‘arthritis’ nomenclature in the daily practice luc de clercq, md

‘Arthritis’ nomenclature in the daily practiceLuc De Clercq, MD

Nomenclature for Arthritis Care• The K55 nomenclature offers broad

perspectives for new initiatives• Diversification; individually adaptable• Direct correlation between amount of

provided care and financial support• But also with direct, new responsibilities

– Financial support must finally lead to better care for the patient with arthritis

K55 Arthritis Nomenclature• Publication B.S. / M.B.: 04-12-08• Applicable: 01-02-09• K55 ; Art. 20 § 1 g (= rheumatology)• 478030 (amb.) – 478041 (hosp.)• Honorary: 61,77 euro

(100% reimbursement for all categories)• Max: 2 x / year (cum. with consultation)

K55 Arthritis Nomenclature• Standaardevaluatie van het actief

ziekteproces, de evolutie en de prognose, door de geaccrediteerde geneesheer-specialist voor reumatologie, bij een patiënt met chronisch inflammatoir reumatisch lijden, met behandelingsplan en schriftelijk verslag aan de huisarts’

• Evaluation standard par le médecin spécialiste en rhumatologie accrédité du processus actif de la maladie, de l'évolution et du pronostic, chez un patient avec une pathologie inflammatoire rhumatoïde, avec plan de traitement et rapport écrit au généraliste

K55 Arthritis Nomenclature• Patients with

– Rheumatoid Arthritis (RA)– Ankylosing Spondylitis (AS)– Psoriatic Arthritis (PsA)

• DMARD and / or Biological treatment• ‘Standard-evaluation’ Patient File• Report to generalist

K55 Arthritis Nomenclature• Standard evaluation consists of :

– Specific Assessment • > Care provider• > Patient

– Global interpretation – ‘reflection’• Confrontation with other findings

(Biology, X ray, US, ….)• Disease Activity, Evolution, Prognosis• Analysis / Definition / Refining of therapeutic

plan

K55 Arthritis Nomenclature• Specific Assessment:

– For RA:• DAS 28 + HAQ

– For AS• BASFI + BASDAI

– For PsA• PsARC + HAQ (poly) / NRS scale (pauci)

PsARC : Psoriatic Arthritis Response Criteria• Physician’s global assessment (0-5)• Patient’s global self-assessment (0-

5) • Joint tenderness • Joint swelling

• You will obtain a ‘set’ of 4 ‘results’.• You will not have a ‘composite’ score

PsARC : Psoriatic Arthritis Response Criteria• Treatment response = Improvement in at

least 2 of 4 criteria – one must be joint tenderness or swelling– with no worsening in the others

• 1 and 2 : – improvement decrease > 1 unit– worsening increase > 1 unit

• 3 and 4 :– improvement decrease > 30%– worsening increase > 30 %

BASFI

DAS 28

DAS 28 = • 0,56*√(TJC28)+• 0,28*√(SJC28)+• 0,7*LN(ESR)+• 0,014*VAS GA

Patient

We look forwards ….