This Lead and Inform Clinical Reference Group (CRG) 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: Shouvik Dass, National Specialty Advisor
• Kathy Blacker, Lead Commissioner
• Ben Rhodes, Clinical member
• Voon Ong, Clinical member
• Frances Hall, Clinical member
• Kaushik Chaudhuri, Clinical member
• Athiveeraramapandian Prabu, Clinical member
• Bridget Griffiths, Clinical member
• Kalveer Flora, Pharmacy lead
• Jane Robinson, Patient and Public Voice representative

Affiliates

• Dr Peter Lanyon, GIRFT
• Alan Salama, UK Kidney Association
• British Society of Rheumatology – TBC
• Andrew Bennett, Arthritis and Musculoskeletal Alliance

Scope

This clinical reference group 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
• 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 refractory idiopathic inflammatory myopathies (adults and children aged 2 years and over)
• Abatacept for treatment of severe treatment-resistant morphoea (localised scleroderma)
• Anakinra for haemophagocytic lymphohistiocytosis for adults and children in all ages
• Baricitinib for use in monogenic interferonopathies (adults and children 2 years and over)
• Infliximab for refractory sarcoidosis (excluding neurosarcoidosis)
• 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 in adults
• Teriparatide for osteoporosis in men (adults)
• Tocilizumab for takayasu arteritis (adults)
• Tocilizumab for the treatment of adult-onset Still’s disease refractory to second-line therapy (adults)

Not routinely commissioned

• Obinutuzumab for systemic lupus erythematosus with secondary non-response to rituximab (adults and post-pubescent children)
• Rituximab for the treatment of primary Sjogren’s syndrome 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:

• Abatacept for treatment of severe treatment-resistant morphoea (localised scleroderma)
• Use of adalimumab for refractory chronic non-bacterial osteomyelitis/osteitis (CNO) (all ages)
• Rituximab for the treatment of systemic lupus erythematosus in adults

Get involved

If you are interested in the work of the internal medicine NPOC or its CRGs, you can register as a stakeholder.  For details on our latest consultations please visit NHS England » Consultations

Get in contact

For any questions or queries relating to the work of the internal medicine NPOC or any or its CRGs, please contact: england.npoc-internalmedicine@nhs.net