a red-filtered hand in pain with text next to it: "Unifying SJIA and Still’s disease"

Unifying SJIA and Still’s disease

EULAR and PReS have published a journal article detailing “the diagnosis and management of Still’s disease, comprising systemic juvenile idiopathic arthritis and adult-onset Still’s disease.”

This combination will help to solidify that SJIA and AOSD are the same disease. It will also help clarify what treatment should look like, for those who have decent access to healthcare. The author issue 14 recommendations, with 3 on diagnosis, 2 on treatment timing, 3 on treatment options, and the rest focused on complications and issues to watch out for.

Check out the Medical Xpress article that goes into a high-level look at the article. You can also check out the full open-access article itself.

DeepCure’s AI Platform Creates Novel Brd4 Inhibitor

The following is an excerpt of an article on Drug Discovery Trends, dated 9/9/2024:

The company’s first AI-generated drug candidate, DC-9476, a selective Brd4 BD2 inhibitor, embodies this approach, showing promise in preclinical models of autoimmune diseases like rheumatoid arthritis (RA) and Still’s disease. In RA models, DC-9476 demonstrated superior efficacy compared to standard treatments, including TNF-alpha inhibitors, IL-6 inhibitors, and the JAK inhibitor tofacitinib. DeepCure recently announced a collaboration with the Leeds Institute of Rheumatic and Musculoskeletal Medicine (LIRMM) to test DC-9476 in RA.

Read the full article here

ACR Encourages Patients to Implement Self-Management Strategies #RDAM

The following is a press release from ACR dated September 9, 2024:

The ACR Encourages Patients with Rheumatic Diseases to Implement Self-Management Strategies to Improve Quality of Life

American College of Rheumatology (ACR) experts identified research suggesting that patient self-management is not as prevalent as it should or could be despite the improvements patients experience when implemented. This is due, in part, to many patients lacking awareness and motivation to self-manage and thinking the only way to control their disease is by taking their medication.

Today, the ACR launched its patient education campaign, Self-Management for Patients Living with Rheumatic Conditions for Rheumatic Disease Awareness Month (RDAM)The campaign addresses the current knowledge gap, educates patients about self-management techniques, and encourages them to collaborate actively with their rheumatology healthcare team to manage their rheumatic condition.

The campaign does not delve into self-care practices yet focuses on self-management strategies for managing a patient’s rheumatic condition.

“One thing that is important to note is that self-management is often used interchangeably with self-care, but they are different. Self-management is an individual’s day-to-day management of their chronic conditions over the course of an illness,” says Bhakti Shah, MD, a rheumatologist with Crystal Run Healthcare in Middletown, N.Y., and the campaign’s medical spokesperson. “Self-care consists of those tasks performed by healthy people to prevent illness rather than manage an existing illness.”

The campaign highlights five overarching strategies patients can incorporate in their lives. They are:

  • Stress Management –Rheumatic conditions can impact a person’s physical and mental health. Patients can create relaxation practices like meditation, self-reflection, or journaling.
  • Medication Adherence –Patients should partner with a clinician to understand their medications, what aspects of their disease they treat, and the importance of continuing these medications.
  • Lifestyle Changes –Regular exercise and eating a healthy diet are essential for general well-being and may help improve symptoms.
  • Communicate and Collaborate with a Healthcare Team –Patients should maintain open communication with their rheumatology healthcare team, including the rheumatologist, physical therapist, and other specialists.
  • Maintain a Support System—Patients should ask family or friends for help when needed, especially during a flare.

“Each patient encounter is an opportunity for rheumatologists (and rheumatology health professionals) to remind patients to incorporate self-management techniques in their lives. During my patient visits, I try to review topics such as medication adherence, physical activity and quality of life and I remind them that we are a team and collaboration will lead to improved outcomes for them,” Dr. Shah continues. “We hope this campaign will empower patients to take a more proactive role in their treatment journey.”

Rheumatic Disease Awareness Month is recognized each September, drawing attention to more than 100 conditions under the umbrella of rheumatic diseases. Rheumatoid arthritis, osteoarthritis, and lupus are some of the most commonly known. Others include Sjögren’s syndrome, gout, scleroderma, and psoriatic arthritis. More than 53.2 million American adults—one in four—have been diagnosed with rheumatic disease.

To view the full self-management toolkit, visit www.RDAM.org.

ACR Responds to Congressional Hearing on Private Practice Challenges

The following is a press release from ACR dated June 24, 2024:

The American College of Rheumatology (ACR) has submitted to the United States House Committee on Ways and Means Health Subcommittee a response to the recent subcommittee hearing, The Collapse of Private Practice: Examining the Challenges Facing Independent Medicine, highlighting issues facing private practices, including inadequate reimbursement for Medicare physicians, burdensome prior authorization policies, and the growing shortage of physicians in the workforce.

In its letter, ACR notes that rising inflation, cuts to reimbursements to below the cost of treating Medicare patients and growing operating costs threaten the viability of private practices. To address these concerns, ACR advocates for legislation to address two persistent challenges impacting Medicare payment to physicians: inflation and a mandatory budget-neutrality requirement. The Strengthening Medicare for Patients and Providers Act (H.R. 2474) would add a permanent annual inflationary update for Medicare physician payments, while the Provider Reimbursement Stability Act (H.R 6371) would help to curtail the negative impact of budget neutrality requirements by raising the current budget neutrality threshold from $20 million to $53 million and requiring its regular re-evaluation.

Given the administrative burden created by costly prior authorization policies, ACR noted its support for efforts to streamline the process so that healthcare team members can spend less time negotiating with insurance companies and more time taking care of patients.

Finally, the shrinking physician workforce creates significant challenges across the healthcare continuum. Unless policymakers intervene, the problem will continue to worsen as fewer physicians are asked to meet the treatment needs of a growing and aging patient population. To address this issue, ACR recommends policies to increase training opportunities, address burnout and early retirement in the healthcare workforce, mitigate the impact of medical education debt, and expand workforce access for visa-holding physicians.

“Private practices are essential to our communities and should be supported by policy,” the letter concludes. “The ACR looks forward to partnering with the Ways & Means Health subcommittee as legislative solutions are considered.”

ACR’s full response letter is available here.

ACR Applauds Re-introduction of Legislation to Reform PA Policies

The following is a press release issued by ACR and dated June 12, 2024:

The American College of Rheumatology (ACR), representing more than 9,100 rheumatologists and rheumatology professionals, applauds the reintroduction of the bipartisan, bicameral Improving Seniors Timely Access to Care Act by U.S. Senators Sherrod Brown (OH), Roger Marshall (KS), Kyrsten Sinema (AZ), and John Thune (SD) as well as Congressmen Ami Bera (CA-6), Larry Bucshon (IN-8), Suzan DelBene (WA-1), and Mike Kelly (PA-16).

“The prior authorization process has become unmanageable for both doctors and patients. Insurer red tape imposes a significant burden on clinicians, leading to unnecessary and unclear delays, or even outright denials of patient care,” shared Dr. Deborah Dyett Desir, president of the ACR. She also praised the legislative efforts to address these issues: “We applaud lawmakers’ leadership in pushing legislation that streamlines the prior authorization process. This bill enhances transparency and urges insurers to adopt evidence-based medical guidelines in their prior authorization decisions.”

The new bill is based on legislation that unanimously passed the U.S. House of Representatives and garnered over 50 Senate co-sponsors in the last Congress. The Improving Seniors Timely Access to Care Act of 2024 includes changes to reflect policies implemented by CMS since the last attempt at passage, which have the benefit of reducing the legislation’s Congressional Budget Office (CBO) score – the stumbling block for the Senate in the 117th.

Payers use prior authorization to limit or control access to specific medical treatments and services, often defaulting to denial of treatments that are ultimately approved in over 95% of cases. Since the requirements for prior authorization are not uniform, the process frequently involves hours of paperwork and administrative strain for physicians and healthcare professionals, often preventing patients from promptly accessing their best treatment options.

“ACR stands united with hundreds of physicians, patients, hospitals, and other key stakeholders in endorsing this bill,” Dr. Desir stated. “This legislation represents a crucial initial step toward alleviating the burdensome prior authorization process. We strongly urge Congress to act swiftly and pass this bill,” she concluded.

Rheumatologists Advocate for Payer Transparency, Health Equity, and Financial Relief for MA Beneficiaries in RFI Response

The following is a press release issued by ACR dated June 3, 2024:

The American College of Rheumatology (ACR) has submitted its response to the Centers for Medicare & Medicaid Services (CMS) request for information (RFI) and feedback from stakeholders on how best to enhance Medicare Advantage (MA) data capabilities and increase public transparency.

“Given more than half of Medicare beneficiaries are now choosing Medicare Advantage plans, we applaud CMS for more closely examining this program and, in particular, its impact on those living with complex chronic and acute conditions—including many rheumatic diseases that require specialized expertise and care,” said Dr. Christina Downey, chair of ACR’s Government Affairs Committee. “More reporting and greater transparency around prior authorization processes, care quality, health equity, MA market competition, and prescription drug plans can inform CMS’ decision to implement policies that improve the system for physicians and the healthcare experience for patients.”

ACR notes in its response letter that, “for too long, prior authorization policies by MA-managed care plans have been burdensome and time-consuming and have delayed care for beneficiaries.” To begin addressing this issue, the ACR requests that CMS make publicly available certain metrics on prior authorization, including requests, denials, response rates, reasons for denials, and frequency of denials categorized by type of service. ACR also joined a similar request letter from the Regulatory Relief Coalition asking CMS to implement policies that remove prior authorization barriers to timely care.

ACR also asks CMS to collect and report metrics that would help to better evaluate care quality and outcomes, including value-based care arrangements and efforts to meet health equity goals. This reporting should evaluate potential care disparities faced by MA beneficiaries of color by looking at the prevalence of certain diseases, enrollment in low-rated plans, access to 5-star plans, care outcomes, and average annual premiums. Additional reporting on the percentage of MA beneficiaries under 65 would help paint a clearer picture of how plan design and features impact various populations.

Additionally, given the growth of MA plans, ACR requests that policies support a truly competitive healthcare market. Concerns about consolidation and its impact on quality-of-care prompted ACR to request CMS evaluate bidding figures from each MA plan on an annual basis juxtaposed to the Herfindahl-Hirschman Index score of the markets in which each MA plan operates. Both pre- and post-merger analyses should look at the changes in average annual premiums by the state of residence, plan type, calendar year, and the number of rheumatologists each MA beneficiary has in-network. Consolidation has driven many independent rheumatologists out of practice and limited beneficiaries’ access to care, particularly in underserved communities challenged with accessing a local rheumatologist.

Finally, ACR asks that CMS look specifically at MA prescription drug plans to evaluate their quarterly listings of medications MA beneficiaries have access to and the percentage of MA beneficiaries who reach their out-of-pocket limits every year. Policies that limit choice or increase the cost burden for patients often lead patients to ration their doses or even abandon treatment altogether; in fact, according to recent research, 70% of new patients opt out of filling their prescriptions due to cost. Instead, ACR strongly supports patients having access to the right treatment and any necessary reference products at the right time.

“As the agency begins to explore changes and improvements to MA, ACR stands by as a resource to help ensure that enrollees with rheumatic diseases have better access to the quality care they deserve,” concluded Dr. Downey.

ACR Launches a New, Virtual Resource to Support PCPs

The following is a press release from ACR dated May 28, 2024:

The American College of Rheumatology recently launched Rheumatology for Primary Care, a new resource for primary care physicians (PCP) and advanced practice providers (APP) offering them expanded support and guidance to identify rheumatic diseases in their patients. As the healthcare professionals who often are the first to encounter patients experiencing symptoms consistent with autoimmune conditions like rheumatoid arthritis, gout, and lupus, the ACR hopes to supplement the decreasing rheumatology workforce with the support of PCPs and APPs.

Rheumatology for Primary Care is the latest initiative from the College that provides primary care professionals with tools for patient medical workups, early treatments, medications, referrals to a rheumatology specialist, and more. It is a quick reference tool for PCPs to use when caring for patients before or between their visits to a rheumatologist. The resource includes information about:

  • Symptoms of rheumatic conditions such as fever, rashes, or joint pain and associated medical workups for each
  • The various disease types with images and descriptions
  • Case studies
  • Labs to consider and when to order them
  • Common rheumatology medications and treatment considerations

“By creating this resource for our primary care colleagues, we can help reinforce rheumatology skills amid a pending workforce shortage and most importantly, meet patients’ needs,” said Beth Jonas, MD, member of the ACR Workforce Solutions Committee and past chair of the ACR’s Committee on Training. “We want rheumatologists to have the support they need at a time when physician availability and patient access can be challenging.”

It is expected that 67M American adults and more than 300K children will have a doctor-diagnosed rheumatic condition over the next several years.

“Many patients with rheumatic symptoms spend months, even years, waiting for an appropriate diagnosis for treatment. The more knowledgeable a primary care physician or APP is regarding appropriate referrals for rheumatic diseases, the faster patients can receive proper diagnosis and better care. Creating this tool was a prudent decision by the ACR and is a sensible next step in working collaboratively with our primary care colleagues,” Jonas concluded.

For more information, visit rheumforprimarycare.org.

ACR Cheers Funding for Rheumatology Research, Workforce Relief Inclusion

The following is a press release issued by ACR on March 25, 2024:

The American College of Rheumatology (ACR) today expressed strong support for several key measures included in the Fiscal Year (FY) 2024 budget. The budget allocates crucial funding to the Department of Defense’s Congressionally Directed Medical Research Program (CDMRP) for research on arthritis risks, outcomes, and treatments among service members; secures a significant funding increase for the National Institutes of Health (NIH), the cornerstone of medical research in the United States; and extends the Conrad 30 program. This program allows foreign-trained physicians to seamlessly enter the United States healthcare workforce after residency completion.

“The ACR applauds Congress for including provisions in the budget that prioritize the future of rheumatology. This budget recognizes the critical need for both a stronger physician workforce and continued research funding for arthritis and rheumatic diseases, ultimately benefiting millions of patients,” said Deborah Dyett Desir, MD, president of the ACR.

The Further Consolidated Appropriations Act of 2024 delivers a win for veterans and active-duty service members. The act allocates $10 million in the CDMRP for needed arthritis-related research among those who serve our nation. This targeted funding is crucial considering the alarming statistic that one in three veterans is battling arthritis, making it the second leading cause of medical discharge from the Army. By supporting research in this area, the CDMRP benefits veterans and service members and contributes to a broader understanding of rheumatic diseases.

This package also secures a notable funding boost for the NIH, reversing earlier proposals for deep cuts. Importantly, it protects funding for the National Institute of Allergy and Infectious Diseases (NIAID), which plays an important role in ongoing public health battles. This robust NIH funding ensures continued progress in critical medical research, including advancements in treatments and prevention strategies for rheumatic diseases.

The final spending bill also includes an extension of the Conrad 30 program, which allows U.S.-educated and trained physicians with a J-1 visa to enter the American medical workforce upon the completion of their residency. This delivers a much-needed boost to the American medical workforce given the current physician shortage. Typically, J-1 visa-holders training in the U.S. must return to their home country for two years after their program ends before they can apply for a work visa or green card to work in America. Each Conrad 30 waiver translates directly to a physician serving patients in underserved communities, for at least three years, who might otherwise face limited access to care.

“This budget represents a major victory for the 53.2 million Americans living with physician-diagnosed rheumatic conditions,” said Desir. “Including these vital programs promises to unlock significant patient care and research advancements in the coming years. We eagerly await the positive impact this will have on millions of lives.”

ACR Commends Congress for Mitigating Medicare Cuts, Calls for Ongoing Healthcare Reforms

The following is a press release issued by the ACR on March 11, 2024:

The American College of Rheumatology (ACR) applauds Congress for passing legislation to mitigate the 3.4 percent reduction in physician payments outlined in the Medicare Physician Fee Schedule (MPFS) Final Rule for CY2024 but also calls on policymakers to seek long-term systemic policy changes that will provide more stability and predictability for providers.

“While we commend Congress for this partial fix, rheumatologists remain concerned that without long-term reform to the Medicare payment system, maintaining access to quality care for individuals managing rheumatic diseases and other chronic conditions will be in jeopardy,” remarked Deborah Dyett Desir, MD, President of the American College of Rheumatology. “The annual recurrence of MPFS cuts underscores the urgent need for comprehensive healthcare reforms. The American College of Rheumatology urges Congress to prioritize sustainable solutions, ensuring patient access to essential services and fair reimbursement for healthcare providers.”

The payment cut reduction, from 3.4 percent to 1.68 percent, was included in recently passed broader funding legislation. This reduction comes on top of cumulative cuts that, when adjusted for inflation, amount to an overall decline in Medicare physician payment of 30 percent since 2001, according to the American Medical Association.

As the nation’s leading medical specialty society representing rheumatologists, the ACR remains committed to advocating for policies that prioritize patient well-being and support the needs of rheumatology practices across the country.

ACGME and Docs with Disabilities Initiative Partner for Disability Hub

The following are excerpts from a press release issued by the Accreditation Council for Graduate Medical Education on January 23, 2024:

The ACGME, in partnership with the Docs with Disabilities Initiative (DWDI), is a recipient of the Josiah Macy Jr. Foundation Catalyst Award for Transformation in Graduate Medical Education for their project, Multimedia Resource Hub for Disability Inclusion in Graduate Medical Education. The aim of the project is to support education and enhance disability inclusion, learner safety, and accessibility in the clinical learning environment for residents and fellows.

The Multimedia Resource Hub for Disability Inclusion in Graduate Medical Education will be added to the content portfolio available on the ACGME’s distance learning portal, Learn at ACGME. The ACGME Equity Matters® program supports the development of innovative resources that increase workforce diversity, encourage adoption of equity practices, and foster inclusive learning environments.

Calls for community involvement and inclusion in the hub will be forthcoming.

Read the full press release here.