The Year in Rheumatology: 2013
The Year in Rheumatology: 2013
A number of important rheumatology society guidelines were released this year. In June, at their 2013 annual meeting, the EULAR announced the forthcoming release of new guidelines [not yet published] for the management of RA, updating their 2010 recommendations. The new guidelines focus on the efficacy of conventional first-line disease-modifying antirheumatic drugs (DMARDs), considers approved biologics to be similarly effective, and recommends that biologics be combined with methotrexate rather than used as monotherapy. The update is more general than the ACR's 2012 RA recommendations that were geared toward the private practice rheumatologist. It is felt that the 2013 EULAR guidelines will avoid the overtreatment of 20%-30% of patients with RA.
New juvenile idiopathic arthritis (JIA) guidelines were also released this year. Pathophysiologic and therapeutics advances in systemic JIA spurred the ACR to update its 2011 recommendations to now include several medications not previously considered: the anti-interleukin (IL)-1 agents canakinumab and rilonacept and the anti-IL-6 agent tocilizumab. The addition of these drugs is a giant step toward improving patient outcomes and in greater understanding of the role of IL-1 and IL-6 in these disorders.
The ACR and the EULAR jointly commissioned and published the updated classification criteria for systemic sclerosis (SSc), replacing the ACR's 1980 criteria, which lacked sensitivity. The most significant change is the criterion that "...skin thickening of the fingers extending proximal to the metacarpophalangeal joints is sufficient for the patient to be classified as having SSc." If skin thickening is not present, 7 other additive findings apply and are used to assign a classification score. These are skin thickening of the fingers, fingertip lesions, telangiectasia, abnormal nailfold capillaries, interstitial lung disease or pulmonary arterial hypertension, the Raynaud phenomenon, and SSc-related autoantibodies.
Choosing Wisely®, an initiative of the ABIM Foundation, is focused on encouraging physicians, patients, and other healthcare stakeholders to think and talk about medical tests and procedures that may be unnecessary, and in some instances can cause harm. To spark these conversations, leading specialty societies have created lists of "Things Physicians and Patients Should Question"-- evidence-based recommendations that should be discussed to help make wise decisions about the most appropriate care on the basis of a patient's individual situation.
The ACR established a Top 5 Task Force to oversee the creation of the following recommendations:
Guidelines, Guidelines, Guidelines
A number of important rheumatology society guidelines were released this year. In June, at their 2013 annual meeting, the EULAR announced the forthcoming release of new guidelines [not yet published] for the management of RA, updating their 2010 recommendations. The new guidelines focus on the efficacy of conventional first-line disease-modifying antirheumatic drugs (DMARDs), considers approved biologics to be similarly effective, and recommends that biologics be combined with methotrexate rather than used as monotherapy. The update is more general than the ACR's 2012 RA recommendations that were geared toward the private practice rheumatologist. It is felt that the 2013 EULAR guidelines will avoid the overtreatment of 20%-30% of patients with RA.
New juvenile idiopathic arthritis (JIA) guidelines were also released this year. Pathophysiologic and therapeutics advances in systemic JIA spurred the ACR to update its 2011 recommendations to now include several medications not previously considered: the anti-interleukin (IL)-1 agents canakinumab and rilonacept and the anti-IL-6 agent tocilizumab. The addition of these drugs is a giant step toward improving patient outcomes and in greater understanding of the role of IL-1 and IL-6 in these disorders.
The ACR and the EULAR jointly commissioned and published the updated classification criteria for systemic sclerosis (SSc), replacing the ACR's 1980 criteria, which lacked sensitivity. The most significant change is the criterion that "...skin thickening of the fingers extending proximal to the metacarpophalangeal joints is sufficient for the patient to be classified as having SSc." If skin thickening is not present, 7 other additive findings apply and are used to assign a classification score. These are skin thickening of the fingers, fingertip lesions, telangiectasia, abnormal nailfold capillaries, interstitial lung disease or pulmonary arterial hypertension, the Raynaud phenomenon, and SSc-related autoantibodies.
Choosing Wisely®, an initiative of the ABIM Foundation, is focused on encouraging physicians, patients, and other healthcare stakeholders to think and talk about medical tests and procedures that may be unnecessary, and in some instances can cause harm. To spark these conversations, leading specialty societies have created lists of "Things Physicians and Patients Should Question"-- evidence-based recommendations that should be discussed to help make wise decisions about the most appropriate care on the basis of a patient's individual situation.
The ACR established a Top 5 Task Force to oversee the creation of the following recommendations:
Don't test antinuclear antibody (ANA) subserologies without a positive ANA screen and clinical suspicion of immune-mediated disease.
Don't test for Lyme disease as a cause of musculoskeletal symptoms without an exposure history and appropriate examination findings.
Don't perform MRI of the peripheral joints to routinely monitor inflammatory arthritis.
Don't prescribe biologics for RA before a trial of methotrexate (or other conventional nonbiologic DMARDs).
Don't routinely repeat DXA scans more often than once every 2 years.