from the annual scientific sessions of the American College of Rheumatology in Philadelphia
During the past 5 months, rheumatology societies issued substantively updated criteria for classifying two major rheumatic diseases. In June, the Assessment of Spondyloarthritis International Society (ASAS) published new guidelines for classifying axial spondyloarthritis. And earlier this week, a collaborative group from the American College of Rheumatology (ACR) and the European League Against Rheumatism (EULAR) unveiled their new revision of diagnostic criteria for rheumatoid arthritis during the ACR’s annual meeting. (A few days ago I posted a blog on this site about the new RA criteria).The parallels between the two actions are striking. Both sets of new criteria eliminated x-ray evidence of disease as a factor for patient identification. The thinking is that when patients develop joint damage that’s visible on x-rays it’s already too late; their disease has progressed to irreversible pathology. Both sets of new criteria allow identification of patients earlier in their disease course. And treatment options now exist that, when started at this earlier point, have a good chance of slowing or stopping further damage and preventing patients from reaching an irreparable end stage.
Better medicine isn’t the only result. These new criteria have economic implications too, especially for spondyloarthritis.
For patients with early-stage rheumatoid arthritis, “I don’t get a lot of pushback from insurers” about paying for disease-modifying therapy, said Dr. Eric M. Ruderman, a Chicago rheumatologist, in an interview. “Most insurers see the value of disease modifying therapy, and they see a turn around in their costs after a year or 2.”
But, for spondyloarthritis, it’s different. Insurers “say show me the sacroiliac joint films,” a key part of the old criteria that was eliminated as a requirement in the June update, Dr. Ruderman said. “We have patients with clear, inflammatory spine disease who don’t meet the [old] New York criteria,” and fail treatment with the entry agent, a nonsteroidal anti-inflammatory drug. “The new ASAS criteria take the x-ray out and give you other options” for treatment.
Will the new classification criteria ease insurance coverage for disease-modifying treatment of early-stage spondyloarthritis? “I hope it does,” Dr. Ruderman said when I spoke with him on Oct. 21. Right now, it’s still too soon to know for sure, he added.
—Mitchel Zoler, 12:30 AM, Oct. 23, Wynnewood, PA (on Twitter @mitchelzoler)