BSc, FRCP Anthony D. Woolf (Consultant Rheumatologist, Editor-in-Chief)
{"title":"Introduction How does evidence that is available affect decisions with an individual patient?","authors":"BSc, FRCP Anthony D. Woolf (Consultant Rheumatologist, Editor-in-Chief)","doi":"10.1016/S0950-3579(97)80029-5","DOIUrl":"10.1016/S0950-3579(97)80029-5","url":null,"abstract":"","PeriodicalId":77032,"journal":{"name":"Bailliere's clinical rheumatology","volume":"11 1","pages":"Pages 1-12"},"PeriodicalIF":0.0,"publicationDate":"1997-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/S0950-3579(97)80029-5","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"20039807","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
MA, FRCP Adam Young (Consultant Rheumatologist), MD, PhD Désirée M.F.M. van der Heijde (Assistant Professor of Rheumatology)
{"title":"2 Can we predict aggressive disease?","authors":"MA, FRCP Adam Young (Consultant Rheumatologist), MD, PhD Désirée M.F.M. van der Heijde (Assistant Professor of Rheumatology)","doi":"10.1016/S0950-3579(97)80031-3","DOIUrl":"10.1016/S0950-3579(97)80031-3","url":null,"abstract":"<div><p>This chapter will describe the reasons why prognostic factors that predict aggressive disease are helpful and what the problems are in interpreting studies in this field. A summary of cohort studies on prognosis of patients with early rheumatoid arthritis are presented. This is done separately for studies predicting radiographic damage, functional outcome and mortality. The overall conclusions of these studies and the value they have for the clinician are demonstrated.</p></div>","PeriodicalId":77032,"journal":{"name":"Bailliere's clinical rheumatology","volume":"11 1","pages":"Pages 27-48"},"PeriodicalIF":0.0,"publicationDate":"1997-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/S0950-3579(97)80031-3","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"20039809","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
MD, PhD Ferdinand C. Breedveld (Professor, Head of Department)
{"title":"5 Future treatment","authors":"MD, PhD Ferdinand C. Breedveld (Professor, Head of Department)","doi":"10.1016/S0950-3579(97)80034-9","DOIUrl":"10.1016/S0950-3579(97)80034-9","url":null,"abstract":"<div><p>As the pathophysiology of rheumatoid arthritis (RA) becomes more clearly defined there is the expectation that biotechnological advances may allow additional forms of therapeutic intervention that are specific for the disease process. The purpose of this review is to describe the use of biological agents in the treatment of RA. Encouraging results in animal models using vaccines based on the pathogenic T-cell or the autoantigen have prompted the design of selective immune-based therapies. Preliminary studies following this strategy have not yet shown clinical efficacy. The results of early studies with monoclonal antibodies against leukocyte surface antigen were promising but were not sustained in controlled studies. Exciting data have been collected from placebo-controlled studies of monoclonal antibodies against TNFα. The development of biological agents in RA may not be as quick as expected but the steady progress makes it likely that our weapons to combat unwanted autoimmune responses will become more accurate and effective.</p></div>","PeriodicalId":77032,"journal":{"name":"Bailliere's clinical rheumatology","volume":"11 1","pages":"Pages 83-96"},"PeriodicalIF":0.0,"publicationDate":"1997-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/S0950-3579(97)80034-9","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"20040263","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
MD, MS Gerold Stucki (Assistant Professor of Rheumatology, Physical Medicine and Rehabilitation)
{"title":"6 Specialist management: needs and benefits","authors":"MD, MS Gerold Stucki (Assistant Professor of Rheumatology, Physical Medicine and Rehabilitation)","doi":"10.1016/S0950-3579(97)80035-0","DOIUrl":"10.1016/S0950-3579(97)80035-0","url":null,"abstract":"<div><p>In increasingly cost-conscious, accountable and integrated health-care systems, the appropriate role of speciality care is under scrutiny. The data on the impact of rheumatologist care on outcomes in patients with rheumatoid arthritis (RA) is limited and inconclusive. However, based on a review of processes of care known to be related to superior patient outcomes it is suggested that rheumatologists should be the lead physicians in patients with RA. Rheumatologists but usually not generalists have the experience necessary to make an early diagnosis and to initiate appropriate disease modifying anti-rheumatic drug (DMARD) treatment. Rheumatologists have an in-depth understanding of new assessment methods to optimize medical treatment and to make best use of and co-ordinate multi-disciplinary care. To avoid delay of diagnosis and initiation of treatment, patients with polyarthritis should be referred to rheumatologists as soon as possible. This requires that access to rheumatologist care is guaranteed.</p></div>","PeriodicalId":77032,"journal":{"name":"Bailliere's clinical rheumatology","volume":"11 1","pages":"Pages 97-107"},"PeriodicalIF":0.0,"publicationDate":"1997-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/S0950-3579(97)80035-0","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"20040264","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
MA, MD, FRCP Paul Emery (ARC Professor of Rheumatology, Consultant Rheumatologist) , MD, FRCP Deborah P.M. Symmons (Consultant Senior Lecturer, Consultant Rheumatologist)
{"title":"1 What is early rheumatoid arthritis?: definition and diagnosis","authors":"MA, MD, FRCP Paul Emery (ARC Professor of Rheumatology, Consultant Rheumatologist) , MD, FRCP Deborah P.M. Symmons (Consultant Senior Lecturer, Consultant Rheumatologist)","doi":"10.1016/S0950-3579(97)80030-1","DOIUrl":"10.1016/S0950-3579(97)80030-1","url":null,"abstract":"<div><p>The diagnosis of <em>early</em> rheumatoid arthritis (RA) has inherent difficulties. It requires assessment, not only of the current clinical picture, but of the potential for change. As the pathognomonic feature of RA, is persistence it is not surprising that the American College of Rheumatologists criteria perform better in predicting persistence than severity. An adequate histological/imaging method of diagnosing RA is awaited. In the interim, a pragmatic approach to defining disease has been suggested, which takes a homogeneous group of patients with persistent inflammatory small joint synovitis and secondarily stages them for severity. This proposal is currently being assessed for clinical usefulness.</p></div>","PeriodicalId":77032,"journal":{"name":"Bailliere's clinical rheumatology","volume":"11 1","pages":"Pages 13-26"},"PeriodicalIF":0.0,"publicationDate":"1997-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/S0950-3579(97)80030-1","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"20039808","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
MSc Anke M. van Gestel (Health Scientist), MD, PhD Piet L.C.M. van Riel (Associate Professor of Rheumatology)
{"title":"3 Evaluation of early rheumatoid arthritis disease activity and outcome","authors":"MSc Anke M. van Gestel (Health Scientist), MD, PhD Piet L.C.M. van Riel (Associate Professor of Rheumatology)","doi":"10.1016/S0950-3579(97)80032-5","DOIUrl":"10.1016/S0950-3579(97)80032-5","url":null,"abstract":"<div><p>In rheumatoid arthritis nowadays a more aggressive treatment strategy is followed based on early consistent use of second-line agents frequently given in combination. This approach requires an accurate monitoring of the disease activity to follow the course of the disease and to evaluate therapeutic interventions. International consensus is reached over a core set of disease activity variables, including: a 28-joint count for tenderness and swelling, an acute phase reactant, patient's pain and global disease activity, physician's global disease activity, functional disability and radiographs. Guidelines for measurement techniques need to be further specified. Indices of disease activity are developed to improve the unambiguous interpretation of disease activity and comparability of trial results. These measures can be divided in measures for current disease activity and improvement criteria. Further validation will be necessary to adapt finally a uniform measurement technique. The usefulness of self-administered joint counts needs to be studied further.</p></div>","PeriodicalId":77032,"journal":{"name":"Bailliere's clinical rheumatology","volume":"11 1","pages":"Pages 49-63"},"PeriodicalIF":0.0,"publicationDate":"1997-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/S0950-3579(97)80032-5","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"20039810","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"8 Patient viewpoint: a reconstruction","authors":"MD Abraham G.L. van der Ende","doi":"10.1016/S0950-3579(97)80037-4","DOIUrl":"10.1016/S0950-3579(97)80037-4","url":null,"abstract":"","PeriodicalId":77032,"journal":{"name":"Bailliere's clinical rheumatology","volume":"11 1","pages":"Pages 129-143"},"PeriodicalIF":0.0,"publicationDate":"1997-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/S0950-3579(97)80037-4","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"20040266","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
BSc, MD, FRCP David L. Scott (Reader in Rheumatology)
{"title":"10 Clinical guidelines for management","authors":"BSc, MD, FRCP David L. Scott (Reader in Rheumatology)","doi":"10.1016/S0950-3579(97)80039-8","DOIUrl":"10.1016/S0950-3579(97)80039-8","url":null,"abstract":"<div><p>Guidelines provide explicit recommendations and seek to influence practice using a formal process to disseminate advice on most effective management in the light of scientific evidence. They provide a framework for the evaluation and treatment of common clinical problems, but are not intended to replace clinical judgement. There is considerable variation in rheumatology practice, fuelled by uncertainty about the optimal measurement of disease outcome. Guidelines can help identify and eliminate ineffective or unnecessary care as they are systematically developed statements to assist practitioners and patients' decisions about appropriate health care. There are North American guidelines for: the initial evaluation of adult patients with acute musculoskeletal symptoms, the management of rheumatoid arthritis and the management of osteoarthritis. These are discussed together with proposed guidelines for the management of early rheumatoid arthritis and areas of research into the value of guidelines. It is recommended that future work in this area should: (i) identify aspects of current guidelines which are directly related to outcome; (ii) educate clinicians in these aspects of care; (iii) ensure they are introduced into practice and the outcome of care subsequently improves; (iv) regularly update the guidelines to reflect current opinion. Present guidelines that give broadly similar recommendations from North American and UK perspectives. However, the available evidence all points to large variations between how clinicians practise and how they make their decisions and it may be unlikely that laying down exact recipes for practice will necessarily influence the clinician. Guidelines may appear relevant but they could prove to have very limited utility.</p></div>","PeriodicalId":77032,"journal":{"name":"Bailliere's clinical rheumatology","volume":"11 1","pages":"Pages 157-179"},"PeriodicalIF":0.0,"publicationDate":"1997-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/S0950-3579(97)80039-8","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"20040268","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
MPhil, RGN Jackie Hill (Lecturer, Rheumatology Nurse Practitioner)
{"title":"7 a practical guide to patient education and information giving","authors":"MPhil, RGN Jackie Hill (Lecturer, Rheumatology Nurse Practitioner)","doi":"10.1016/S0950-3579(97)80036-2","DOIUrl":"10.1016/S0950-3579(97)80036-2","url":null,"abstract":"<div><p>Patient education is accepted as an essential component in the management of rheumatoid arthritis (RA) and this chapter provides an overview of patient education for practising clinicians. It includes an explanation of the need for patient education including the results of studies into what patients already know. The effectiveness of patient education and its benefits to patients are discussed in the light of recent research, reviews and meta-analyses. Alternative methods of delivering patient education are compared including, one-to-one teaching, opportunity education, group teaching and self-management programmes. Topics for inclusion in education programmes are suggested and the merits of written literature, audio-visual and computer assisted learning are explained. Practical guidance is given on methods of ensuring that written information is readily understandable by patients, including the use of readability formulae.</p></div>","PeriodicalId":77032,"journal":{"name":"Bailliere's clinical rheumatology","volume":"11 1","pages":"Pages 109-127"},"PeriodicalIF":0.0,"publicationDate":"1997-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/S0950-3579(97)80036-2","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"20040265","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}