Clinical Practice in Rheumatology


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Clinical practice guidelines are developed to reduce inappropriate care, minimize geographic variations in practice patterns, and enable effective use of health care resources.

The ACR considers adherence to these guidelines and recommendations to be voluntary, with the ultimate determination regarding their application to be made by the physician in light of each patient's individual circumstances. Guidelines and recommendations are intended to promote beneficial or desirable outcomes but cannot guarantee any specific outcome.

Guidelines and recommendations developed or endorsed by the ACR are subject to periodic revision as warranted by the evolution of medical knowledge, technology, and practice. To promote transparency and assist ACR guideline development groups in their work, the ACR has outlined its policies and procedures for guideline development and maintenance in the ACR Guideline Manual.

Issues concerning access to clinical care services, rheumatology education and research are particularly problematic in developing countries and rural areas, yet challenges faced in developed countries hinder the progress of RMD healthcare worldwide. By increasing awareness of the burden of RMDs at the policy-maker level and identifying key challenges, it may be possible to identify realistic opportunities to address the global RMDs problem.

The WFRMD aims to address important challenges for the RMDs by facilitating discussions with rheumatology experts and lobbying stakeholders, internal and regional rheumatology associations, local governments and the WHO to raise awareness of these prevalent and burdensome diseases. Writing support and editorial assistance was provided by Costello Medical Consulting. All authors declare no conflict of interest related to this manuscript. National Center for Biotechnology Information , U.

Clinical Rheumatology. Clin Rheumatol.

American College of Rheumatology, Eric Ruderman, MD

Published online Dec Tore K. Author information Article notes Copyright and License information Disclaimer. Mustafa Al Maini, Email: gro. Corresponding author. Open Access This article is distributed under the terms of the Creative Commons Attribution License which permits any use, distribution, and reproduction in any medium, provided the original author s and the source are credited.

This article has been cited by other articles in PMC. Abstract Rheumatic and musculoskeletal diseases RMDs represent a multitude of degenerative, inflammatory and auto-immune conditions affecting millions of people worldwide. Electronic supplementary material The online version of this article doi Introduction The term rheumatic and musculoskeletal diseases RMDs largely encompasses over one hundred degenerative, inflammatory and auto-immune conditions which in their most advanced form are associated with severe pain, joint damage, disability and even death.

Open in a separate window. Rheumatic and musculoskeletal diseases RMDs and their estimated prevalence. Summary of the global challenges and opportunities facing rheumatology today. Methodology A preliminary PubMed literature search focusing on challenges in the areas of RMDs clinical care, education and research was conducted to identify key questions for the authors to address. Challenges within the clinical care services According to the WHO, a key component of a well-functioning health system is to provide equitable access to people-centred care [ 12 ]. Table 1 Estimated rheumatologist workforce across different countries.

Education of rheumatologists and other experts in RMD care Successful education in the RMDs requires a collaborative, constructive, and contextual approach, aimed at providing education across professions. Specialist training Collaborations between rheumatology associations and universities could help strengthen existing teaching, provide core knowledge of the RMDs to all practitioners and encourage rheumatology as a specialty within that region.

Continuing education Regional and national rheumatology leagues should help to deliver courses with clear curricular goals. Patient awareness of RMDs In some areas of the world, a lack of basic education and literacy, poorer socioeconomic status and cultural beliefs can influence the decision of patients to seek medical attention from a PCP, or they may only seek help from alternate care practitioners [ 9 ].

Research challenges The impact of financial, political, social, or environmental factors on the opportunity to conduct clinical, epidemiological, as well as basic and translational research creates major challenges worldwide. Clinical trials research Ethnicity may influence the manifestation of various RMDs, due to underlying genetic differences, environmental factors, cultures and socioeconomic status [ 42 ].

Table 2 Number of registered clinical trials listed on ClinicalTrials. Studies with no locations are not included; studies with multiple locations are included in each region containing locations a Latin America values obtained by adding number of trials in Central America and South America. Investigator-initiated research There are many existing programmes to support investigator-initiated RMDs research including the Canadian Initiative for Outcomes in Rheumatology Care CIORA which offers awards to new clinicians to carry out independent arthritis research.

Epidemiological research Real-life efficacy and safety data from registries provide a valuable source of data for the RMDs. Conclusions The high prevalence and burden of RMDs presents a number of global challenges for the practice of rheumatology and more generally for chronic diseases. Conflict of interest All authors declare no conflict of interest related to this manuscript.

Guideline Policies and Procedures

Footnotes 1 For the purpose of this manuscript, developing countries are defined by World Bank criteria as low- and middle-income economies, i. References 1. Years lived with disability YLDs for sequelae of diseases and injuries — a systematic analysis for the global burden of disease study The global burden of rheumatoid arthritis: estimates from the global burden of disease study. Ann Rheum Dis. The global burden of hip and knee osteoarthritis: estimates from the global burden of disease study. The global burden of low back pain: estimates from the global burden of disease study.

The global burden of neck pain: estimates from the global burden of disease study.


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The global burden of gout: estimates from the global burden of disease study. The global burden of other musculoskeletal disorders: estimates from the global burden of disease study. Rheum Dis:annrheumdis [ PubMed ].

Bibliographic Information

Improving musculoskeletal health: global issues. Best Pract Res Clin Rheumatol. Early rheumatoid arthritis in Latin America: low socioeconomic status related to high disease activity at baseline. Arthritis Care Res. Woolf AD The bone and joint decade: working together to make musculoskeletal conditions a public health priority. Accessed 5th Nov Key components of a well functioning health system. World Health Organization, Improved clinical outcome of lupus nephritis during the past decade: importance of early diagnosis and treatment.

Benefit of very early referral and very early therapy with disease-modifying anti-rheumatic drugs in patients with early rheumatoid arthritis. The United States rheumatology workforce: supply and demand, — Arthritis Rheum. Cardiel MH. Present and future of rheumatic diseases in Latin America.

RA Remission: Assessing Clinical Practice Definitions and Functional Status

Are we prepared to face them? Regional distribution of adult rheumatologists. Arthritis Rheuma. Badley EM, Canizares M, Gunz AC, Davis AM Visits to rheumatologists for arthritis: the role of access to primary care physicians, geographic availability of rheumatologists, and socioeconomic status. Arthritis Care Res [ PubMed ]. Access to rheumatologists among patients with newly diagnosed rheumatoid arthritis in a Canadian universal public healthcare system.

Clinical Practice in Rheumatology | SpringerLink

BMJ Open. Rheumatology:ker [ PubMed ]. Gibson T Rheumatology in India and Pakistan today. Rheumatology:keu [ PubMed ].

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