Over the last few decades several new medicines have been introduced into the rheumatology armamentarium for treatment of “arthritis” or “rheumatism”.
While these medicines offer better control for some patients, they do not add much benefit for a lot of other patients, but they may increase the cost of treatment substantially.
Unfortunately, due to the allure of “new” or the fact that these medicines are usually more expensive and offer higher financial rewards, directly to centers selling them, and indirectly to some prescribers due to the drug companies marketing strategies (see section on Medical Ethics), they are being over-prescribed in a significant number of cases without a real need for them, resulting in higher cost of treatment, and the potential for unwanted side effects in the wrong setting.
These new medicines should be reserved for cases that do not respond to “older”, more “established” medicines, since these “older” medicines in addition to being of much lower cost, they also have the major advantage of being around for much longer time with much more accumulated experience regarding their benefits, and side effects.
In addition to the above, overuse of these medicines and the use in inappropriate settings increases the pressure on society resources like insurance companies, or government services resulting in higher burden on the society in general that can manifest in unnecessary increased insurance premiums and increased taxes in some countries, in addition, misdirecting these resources inappropriately, results in some patients using these medicines though they do not need them, while others who really need them are deprived of using them because the available resources have been already been exhausted inappropriately.
In summary, these new medicines can be very helpful but in the proper setting, and they should be reserved for the appropriate conditions only.
New diagnostic imaging/modalities:
In a somewhat similar manner to new medicines, new diagnostic modalities can offer significant advantage in some cases, but if overused they just raise the cost, sometimes the exposure to radiation, and sometimes side effects risk without much of benefit.
Again due to their higher cost they offer more financial rewards to centers doing them, which may result in many of them being done without real benefit to the patient.
Below are links to 2 studies (as examples, among many others) to show that in a lot of cases the use of ultrasound imaging in rheumatology does not add significant benefit, so its use should be limited to only conditions in which studies have shown it offers REAL benefit to patients:
https://ard.bmj.com/content/early/2016/03/29/annrheumdis-2015-208941
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4986519/
While these examples are of ultrasound, the same applies also to MRI, CT or others.
As mentioned also for “New medicines” overuse of these imaging modalities inappropriately will result in exhausting the available resources without much benefit and the inability to use them in the proper setting for patients who really need them.
