[Enhancing awareness of the modalities in the management of chronic inflammatory diseases]

From an epidemiologic point of view, the incidence of rheumatoid arthritis in the French regions we studied appears relatively stable and about the same as the prevalence of rheumatoid spondylosis. The incidence of Crohn's disease, among the chronic inflammatory bowel diseases, is currently increasing. Treatment for rheumatoid arthritis, other than symptomatic and maintenance treatments, now includes various specific forms of "biotherapy". Their development was made possible through the decoding of the pathophysiological mechanisms of inflammation and joint destruction, basically involving pro-inflammatory cytokines. Currently, it appears that these treatments should be limited to severe or active progressive rheumatoid arthritis that is resistant to maintenance therapy. For rheumatoid spondylosis, the prescription of anti-TNF alpha agents requires early diagnosis and prognostic assessment of the disease, together with the implementation of an individualized therapeutic strategy for the global multidisciplinary management of each patient. The introduction of immunosuppressors and anti-TNF alpha agents for chronic inflammatory bowel diseases constitutes a major advance in the management of their severe forms, but nevertheless raises the issues of whether their use should be systematic or depend on the severity of the disease. They also require the training of practitioners in their use and monitoring. Patients' groups have requested more collegial decision-making, decompartmentalization of practices, widespread development of health care networks, the development of clinical trials and improved communication. The regional disparities in patient management stem from epidemiologic variations in the demand for care and from social and demographic differences in the populations. They also depend on the overall health-care supply. Health networks can be defined as structures of coordination and non-mandatory, non-hierarchical services to patients that help to improve care and/or prevention by the appropriate involvement of various healthcare professionals. Regional particularities are observed, as is shown by the studies conducted in Brittany, the Loire Valley and Nord Pas-de Calais. The questions regarding the networks do not concern their effectiveness in the management of chronic inflammatory diseases, but their structure, day-to-day operations, and financing.