The Journal of rheumatology. Supplement
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We live in a culture of evidence-based medicine. Many areas of medicine have embraced this culture. However, for unusual diseases, like the childhood arthritides, there is little evidence. ⋯ The best known are the Pediatric Rheumatology Collaborative Study Group in North America, and the Paediatric Rheumatology International Trials Organization in Europe, South America, and Asia. A new North American collaborative study group has formed--the Childhood Arthritis and Rheumatology Research Alliance (CARRA)--to undertake investigator-initiated clinical trials. These groups might potentially lead the way to a new evidence-based culture for childhood arthritis.
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Nonpharmacological treatments, including physiotherapy and occupational therapy, have assumed a complementary role to drug therapy in managing inflammatory arthritis. Clinicians and researchers are facing 3 major challenges concerning the use of these treatments. First, strong evidence is only present in a few nonpharmacological interventions, such as exercise, patient education, and low level laser in the treatment of rheumatoid arthritis. ⋯ Understanding the relationships among rehabilitation-related variables and disability; 3. Development and evaluation of innovative care models; and 4. Design and evaluation of knowledge transfer innovations.
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Review
Integrating biologic therapy into the comprehensive care of patients with rheumatoid arthritis.
The advent of biologic therapy has not only provided the opportunity for better care of patients with rheumatoid arthritis (RA), but also has permitted a better understanding of the pathogenesis of this autoimmune/inflammatory disease. The capacity of these agents to suppress signs and symptoms as well as radiographic progression of RA strongly indicates that they can alter the course of the disease. Appropriate analysis of the effect of biologics should provide new insight into the role of the specific targeted molecules in rheumatoid inflammation, and provide information about means to optimize therapy with these highly potent therapeutics.