US Rheumatologists Research Articles

Biological drug use: US perspectives on indications and monitoring

An estimated 20% of patients with rheumatoid arthritis (RA) receive tumour necrosis factor (TNF) inhibitor treatment. This paper presents the results of an online survey of US rheumatologists (1023 respondents)...

Tolerability and efficacy of nabumetone and naproxen in the treatment of rheumatoid arthritis

The purpose of this study was to compare the tolerability and efficacy of nabumetone and naproxen in the treatment of patients with rheumatoid arthritis (RA). The occurrence of gastrointestinal (GI) adverse events was compared. Nonsteroidal anti-inflammatory drugs (NSAIDs) have similar efficacy at equipotent doses, but the therapeutic response to various NSAIDs often differs in individual patients. This was a 3-month, randomized, double-blind, multicenter, parallel-group study conducted in adult patients with RA. The study had 2 phases: a 3- to 14-day washout period and a 12-week treatment period. During the treatment phase, the tolerability and efficacy of nabumetone 2000 mg/d were compared with those of naproxen 1000 mg/d. The change from baseline in efficacy variables, including global assessments, number of tender or swollen joints, and pain, was evaluated. The study was sized to provide an 80% power to detect a 15% difference in the percentage improvement on the physician's global assessment (alpha = 0.05). GI safety was assessed by monitoring the occurrence of clinically important adverse GI events. A total of 346 RA patients at 31 US rheumatology centers were randomly assigned to treatment (173 patients per group). The study population was predominantly white (87.0%) and female (70.5%), with a mean age of 54 years. Both treatments improved the signs and symptoms of RA, with no statistically significant differences between groups for any efficacy variables. No serious GI adverse events occurred with either NSAID. The most frequent treatment-related adverse events in both groups were predominantly GI in origin, as were those that resulted in withdrawal from the study. Diarrhea with lower abdominal pain was the most common adverse event in the nabumetone group; upper abdominal pain was the most common adverse event in the naproxen group. The only significant difference between the 2 groups was a higher incidence of diarrhea (P < 0.01) in patients receiving nabumetone. Nabumetone 2000 mg/d was as effective as naproxen 1000 mg/d in relieving the signs and symptoms of RA. In this study, no serious GI adverse events were observed with either NSAID, but nabumetone was associated with a higher incidence of diarrhea.

A survey of United States rheumatologists concerning effectiveness of disease-modifying antirheumatic drugs and prednisone in the treatment of rheumatoid arthritis.

To collect the ratings of American rheumatologists regarding relative short-term and long-term effectiveness of disease-modifying antirheumatic drug (DMARD) therapy in the treatment of rheumatoid arthritis and to compare these data with results of a meta-analysis of randomized, controlled clinical trials (RCTs) of these drugs. A survey was mailed to 3,200 United States rheumatologists who were members of the American College of Rheumatology during the summer of 1996. The survey was completed by 645 rheumatologists. Methotrexate (MTX) was rated as substantially more effective than any other DMARD after both 1 year and 4 years of therapy. At 1 year, more than 90% of rheumatologists rated MTX as "good or excellent," compared with 35% giving a similar rating to intramuscular (IM) gold, the second-ranked DMARD. At 4 years, MTX was rated as "good or excellent" by 65%, compared with 53% for combinations, 30% for prednisone, and 11% for hydroxychloroquine, the second-ranked single DMARD. These ratings reflect results of long-term observational studies, but differ considerably from a meta-analysis of results of short-term RCTs, in which the efficacy of MTX, sulfasalazine, penicillamine, and IM gold were indistinguishable. The ratings of US rheumatologists regarding effectiveness of DMARD therapies are in agreement with observational data, but differ substantially from results of RCTs. These findings suggest that observational studies may yield useful and important information about treatment results, which are complementary to, but not available from, the RCT model. Regulatory agencies should consider long-term observational studies as a part of the evaluation of drugs.

US jury and rheumatologists weigh in on silicone

US jury and rheumatologists weigh in on silicone

Correlatives of the Port Huron morainic system of Michigan in Ontario and western New York

<h3>Background:</h3> Mechanical musculoskeletal pathologies put high demands on the Public Health Service, as they affect a significant percentage of the population, and cause both temporary and permanent disabilities. The specialised High Resolution Rheumatology Clinic (CAR in Spanish) at our centre started up in October 2017, and focuses on the diagnosis and treatment of pathologies which are fundamentally of a mechanical ethology. The centre covers a population of approximately 328,868 inhabitants (Álava 2018 census). The aim of our study, carried out at the unit over one year, is to determine the patients’ epidemiological features. <h3>Objectives:</h3> To provide the Primary Care Centres with a “fast–track” and immediate care system in order to guide, diagnose, and treat patients who have worsening acute or chronic mechanical afflictions to the musculoskeletal system. Diagnosis confirmation, request for non–accessible tests, adaptation of treatments mainly for the primary care doctor. To speed up and reduce waiting lists, for both inflammatory rheumatic pathologies and mechanical rheumatic pathologies, by establishing new referral guidelines. To draw up protocols in agreement with primary care doctors and related specialists. To act as a support for other medical services. <h3>Methods:</h3> The main services available are those offered mainly to primary care level. There are 3 clinics a week, attending to approximately 30 new patients per week. 1330 patients are included in the study, seen at the High Resolution Rheumatology Clinic (CAR) over 12 consecutive months (November 2017 – 2018), with non-complex regional pathologies and/or soft tissue rheumatism, which are able to be resolved with one or two visits. <h3>Results:</h3> 1330 patients were seen, with an average age of 58 ±15.6 years, 64.64% female and 35.36% male, mainly for musculoskeletal ailments. In order of frequency, the visits were for shoulder (25.79%), hip (16.10%), axial skeleton (15.13%), ankle/foot (13.06%), wrist/hand (12.08%), knee (11.21%), and elbow (6.63%). 61.95% of the patients were discharged after the first visit, and one year later, this figure rose to 90.15% of all the patients discharged; only 2.78% made a return visit after being discharges. 22.26% were referred to other services, mainly Traumatology and Orthopaedics (10.53%); Rehabilitation and Physiotherapy (8.72%); and the Pain Management Unit (1.65%). The 3.68% were referred to the usual Rheumatology department. For 52.33% of the patients seen, there was no need to request more than one diagnostic tests, even though 12.41% visited for reasons other than the main one. Moreover, 63.08% received some kind of infiltration injection. The negative point was that 7.89% of the referrals had been made from Primary Care to several specialists at the same time; and 7.98% were consultations regarding traumatic injuries. <h3>Conclusion:</h3> Systematising a clinic for mechanical musculoskeletal pathologies which have a high chance of being resolved in the short term, means that the quality of the care given, the waiting times, and the demand on the health service can be improved. Developing these can have important repercussions on waiting lists for other related services, and even for the Rheumatology service itself, allowing more serious cases to be seen earlier. Creating multi-disciplinary units should be encouraged, in order to improve care quality and prevent the various medical services involved from all carrying out fragmented courses of action. New guidelines could be considered, to optimise the care and management of new resources and/or links to other services, as the most prevalent pathologies can be identified. Most of the patients seen represent the economically active part of the population; there are therefore, repercussions as far as sick leave, disability leave, etc. is concerned. <h3>Disclosure of Interests:</h3> Orlando Pompei Fernández: None declared, Susana Gil Barato: None declared, Belén Álvarez Rodríguez: None declared, Juan Ramón De Dios: None declared, Margarida Vasques Rocha: None declared, Claudia Stoye: None declared, Jaime Calvo Consultant for: Bristol-Myers Squibb, Janssen, Celgene, Sanofi Genzyme, Speakers bureau: Bristol-Myers Squibb