Abstract
Treatment changed dramatically in the field of rheumatology with the advent of methotrexate and biologics such as anti-TNF or anti-IL-6. Early treatment, window of opportunity, tight control and treat to target are emphasized triumphantly. Who are expected to implement newer treatment to the RA patients? RA specialists are, of course. Specialists/rheumatologists are responsible for evaluation of the patients’-status, initiation of the treatment and preparation for the adverse events which could happen anytime. However, the number of the specialists is very limited, especially in the rural areas. To implement newer treatment even in those areas with scarce rheumatologists, we need a team comprising rheumatologists and general practioners or home doctors (HHC: hospital and health-care clinic co-operation).
The roles of the rheumatologists and general practioners are distinct. The rheumatologists’ is mentioned above. Generalists are expected to practice near the patients’ home along with a close-relationship between patients and doctors as family practitioners. Care is the main theme of the generalists. By co-operating with generalists, rheumatologists can reduce the number of everyday patients, which will allow them longer time for the treatment. Each patient has two doctors in charge: rheumatologist and general practioner. This type of co-operation is ideal not only in rheumatology but also in any field of medicine. However, this is not prevailing in Japan thanks to huge endeavor imposed on big hospitals. It may not be so easy to pave the way to set the stage for HHC.
