Rheumatology
-
Optimizing the use of key non-biologic drugs (MTX, prednisone) may prolong disease control, thereby delaying the need for costly biologic therapies. A number of lessons about the optimal use of therapy emerge from clinical studies. Clinical outcomes with non-biologic treatments, given early in the course of the disease, are as good as with biologic treatments. ⋯ The risk of adverse effects of low-dose glucocorticoids is often overestimated. Administration of low-dose glucocorticoids in accordance with physiological circadian rhythms may bring efficacy and safety benefits. As a case in point, the CAMERA (Computer Assisted Management in Early Rheumatoid Arthritis) II study applied these lessons and has clearly shown the benefits of optimizing MTX and prednisone therapy.
-
To determine patterns on pain diagrams and corresponding diagnoses in patients referred to a rheumatology clinic and their sensitivity, specificity, and positive and negative predictive values (PPV and NPV, respectively). ⋯ Pain diagram patterns may help to increase the likelihood of various rheumatic diagnoses including polyarticular pattern and inflammatory arthritis, and there was high inter-rater reliability. However, testing the value of pain diagrams in addition to a referral note is necessary to determine if they have added value.