Faculty Bibliography

One of the major developments in the treatment of rheumatoid arthritis over the last decade and a half has been the realization that early and aggressive treatment leads to better outcomes for most patients. Early use of methotrexate and switching to a combination treatment regimen within the first 3-6 months if there is inadequate response to methotrexate is the currently accepted paradigm for rheumatoid arthritis treatment. To achieve better outcomes it is not enough to just use combination treatments; disease activity also needs to be measured and monitored with a 'treat-to-target' approach, where remission or low disease activity is the target and available medications are used either alone or in combination to get there. 2013 Future Medicine Ltd

Background The magnitude of the association of cancer with rheumatoid arthritis, especially after anti-TNF use, remains in dispute. We recently proposed (1) an important selection bias was potentially inherent in the registry data especially when the comparator for the sought cancer incidence in RA was the cancer incidence in the "mother population", the population from which the registry is derived from. In a mother population within a given time there would be many patients with cancer who would not have the chance to develop RA since a. a sizeable fraction would die from their disease before having the chance to develop RA; b. The cancer treatment could potentially prevent the development of RA or finally, and particularly in the case of anti-TNF registries, c. If they remained alive and developed cancer the likelihood of them being included in such a registry would be small. All 3 factors could render the incidence ratio (incidence in the registry/incidence in the mother population) less than unity even if biologically there are no real differences in the cancer frequencies between the 2 populations. Lastly this ratio would decrease in time as was observed in the Taiwan registry (1). Objectives We formally surveyed whether the same potential selection bias was present in other manuscripts reporting similar data. Methods We conducted a PubMed search with the search terms "registry" "cancer" and "rheumatoid arthritis" among 7 high-impact rheumatology journals between 2001 and May-2011 (inclusive). First, articles that reported cancer incidence in patients with RA were retrieved in full-text. Among these, those manuscripts which reported an incidence ratio at 2 or more time-points were included in this survey. We specifically sought a. whether the comparisons were made between the registry and a "mother population" and b. the changes in the above described ratio between the first and last time points. Results We retrieved 36 articles among 1274 search results. In 6/36 the incidence ratio compa!

Background A patient self-report joint count, rheumatoid arthritis disease activity index (RADAI),1 is correlated significantly with tender and swollen joint counts performed by a health professional in rheumatoid arthritis (RA) patients2. The RADAI is included on the multidimensional health assessment questionnaire (MDHAQ), which is completed in many rheumatology settings by all patients with all diagnoses, as the same questionnaire is (logistically) most feasible. Objectives To analyze RADAI painful joint count scores in patients with diagnoses other than RA in usual care setting. Methods Each patient seen at an academic rheumatology site completes an MDHAQ at each visit, while waiting to see the doctor in the infrastructure of clinical care. The RADAI on the MDHAQ includes 8 bilateral specific joint groups: fingers, wrist, elbow, shoulder, hip, knee, ankle and toes, each scored from 0 ("no pain") to 3 ("severe pain") (total 0-48). A random visit of 465 patients was analyzed including 75 with SLE, 50 with gout, 53 with PsA, 113 with OA, as well as 174 with RA. Mean RADAI and % of patients scoring each specific joint group as affected were computed for each diagnosis, and compared to the MDHAQ patient global estimate (PATGL) and physician global estimate (DOCGL) using Spearman correlations. Results Patients were primarily women (68%), age 51+16 years;SLE patients were youngest (39.5+13.8) and OA patients oldest (62.8+12.5). An abnormal RADAI score >0 was reported by 99% of patients with OA, 87% of patients with RA, 83% with PsA, 60% with gout, and 59% with SLE. The joints reported as most affected were knees (58%) and fingers (52%) in all patients; in RA, fingers (52%), wrists (58%), and knees (58%); in SLE, fingers (37%) and shoulders (32%); in gout, toes (24%) and knees (22%); in PsA, knees (43%) and fingers (40%), and in OA, knees (68%) and fingers (42%) (Table). RADAI scores were correlated significantly with PATGL (rho =0.50-0.75, p<0.001), and moderately, though significantly, with DOCGL!