Two leading academic rheumatologists who took part in a live discussion with
The full discussion can be accessed here and will be published in the summer issue of Evidence-Based Immunology and Infectious Disease, one of four news publications of
• According to Dr O'Dell, if therapeutic principles are followed, more than 50 percent of RA patients should be able to achieve remission.
• Despite busy schedules of rheumatologists, most will find a way to work in a patient with suspicious symptoms to find out if the person has RA. Said Dr Ruderman, "We want to get the patients before there's damage that's permanent."
• Another error is being too reliant on tests or imaging to make a diagnosis. Primary care physicians shouldn't hesitate to make referrals in borderline cases because the "test" is negative, Dr Ruderman said.
• RA patients need to be treated by a rheumatologist, but the primary care physician plays a critical role in managing comorbidities, such as cardiovascular disease.
• Lifestyle modifications, especially quitting smoking, are important, but they do not replace disease modifying therapy, which almost always starts with methotrexate.
• Additional therapies, including biologics, are added after a rheumatologist evaluates a patient's response to methotrexate. A critical error may be not waiting to let methotrexate work.
The final part of the discussion involved issues of insurance coverage for therapies. Both rheumatologists told Dr Fendrick that issues of cost and coverage come up almost every day they spend in the clinic. Dr Ruderman said it's especially frustrating to see some patients go without their medication for a month at the beginning of each calendar while going through prior authorization. "It just can't be good for care," he said.
Dr Fendrick said under healthcare reform, the goal of "value-based" medicine aims to eliminate these kinds of hurdles for doctors and patients who have already demonstrated the need and effectiveness of a therapy. Repeat prior authorizations should not occur just because a drug is expensive, he said.
About the Journal
Read the full story at http://www.prweb.com/releases/2014/05/prweb11810068.htm
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