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.
Prof Robert Moots
Dr Shouvik Dass
Prof Christopher Denton
Dr Frances Hall
Prof Kassim Javaid
Dr Athiveeraramapandian Prabu
Dr Shane Clarke
Kathy Blacker, lead commissioner
Kalveer Flora, pharmacy leads
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:

• Teriparatide for Osteoporosis in Men (Adults)
• Rituximab for immunoglobulin G4-related disease (IgG4-RD)
• Tocilizumab for Takayasu arteritis (adults)
• Rituximab and Anti-Neutrophic Cytoplasmic Antibody Associated Vasculitis
• Sildenafil and bosentan for the treatment of digital ulceration in systemic sclerosis
• Rituximab for the treatment of dermatomyositis and polymyositis (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:

• Rituximab for refractory Systemic Lupus Erythematosus (SLE) in adults and post-pubescent children
• Rituximab for the treatment of systemic lupus erythematosus in adults