1	Why do we need ERASS? Prof. Dr. N. Gschwend
2	Why do we need ERASS? Founded in 1979 in Oslo by these members The Purpose: to follow the pioneers in this field Kauko Vainio (orthopaedic surgeon) and Veikko Laine (the rheumatologist) In Heinola, Finland: To provide the RA- patients with a comprehensive care in a combined unit.
3	ERASS-Members The increasing interest in this kind of activity is documented by the rapidly Growing Number of ERASS- Members
4	ERASS- Congresses in a 4-year interval 1981 Vienna 1985 Heinola 1989 Bürgenstock 1991 Florence 1993 Oslo 1997 Prague 2001 Montpellier 2002 Berlin 2004 Lund 1983 Moscow 1987 Athens 1991 Budapest 1995 Amsterdam 1999 Glasgow
5	The RA- Patient Number admittet for Surgery: Change since the sixties?
6	The RA- Patient
7	Kind of Surgery
8	"Reasons for the tendency..." Reasons for the tendency of a reduced number of referred patients to the Rheumasurgeon and less Synovectomies: More effective Medication? Greater number of Sub-Specialized Orthopaedic Surg. (Spine- ,Knee-, Foot-, Handsurgeons)? The Rheumatologists Opinion: As long, as we do not know the cause of RA, a considerable reduction of the number of RA patients is not to be expected. The early application of more efficient drugs e.g.Methotrexate and in special cases TNF drugs has certainly an effect on the destructive course of RA: “We see less wheel-chair- patients!”
9	THE PAST 25 years ago: Charley Smith and Mack Clayton “The greatest progresses made in RA treatment: Those made in RA- Surgery”.
10	"Facts" Facts: Still valid today for Non-Responder to modern drug- Therapy or patients missing this medical treatment in the early stage of RA: 1. Restoration of physical Indipendence only with Surgery
11	"2" 2. Rheuma-Surgeons became pioneers of modern reconstructive surgery of the upper extremity (Hand, Shoulder Elbow) 3. Joint- Sub-Specialists: Technical Progress, but Risk: Tunnel- View.
12	THE PAST 4. Rheuma- Surgeon: A special Philosophy, a Global View. Art: Treatment- Plan with Priorities (W. Souter). 5. Early application of EBM- Principles:
13	"6" 6. Global View comprises also the psychological aspect: We were successful in restoring physical independence but failed in preparing our young patients to cope with the demands of our materialistic western world.
14	Do we need sub-specialized Rheuma- Surgeon? Yes, as long RA cannot be healed definitely by conservative measures. But Should the number of RA- patients needing surgery decrease Considerably, a concentration of the more demanding cases in fewer Rheumacenters disposing of a 1.pretentious infrastructure 2.Research facilities 3. intimate relation to a subspecialised Team of orthopaedic surgeons (Spine, Joints of the upper and lower Extremity) has to be considered not the least from a economic point of view (EBM!). Rheumacenters are more and more faced with an increasing number of all kind of degenerative diseases of the locomotor System due to the demographic development with an increasing aging of our population. An even closer cooperation of the Rheumacenters with all kind of sub-specialized orthopaedic surgeons is a must!
15	Schulthess- Clinic 2004
16	Schulthess- Clinic 2004
17	Schulthess- Clinic 2004 The orthopaedic surgeon responsible for the upper extremity is according to our experience the best prepared Sub- Specialist to serve as Rheumasurgeon for all the complex cases of RA sent to Rheumacenters. These centers continue to provide the comprehensive care in a combined unit with a global therapeutic view.
18	Do we need ERASS anymore? Organizing Congresses and supporting the work of a society needs the assistance of Sponsors. Considering the various factors discussed, it is rather doubtful, whether our society, maintaining strictly the concept, which worked well in the first 20 years, can survive in the long run. A much closer cooperation (Congresses, Continuing Education, Publications etc) with those Rheumatologists, who do the daily practical work for the whole spectrum of the so-called “rheumatic diseases” and who feel themselves often lost in a highly scientific (basic Sciences) Rheumatology- Congress could solve great part of the actual problems. The prosperous activity for instance of NERASS,in which 90 orthopaedic surgeons and 90 rheumatologists are meeting twice an year for a full day, contributing both theyr respective experience with conservative and surgical treatment, indicates - I’m convinced - the direction ERASS should envisage to go ARO also increasing number: 230. Applying strictly the EBM principles we could make also a major contribution to a better control of the cost explosion in our health systems especially in view of the rather frightening Demographic development.
19	Do we need ERASS anymore?