Arthritis Care & Research and the changing landscape of health care

We begin our term as co-editors of Arthritis Care & Research with the work before us made much easier because of the tenure of Dr. Gene Hunder and colleagues. Dr. Hunder effectively managed the journal through its incorporation as an official section of Arthritis & Rheumatism and improved its reputation, which has led to an increase in the size of the journal and the quality of the journal’s content. Arthritis Care & Research is now recognized as one of the premier journals in the field of rheumatology. We thank Dr. Hunder for leaving us such a legacy and will strive to continue the high standards he and his editorial team have set. We look forward to our upcoming tenure with the journal and especially to working with our new editorial team —Associate Editors Leonard Callabrese, DO; Loreto Carmona, MD, PhD; Marian T. Hannan, DSc, MPH; C. Kent Kwoh, MD; Daniel J. Lovell, MD, MPH; and Carol Oatis, PT, PhD; Assistant Editor Belinda Wong, MPH, at the University of California, San Francisco, and Managing Editor Nancy Vickers at the American College of Rheumatology in Atlanta. The mission of Arthritis Care & Research is to provide a venue for the best in clinical research related to the rheumatic diseases. However clinical research currently faces a number of challenges, ranging from effects of the changing health care marketplace and health care funding, to the integration and collaboration of the multiple disciplines necessary to address complex issues and funding for research itself. We are currently in the midst of a period of flux in the field of rheumatology, marked first by the introduction of biologic agents for the treatment of rheumatoid arthritis and other rheumatic conditions, and more recently by the withdrawal of rofecoxib and valdecoxib and the discontinuation of consumer-oriented advertising for celecoxib. We expect this period of rapid change to continue because of the promise of new agents in the pipeline for the treatment of rheumatic diseases, and also because the diffusion of the existing biologic agents and, to a slightly lesser extent, the coxibs, into the marketplace has caused a profound disequilibrium in the care of patients. The cost of medications for the treatment of various forms of arthritis has doubled in nominal terms and increased by 50% in real terms between 1997 and 2001. As we write, the US is about to embark on a program of public drug coverage for Medicare recipients, at a time when record numbers of Americans are without any health insurance. The architecture of the Medicare drug program may prove a profound disappointment for persons with severe rheumatic disease. For example, an elderly person with rheumatoid arthritis with a median household income for this age group who does not have a source of drug coverage other than Medicare may have to pay as much as 20% of that income out-of-pocket if taking a biologic agent. For the working person without health insurance, the majority of the uninsured population, the cost of the biologics is either an insurmountable obstacle or a quick route to Medicaid coverage, which have far more restrictions on types of care than the private insurance sector. Although the clinical trials to establish the cost-effectiveness of the biologic agents have not yet been conducted, the form they must take is becoming clear—they must show that treatments reduce the prevalence of total joint replacement and work disability, events that occur many years after disease onset. We mention the example of the impact of the biologic agents because their diffusion has been the most obvious catalyst for change in the care of persons with rheumatic diseases in recent years, but we could as easily draw upon a dozen other issues affecting patient welfare in the years to come. These issues include the role of genetics in the Patricia P. Katz, PhD, Edward H. Yelin, PhD: University of California, San Francisco (Co-Editors, Arthritis Care & Research). Address correspondence to Patricia P. Katz, PhD, UCSF, 3333 California Street, Suite 270, San Francisco, CA 94143. E-mail: pkatz@itsa.ucsf.edu. Submitted for publication June 9, 2005; accepted June 9, 2005. Patricia P. Katz, PhD and Edward H. Yelin, PhD Arthritis & Rheumatism (Arthritis Care & Research) Vol. 53, No. 4, August 15, 2005, pp 481–483 DOI 10.1002/art.21338 © 2005, American College of Rheumatology