Clinical rheumatology
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Clinical rheumatology · Apr 2020
ReviewTreatment strategies are more important than drugs in the management of rheumatoid arthritis.
The treatment of inflammatory arthritides has been changed dramatically in the past two decades with the introduction of the biological (b) disease-modifying anti-rheumatic drugs (DMARDs) as well as the targeting synthetic (ts) DMARDs that can be used as monotherapy or in combination with conventional synthetic (cs) DMARDs. The concept of treat to target (T2T) and tight control monitoring of disease activity represents a therapeutic paradigm of modern rheumatology. In rheumatoid arthritis (RA), this treatment approach has proven to be effective in many clinical trials and is now a well-established approach. ⋯ The results showed that a tight control strategy appears to be more important than a specific drug to control RA. T2T approach aiming for remission or low disease activity can be achieved in early RA patients using less expensive drugs in comparison to newer drugs and this may need to be recognised in the future recommendations for the management of RA. KEY POINTS: • Tight-control and treat-to-target (T2T) strategies are the cornerstone in achieving remission or low disease activity in rheumatoid arthritis (RA) • A plethora of clinical trials has confirmed the efficacy of csDMARDs when the tight-control and T2T strategies are applied • T2T and tight-control strategies are a less expensive option in comparison to newer drugs and may be recognised in the future recommendations for the management of RA. • Treatment decisions and strategies are more important than just the drugs.
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Clinical rheumatology · Apr 2020
Pain catastrophizing affects stair climbing ability in individuals with knee osteoarthritis.
The association between pain catastrophizing and ability to perform activities of daily living (ADL) requiring weight bearing, in particular stair climbing, standing from a seated position, and walking, in individuals with knee osteoarthritis (OA) is unclear. This study aimed to investigate the association between pain catastrophizing and ability to perform these ADLs by this population. ⋯ Pain catastrophizing in knee OA patients showed significantly decreased stair climbing ability. There is a need to consider the effect of pain catastrophizing in rehabilitation of knee OA patients with decreased ability to climb stairs.Key Points• Pain catastrophizing in knee OA patients showed significantly decreased stair climbing ability.• Ability to stand from a seated position and walk were not affected by pain catastrophizing.• There is a need to consider the effect of pain catastrophizing in rehabilitation of knee OA patients with decreased ability to climb stairs.
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Clinical rheumatology · Apr 2020
ReviewBig data and data processing in rheumatology: bioethical perspectives.
Big data analytics and processing through artificial intelligence (AI) are increasingly being used in the health sector. This includes both clinical and research settings, and newly in specialties like rheumatology. It is, however, important to consider how these new methodologies are used, and particularly the sensitivities associated with personal information. ⋯ They may also increase patient and societal participation and engagement in healthcare and research. Developing these methodologies and using the information generated from them in line with ethical standards could positively affect the design of global health policies and introduce a new phase in the democratization of health. Key Points• Current applications of big data, data analytics, and AI in rheumatology-including registries, machine learning algorithms, and consumer-facing platforms-raise issues in four main bioethical areas: privacy and confidentiality, informed consent, the impact on the medical profession, and justice.• Bioethical concerns about rheumatology registries require careful consideration of privacy provisions, set within the context of local, national, and regional law.• Machine learning and big data aid diagnosis, treatment, and prognosis, but the final decision about the use of information from algorithms should be left to rheumatology specialists to maintain the promise of fiduciary obligations in the physician-patient relationship.• International collaboration in big data projects and increased patient engagement could be ways to counteract health inequalities in the practice of rheumatology, even on a global scale.