Rheumatology is a multidisciplinary branch of medicine that deals with the investigation, diagnosis and management of patients with arthritis and other musculoskeletal conditions. This incorporates over 200 disorders affecting joints, bones, muscles and soft tissues, including inflammatory arthritis and other systemic autoimmune disorders, vasculitis, soft tissue conditions, spinal pain and metabolic bone disease.

The services encompassed by this Clinical Reference Group (CRG) relate to the treatment of patients with rare diseases or patients with specific common diseases who have complex needs.

Membership

Chair: Dr Bridget Griffiths, Consultant Rheumatologist, The Newcastle upon Tyne Hospitals NHS Foundation Trust.

Deputy Chair: Dr Athiveeraramapandian Prabu
Deputy Chair: Dr Frances Hall
Prof Robert Moots, clinical member
Dr Shouvik Dass, clinical member
Prof Christopher Denton, clinical member
Prof Kassim Javaid, clinical member
Kathy Blacker, lead commissioner
Kalveer Flora, pharmacy lead
Paul McManus, commissioning Pharmacist
Dr Su Sethi, Public Health England lead
Jane Robinson, Patient and Public Voice representative
Susan Mills, Patient and Public Voice representative

Affiliates:

Dr Peter Lanyon, GIRFT
Prof Alan Salama, Renal Association
Dr Elizabeth Price, British Society of Rheumatology

Scope

This Clinical Reference Group (CRG) covers:

• Services for people with autoimmune connective tissue diseases and vasculitis
• services for people with inherited disorders of connective tissue
• services for people with rare metabolic sclerosing and dysplastic bone diseases
• services for people with defined highly specialised services including Ehlers Danlos syndrome

Products

A key part of the CRG’s work is the delivery of the ‘products’ of commissioning. These are the tools used by the 10 Hub Commissioning Teams to contract services on an annual basis.

Service Specifications

Service specifications are important in clearly defining the standards of care expected from organisations funded by NHS England to provide specialised care. The specifications have been developed by specialised clinicians, commissioners, expert patients and public health representatives to describe both core and developmental service standards. Core standards are those that all funded providers should be able to demonstrate, with developmental standards being those which may require further changes in practice over time to provide excellence in the field.

The following service specifications fall within the scope of this CRG:

• Complex Ehlers-Danlos syndrome service (All Ages)
• Specialised Rheumatology Services (Adult)
• Behcet’s Syndrome (Adults and Adolescents)

Policies

A commissioning policy is a document that defines access to a service for a particular group of patients. A NICE Technology Appraisal Guideline on the same topic will replace, or be incorporated into, a commissioning policy as appropriate. These are important documents that are developed to ensure consistency in access to treatments nationwide.

The following policies fall within the scope of this CRG:

Commissioned:

• Abatacept for treatment of severe treatment-resistant morphoea (localised scleroderma)
• Anakinra and tocilizumab for adult onset stills disease
• Anakinra for haemophagocytic lymphohistiocytosis for adults and children in all ages
• Rituximab and Anti-Neutrophic Cytoplasmic Antibody Associated Vasculitis
• Rituximab for immunoglobulin G4-related disease (IgG4-RD)
• Rituximab for refractory systemic lupus erythematosus (SLE) in adults and post-pubescent children
• Rituximab for the treatment of dermatomyositis and polymyositis (adults)
• Sildenafil and bosentan for the treatment of digital ulceration in systemic sclerosis
• Teriparatide for Osteoporosis in Men (Adults)
• Tocilizumab for Takayasu arteritis (adults)

Not routinely commissioned:

• Rituximab for the treatment of Primary Sjogren’s Syndrome (PSS) in adults

Policy statements

Policy statements are brief documents that define the current commissioning position to support service contracting.

The following policy statements fall within the scope of this CRG:

• Use of Adalimumab for refractory chronic non-bacterial osteomyelitis/osteitis (CNO) (all ages)
• Rituximab for the treatment of systemic lupus erythematosus in adults