TY - JOUR T1 - Good practice in shared care for inflammatory arthritis JF - British Journal of General Practice JO - Br J Gen Pract SP - 275 LP - 277 DO - 10.3399/bjgp16X685177 VL - 66 IS - 646 AU - Mark P Lythgoe AU - Sonya Abraham Y1 - 2016/05/01 UR - http://bjgp.org/content/66/646/275.abstract N2 - Clinical QuestionHow should we manage disease-modifying antirheumatic drugs (DMARDs) in primary care when used as part of a shared-care arrangement in inflammatory arthritis?Inflammatory arthritis such as rheumatoid and psoriatic arthritis are chronic diseases requiring long-term management. The overall goal of treatment is to achieve remission or sustained low disease activity.1 The majority of patients are managed effectively using disease-modifying antirheumatic drugs (DMARDs).Traditionally, patients have been managed in secondary care by planned consultation with a rheumatologist every 3–6 months. This system of follow-up accounts for >75% of a rheumatologist’s workload2 and evidence has shown that up to 45% of routine consultations are undertaken without demonstrated patient need.3 Projected future shortages of specialist physicians including rheumatologists mean this arrangement may be untenable in the near future.3 Greater emphasis has therefore been placed on managing patients with stable inflammatory arthritis within the community using shared-care arrangements. Innovations within primary care have developed the role of specialist nurse practitioners and interface teams responsible for the continued monitoring of DMARDs.Shared care is defined as: ‘… the joint participation of GPs and specialists in the planned delivery of care for patients with a chronic condition, informed by an enhanced information exchange, over and above the routine discharge/referral letters.’ 4This model has been used successfully for >10 years in chronic conditions including asthma and diabetes. Studies have consistently demonstrated that versions of shared care are not inferior to traditional follow-up in controlling disease activity in patients with inflammatory arthritis.3,5,6 Furthermore, symptom control facilitated by shared care is likely to be more cost-effective than treatment delivered in secondary care in 60–90% of cases.7In the UK it is becoming common to manage patients with stable inflammatory arthritis within primary care using a shared-care arrangement, once … ER -