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To evaluate the effect of early 'aggressive' drug treatment on radiographic progression in patients with recent-onset rheumatoid arthritis (RA), compared to conventional stepwise increasing intensity of treatment.Prospective follow-up study with an experimental group and a historical control group both divided into a high-risk subgroup and a low-risk subgroup, based on prognostic factors. The effect of the 'aggressive' and the conventional treatment strategy was compared between both high-risk groups; the low-risk groups, both treated according to the conventional treatment strategy, were used to ensure internal consistency between the experimental and the historical groups.A total of 228 consecutive patients with recent-onset RA (complaints < 1 yr at study entry).The 'aggressive' drug treatment consisted of institution of relatively fast-acting disease-modifying anti-rheumatic drugs (DMARDs) (sulphasalazine, methotrexate) immediately after diagnosis, and rapid adjustment of dosage and/or drug in the case of insufficient response as measured by a change in C-reactive protein (CRP) level. Radiographic damage was assessed according to a modified version of Sharp's method and cumulative disease activity expressed as CRP-area under the curve (CRP-AUC). The occurrence of side-effects was also evaluated.After 2 yr of follow-up, comparison of the two high-risk subgroups showed the radiographic progression in the 'aggressively' treated subgroup to be significantly lower than that in the control group [Sharp score: median (range) 26 (0-100) vs 35 (1-188); P = 0.03]. Cumulative CRP values were also significantly lower than in the control high-risk subgroup [CRP-AUC: median (range) 1963 (212-8515) vs 3025 (46-15 632) mg.week/1; P = 0.002). This was achieved without an increase in the occurrence of side-effects. There was no difference between the two low-risk subgroups with regard to entry characteristics, CRP-AUC values or radiological progression, indicating comparability between the two groups.Early 'aggressive' drug treatment, using sulphasalazine and/or methotrexate, aimed at reduction of the CRP level, significantly reduces the (rate of) radiographic progression in RA.
AnnemiekAMEStenger, Pieternella MHoutman,GeorgeAWBruynThepotentialvalueoftheantifolatemethotrexate(N1O-methylaminopterin) in the treatment ofrheumatoid arthritis (RA) was first recognisedin 1951.' Thelow dose drug administration individeddoses 12 hoursapartwasdevelopedforthe treatment ofpatients with psoriasis, basedonpropertiesofpsoriaticepithelial cells andthebiologicalactionofmethotrexateonthesecells.2To date its mode of action has not been wellestablished.3 It is generally believed that lowdose weekly pulses of methotrexate are notmarkedlyimmunosuppressive. Thisis basedonthe
In calcium pyrophosphate (CPP)-associated arthritis, deposits of calcium pyrophosphate lead to acute attacks of painful joint inflammation. The disease may present with signs of systemic inflammation such as fever, mimicking an infectious disease. Early recognition and treatment of this disease can prevent overdiagnosis and joint damage. In this article we describe three different patient cases of CPP-associated arthritis. The diversity of clinical presentation in CPP-associated arthritis can be of interest to different medical specialties who will occasionally encounter them in daily practice.
