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It’s a Small World After All
Global collaboration can improve care
by Neal S. Birnbaum, MD
The ACR has a role in advancing rheumatology and the care of the patients we treat both within and beyond the borders of the United States. Collaborative efforts across many functional areas without regard to geographic boundaries pay off for all members and for the profession as a whole.
ILAR Revitalization and the ACR
The International League of Associations for Rheumatology (ILAR) is the umbrella organization for the four international leagues of rheumatology: the Panamerican League of Associations for Rheumatology (PANLAR), of which the ACR is a member; the European League Against Rheumatism (EULAR); the Asia Pacific League of Associations for Rheumatology; and the African League Against Rheumatism. ILAR’s mission includes education, epidemiology, international clinical studies, and pediatric rheumatology; it also publishes the journal Clinical Rheumatology. Although ILAR has a global focus, it concentrates on areas of the world with the greatest need.
ILAR is currently undergoing a reorganization of its structure, governance, and programming. The new ILAR Executive Committee will consist of the president and president-elect of each of the four leagues and, in recognition of ACR’s status in the rheumatology community, the president and president-elect of the ACR. A strategic planning process is part of ILAR’s reorganization, although it is anticipated that interacting with the World Health Organization and meeting the needs of rheumatology in developing countries will continue to be core functions of ILAR. The new ILAR executive committee will meet in Boston this November, in conjunction with the ACR Annual Scientific Meeting, to further flesh out reorganization priorities.
Rheumatology societies exist at the local level - including in the communities of our nearly 1,500 members who live and work outside the United States - and help to advance issues of importance to the communities they serve. We can help make the worldwide community a better place for us all by forging a strong international organization with the cooperation of dozens of countries with the goal of improving rheumatology in those areas that need it most. I am honored that the ACR has been invited to play such an important role in the revitalization of this organization.
Global Disease Classification and Response Criteria
Ultimately, it is better for the scientific community, and therefore the patients we treat, if everyone can agree to one criteria set for a disease rather than a different one for each country or continent. We know, for example, that classification criteria are commonly used to determine which group of patients will be enrolled in trials for a particular disease. If the same criteria are used for two different trials, then the trials can be compared more easily. If two different sets of criteria are used, it’s harder to compare the trials because the populations might not match. Especially for those rheumatic diseases with small overall populations, we need to be able to define who actually has the disease so subjects from wide geographic areas can participate in collaborative trials. The same rationale applies to response criteria.
To that end, the ACR is collaborating with EULAR on several projects related to classification/diagnostic and response criteria as well as outcome measures sets. In particular, the two groups are developing polymyalgia rheumatica classification criteria, myositis classification criteria, and gout response criteria. These documents will be completed in late 2007, 2008, and 2009, respectively. In addition, the ACR is participating with EULAR in an RA Trial Reporting Task Force to make recommendations on reporting of disease activity status and response in clinical trials of rheumatoid arthritis.
We can help make the worldwide community a better place for us all by forging a strong international organization with the goal of improving rheumatology in those areas that need it most.
International Education, ACR Journals
It’s no longer a novelty to travel outside one’s own country for world-class education. Consider the more than 4,800 rheumatologists, scientists, and other health professionals from outside the United States who attended the 2006 ACR/ARHP Annual Scientific Meeting in Washington, DC. The ACR waives registration fees for trainees from developing countries, and in 2005 we introduced American Medical Association international CME credits for annual meeting attendees. In addition, opportunities to deliver professional education in other countries are expanding. For example, the ACR planned and implemented review courses for the 2006 and upcoming 2008 PANLAR Congresses, as well as the 2006 biennial APLAR Congress and the 2007 Mexican College of Rheumatology meeting.
ACR leaders serve on the EULAR Scientific Programme Committee, which is responsible for the scientific and educational content of the annual EULAR Congress, and EULAR leaders serve on the ACR’s Annual Meeting Planning Committee. Although both meeting programs are planned independently, the representatives promote collaboration so that the best science is presented at each meeting, ensuring greater access to information.
Through a World Health Organization program, free subscriptions to ACR’s journals - Arthritis & Rheumatism and Arthritis Care & Research - are provided to institutions in underdeveloped countries. In 2006, individuals from outside the United States submitted 1,348 manuscripts to Arthritis & Rheumatism and 382 manuscripts to Arthritis Care & Research.
Residents of a Global Community
Day-to-day, the efforts to advance rheumatology occur at the local level - wherever that may be for each of us. And yet that activity can have a profound effect on the world of rheumatology. As residents of a global community, the ACR and each and every one of you can positively affect our profession and our patients the world over.
Dr. Birnbaum is president of ACR. Contact him via e-mail at firstname.lastname@example.org.