Highly common and debilitating, rheumatism is the overarching term for the various diseases affecting the musculoskeletal system and the locomotor system (bones, joints, muscles, tendons). Rheumatoid arthritis (RA) and Spondyloarthritis are the two main inflammatory rheumatism conditions affecting the population worldwide. Such diseases are characterized by stiffness and articular pains. The medical practice covering these bone and joint diseases, rheumatology, is making continuous progress in terms of the understanding of the various pathologies and treatments. Now, breakthrough treatments are improving the lives of patients as well as impacting how insurers consider the underwriting practices for such chronic conditions.

How are new treatments and therapies making an impact?

Biotherapies are innovative and "revolutionary" treatments in the management of inflammatory rheumatism. They can stop inflammation in the body by inhibiting the substances that activate and maintain this inflammation ("pro-inflammatory cytokines"). The use of these biotherapies now permits better control of the disease which, in turn, reduces mortality rates as well as morbidity for these pathologies.

What is Rheumatoid arthritis (RA)?

Rheumatoid arthritis, or rheumatism as it is commonly known, is the most common inflammatory disease and is primarily observed in women aged 30-50 years old. The adverse prognostic factors of this disease are (and remain):

• Persistent number of swollen and painful joints
• Presence or occurrence of radiographic joint erosion
• Persistent biological inflammation (increased sedimentation rate [VS] and C-reactive protein [CRP])
• Presence of citrullinated anti-peptide antibodies (or anti-CCP Ac)
• Presence of the HLA DR1-DR4 genotype

It is important to identify these elements to better understand the risk of RA.

What’s changed in the categorization of certain types of rheumatism?

Spondyloarthritis is a new term for what used to be called, and is still often referred to as, spondylarthropathies. This includes both ankylosing spondylitis and psoriatic arthritis. Through recent advancements, it is now possible to distinguish and classify the various forms of spondyloarthritiss: axial, peripheral, or enthesitic, all with or without extra-articular manifestations (psoriasis, uveitis, heart disease, etc.).

All these notions in rheumatology are therefore essential toward the better understanding of the risks these pathologies present for Life and Disability insurance.

How do these advancements influence Underwriting?

As outlined above, the revolutionary aspect of the biotherapy treatment in rheumatology can positively impact the progression or even reverse the degree of severity of the disease. As a result, SCOR is developing new guidelines within SOLEM (SCOR’s underwriting guidelines), which recognizes the positive effects on the body. An example will be to provide positive credits for the use of biotherapies as well as potentially changing a rating category from moderate to mild depending on the successful results of the biotherapy treatment. The impact of Biotherapies can also improve remission for those who have previously had severe episodes of inflammatory rheumatism and which would have caused a possible decline for proposed insured benefits, including Life Coverage, Critical Illness, and Disability. SCOR is working to make sure to recognize these improvements, and where possible, offer and apply the most appropriate individual and inclusive Underwriting terms to the applicant.