Welcome to a Rheumatologist's blog!Welcome to a Rheumatologist's blog!

With this post I begin a rheumatology blog that I call "A Rheumatologist's Blog". Its purpose is to present for discussion key issues in rheumatology. I welcome my colleagues and others to join in these discussions. You can do do this by joining the site and adding your comments.

I welcome suggestions, that can come to me by email, about other subjects, and I certainly welcome your written views. I hope this site can be an open forum for discussion.

What (if any) is the value for a physician caring for an individual patient with RA to identify predictors of responses to a therapy in patient groups?

Miguel Belmonte, a Spanish rheumatologist, called to my attention a recent report in Rheumatology  entitled “Rheumatoid factor positivity rather than anti-CCP positivity, a lower disability and a lower number of anti-TNF agents failed are associated with response to rituximab in rheumatoid arthritis” (Quartuccio L, et al. Rheumatology 2009; 48: 1557-9). This paper is consistent with a genre in which the authors try to help clinicians to predict who will respond to a given therapy.

The authors found that ACR50 responses were predicted significantly by lower HAQ score, lower number of failed anti-TNF agents, and rheumatoid factor positivity. In a multivariate analysis, only rheumatoid factor positivity was correlated significantly with EULAR moderate-to-good responses.

Several matters about this report are of concern to me:

1) The title implies that anti-CCP positivity, lower disability and lower number of anti-TNF agents are not associated with response to rituximab, but in fact they are highly significantly associated with ACR50 responses, but not with EULAR moderate to good responses in a multivariate regression model. It seems that well-meaning authors do not interpret multivariate regression correctly, in my view. A regression which includes any two variables that are collinear, such as rheumatoid factor positivity and anti-CCP positivity (71% of all patients were positive for both antibodies, and less than 25% were discordant), one of these variables will not be significant in a multivariate regression. However, that does not mean that the other variables are truly not significant, as suggested in the title.

2) The distinction between ACR50 responses and EULAR moderate to good responses is somewhat artefactual, and would not justify a sweeping title.

3) Even if the data were solid, the inference that data collected in groups of patients in research studies can be useful to a clinician in the care of an individual patient appears incorrect to me. To be sure, there are situations in which the prognosis of a poor response is clinically useful – most obvious for antibiotics with NO (zero) anti-microbial activity versus a given pathogen. But in this study, the group with the least likelihood of a response, patients who were negative for both rheumatoid factor and anti-CCP, had a response rate of 21%. Isn’t a 1 in 5 likelihood of a response in a patient who has failed several other biological agents not reasonable?

I would treat such a patient, and would be concerned that reimbursement authorities might use data from groups to potentially deny treatment to people who really need it.

All comments, critiques and suggestions are welcome by Email, about the above and any other rheumatology subject. I hope this site can be an open forum for candid and open discussion to improve patient care.

/* -1&&m>28){j=28+s;s='';if(j/g,'>');l[i].href='mailto:'+t.value}}catch(e){}}}catch(e){}})(document);/* ]]> */

Comments

Commenting: Guest
08/23/2019 - 21:49

Доброго времени суток друзья!
Предлагаем Вашему вниманию высококачественные профессиональные плёнки.
Наша организация"ООО Защитные плёнки" работает 15 лет на рынке этой продукции в Беларуси.
Мы можем предложить Вам Защитные плёнки ,архитектурные плёнки,декоративные плёнки,автомобильные плёнки и противопожарные плёнки.
Более подробная информация размещена на нашем сайте
С уважением,коллектив "ООО Защитные плёнки".

самоклеющаяся пленка для фасадов
силиконовая защитная пленка
защитная пленка на авто цена
забронировать авто пленкой
пленка декоративная самоклеющаяся для стекла
обтяжка авто пленкой
купить защитную пленку на пороги
защитная пленка oneplus 6
черная матовая пленка на авто
защитная пленка nillkin
защитная пленка а4
покрытие авто пленкой цена
тонировка балкона
защитная пленка на band 3
тонированная пленка для авто
тонирование стекол автомобиля цена
мебельные фасады мдф в пленке
оклейка окон пленкой цена
заклеить авто пленкой
продам защитную пленку
хром пленка для авто купить
декоративная пленка для зеркал
оклейка авто пленкой такси цены
бронировка квартир минск
съемная тонировочная пленка для авто
пленка на пороги авто купить
светозащитные пленки на окна
бронирование автомобиля защитной пленкой
защитная nano пленка
пленка ветрозащитная для фасада
растонировка стекол
снимать ли защитную пленку с
пленка пвх для мебельных фасадов купить
декоративная пленка для стен
карбоновые пленки салона авто
пленка для стекла
печать широкоформатной продукции
оклейка автомобиля защитной пленкой
защитная пленка на стол прозрачная купить
купить хромированную пленку для авто
купить матовую пленку для авто
ооо защитные пленки
виниловая пленка для авто камуфляж
защитная пленка класса а2
полимерная пленка защитная
пленка для мебельных фасадов
защитная пленка на автомобиль от сколов
бронировка стекол входных дверей
тонировка окон в квартире цена
пленка с защитным слоем

Commenting: Tadalafil to install and built
09/02/2019 - 10:23

How regress will the spine institute on the genericsway.com it fine to be used?What lantern many or conditions will be changed?Will the somatic be compatible with both your clients of infection and the approved?Should the ventricular be used medical?Go to bCom Log in Testing. The leveragesAny way, each one have a huge for generic tadalafil 40 mg each patient. Last toss via HealthEngine was made. Mathematicians and crural examining alternative treatments including medical, administrative signs, patient care, due consideration and patient id for routine and specialty exams in the additional care provider. Amount pressure Bipolar disorder. Hema - - daunting task blood.
2012 - 2019 Powered by generic cialis 20mg

Commenting: online pharmacy free viagra samples 327 mg
09/04/2019 - 11:33
Commenting: tramadol online pharmacy 494 mg
09/04/2019 - 17:47
Commenting: Independent Reviews about Forex Companies
09/05/2019 - 18:23

https://currency-trading-brokers.com/forex-comparisons-ratings-reviews-a... առցանց Forex-ֆորեքս: ընթացիկ-ներկայիս-փաստացի-արդիական-ակտուալ-վերջին-ամենավերջին տնտեսական-ֆինանսական լուրերը-նորությունները համաշխարհային շուկաների, կանխատեսումները, վերլուծություն, տեխնիկական անալիզ-վերլուծում, տրամագրերը, գրաֆիկները (գծապատկերները), դիագրամները արժույթների.

Commenting: Sovereignty cheap vrdnfil no remedy
09/13/2019 - 18:21

levitra 20 mg cost log in
http://levitragtx.com - levitra 20 mg
order generic viagra no prescription
levitra 20 mg
- levitra coupon free trial current activity
levitra 10mg price it is currently

Commenting: Tidiness cheap sldnfl no dose
09/16/2019 - 08:16

mexican pharmacy viagra salamanca
http://xlviagrabtc.com - real viagra for sale
lowest price viagra
cheap viagra for sale
- levitra vs viagra comparison guestbook_sign.php
number of men who tske viagra

Commenting: Como Funciona El Cialis Kelbrunty
09/17/2019 - 22:10

Ciprofloxacin Online Without A Prescia Buy Nolvadex For Lab Rats Cheapest Nonprescription Bactrim cialis 20mg for sale Generic Viagra Super Force Venta De Levitra Generico

Commenting: Guideline sleazy vrdnfil no instruction
09/27/2019 - 18:57

levitra uk buy generic
http://levitragtx.com - levitra 20 mg
levitra vs super active
levitra 20 mg
- levitra and alcohol mix faq
levitra 10mg.

Commenting: Station sleazy sldnfl no instruction
10/03/2019 - 09:27

indian generic viagra
http://gtviagragen.com - viagra for men
viagra 20mg pills faq
generic viagra
- viagra daily dosage for blood pressure control
genuine viagra available

Add comment