Another surprise may be that intraarticular therapy and opioid analgesics are not recommended for hand OA. “We don’t have a good survey about how patients with hand OA are treated, so we really don’t know if those are common practices,” he says.
Most important for practitioners is the case-based approach that was used to develop the recommendations, an approach that should make their use easier in clinical practice. The case-based approach was accomplished by a diverse group of providers who worked on the recommendations, including primary care physicians, an orthopedic surgeon, podiatrists, arthritis-related health professionals, and rheumatologists. All members of the technical expert panel submitted patient scenarios based on the patients they typically see. These scenarios were amalgamated and then reviewed by the ACR Board of Directors “to make sure we were not missing anything,” Dr. Hochberg explains. Therefore, “the recommendations are clinically relevant and should cover the vast majority of OA patients.”
Dr. Hochberg anticipates that these recommendations will be used as quality indicators that could determine whether patients are receiving high-quality care. If this happens, “physicians who follow the strong recommendations and document that in their records—particularly regarding physical therapy referrals, nutrition counseling, assessment of pain severity, and provision of analgesic therapy—could eventually receive higher levels of reimbursement than those physicians who don’t document that care in their records.”
Criteria for Sjögren’s Syndrome
The driving force behind development of the “ACR Classification Criteria for Sjögren’s Syndrome” was the need for specificity rather than reliance on symptoms, such as dry eyes and dry mouth that can be very nonspecific and caused by many other conditions.3 With an increasing number of biologic agents being developed for autoimmune rheumatic diseases and being considered and tested in patients with SS, “disease-specific classification criteria were needed,” Dr. Criswell says. These specific and objective classification criteria can be used for future enrollment in clinical trials testing the new agents and other studies of this disease.
There have been 11 classification or diagnostic criteria sets for SS developed since the mid-1960s, and the latest was published by the American–European Consensus Group; none were endorsed by the ACR. According to Dr. Criswell, the new ACR-endorsed classification criteria represent a significant step forward because they were developed from the large SICCA registry, which includes a diverse, international population. The new criteria, unlike previous ones, do not include various alternative ways of meeting individual criteria.
Also, the criteria outlined in the document are simpler, Dr. Criswell says. “Anyone familiar with Sjögren’s syndrome will look at, basically, three points—eye involvement, oral involvement, and the autoantibodies representing the systemic involvement—and say that that makes a whole lot of sense for Sjögren’s syndrome as an autoimmune disease.”