VIDEO: The importance of collaborative care in RA management

Editor’s note: This is a previously posted video, and the below is an automatically generated transcript to be used for informational purposes. Please notify cperla@healio.com if there are concerns regarding accuracy of the transcription.

Collaborative care is critical in rheumatoid arthritis. Unfortunately, there's not enough rheumatologists in the United States to take care of all the patients with rheumatic diseases, so we rely on primary care physicians, general practitioners, internists, family physicians to do a lot of rheumatoid arthritis care.

Being able to start a DMARD like hydroxychloroquine, or sulfasalazine or even methotrexate is important. Being able to recognize a patient who has joint pains, that has inflammation, elevated inflammatory markers, possibly elevations in serologies like rheumatoid factor or anti-CCP antibody, those would be patients that most primary care doctors would recognize as likely having inflammatory arthritis. And they may consider initiating therapy and sending that patient on to a rheumatologist for confirmation and for tailoring therapy further.

But I think that recognizing the patient who likely has an inflammatory arthritis is the first step in the triage pathway. But after a patient gets diagnosed, unfortunately, I want to see that patient frequently when I'm getting them onto the right therapy.

But once I find the right therapy for them, which we can do in about 60 to 70% of patients, then I'm looking for the collaboration of a primary care doctor to follow the patient with laboratories, with a physical examination, and know when they need to be referred back to me as a consulting rheumatologist. In different locales, in different countries, this is handled very differently.

So in a place like Boston, where there's a lot of rheumatologists, I might see patients three times a year, four times a year. But I know in other countries and in other places, rheumatologists are seeing patients far less frequently, and really rely on the primary physicians to do a lot of the care.