment, in these cases, can require trial and error.

Similarly, a diagnosis of psoriatic arthritis depends on a clinical history and exam. Lab tests for certain biomarkers and imaging can help in select cases, but neither can yield a definitive diagnosis on its own. And just like not all patients with psoriasis have psoriatic arthritis, the reverse holds true as well. About 10 to 15 percent of patients have psoriatic arthritis with no associated skin symptoms, a diagnosis known as seronegative spondyloarthritis, says Dr. Kumthekar.

Biologic medications have emerged as the gold standard for treating both psoriasis and psoriatic arthritis. If a patient tries a number of biologics without success, it can be a telltale sign that they may have an alternative diagnosis.

“We had a patient in their 60s who had been diagnosed with psoriasis in their 20s and had failed to improve on multiple biologics,” recalls Dr. Wieder. “When Dr. Kumthekar examined them, he felt the previous longstanding diagnosis of psoriatic arthritis was actually osteoarthritis. And with that, I actually did a new biopsy because I said, maybe we're missing something.”

The patient was ultimately diagnosed with a condition called psoriasiform dermatitis. “While it can look the same, even microscopically, it’s distinct from psoriasis or eczema,” explains Dr. Wieder. “I changed their biologic to one that treats eczema and their skin cleared up. This patient was a mixed picture case, where we need to parse exactly what's going on. It’s especially important to have this collaboration and insights from both specialties.”

She continues, “Their care was a perfect example of how a multidisciplinary approach can lead to a terrific outcome.” Especially in cases where the right treatment doesn’t come on the first try, she adds, “It’s really helpful to have another pair of eyes coming from the other specialty.”

Dr. Kumthekar adds, “When someone fails a biologic, at least for psoriatic arthritis, we always like to go back and reconsider the initial diagnosis, because the most common arthritis with psoriasis is actually osteoarthritis, not psoriatic arthritis.”

Choosing a biologic is also a collaborative decision. “It’s generally based on what symptoms are the most bothersome for the patient, and then what data we have in the literature, which biologics work best for the skin or the joints,” says Dr. Kumthekar. “Some work very well for one but aren’t as effective for the other.”

They also take into account the full picture of a patient’s health. Certain biologics pose risks for patients with other chronic health concerns, including inflammatory bowel diseases like Crohn’s or ulcerative colitis, congestive heart failure, depression, and many others.

For a few select patients whose symptoms don’t clear up fully with one biologic, combining two different biologics can potentially help after carefully reviewing the risks and benefits. But there is no clinical trial data yet to guide physicians in these difficult-to-treat cases. “We turn to individual case studies that have been published,” says Dr. Kumthekar, adding, “There are ongoing efforts from international professional societies to address this gap.”

Dr. Wieder first became interested in psoriasis during residency. She trained at Mount Sinai in Manhattan, with Mark Lebwohl, MD, one of the foremost researchers in psoriasis. “From first-year on, we had enormous exposure to treating psoriasis and the use of the biologics,” says Dr. Wieder. “You come out of that program very comfortable prescribing biologics. I found it fascinating and I gravitated towards it. And I have continued to love working with these patients. If you show passion for something, patients will respond, and more and more have come to us. It's been really gratifying.”

Dr. Kumethkar likewise was inspired by his mentor, Atul Deodhar, MD, a prolific researcher and clinician at Oregon Health & Science University. Now Dr. Kumthekar and Dr. Wieder are themselves both training residents and fellows who observe in the clinic, giving them critical exposure to multidisciplinary treatment. “I tell my residents, this is your chance to learn how to conduct a joint exam,” says Dr. Wieder. “Depending on where they practice in the future, it’s important that they be able to do basic screenings for patients who may not have easy access to a rheumatologist.”

O’Keefe is just one of their many patients who can speak to the benefits of the combined clinic. “I would highly recommend them to anybody,” she says.