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- W2023079206 abstract "In this issue of The Journal , Ciubotariu, et al 1 examine joint damage and progression in patients with rheumatoid arthritis during clinical remission. They report less erosion progression in patients receiving biologic disease-modifying antirheumatic drugs (DMARD) compared to nonbiologic DMARD (nbDMARD). In addition, scores on the Health Assessment Questionnaire-Disability Index (HAQ-DI), a secondary outcome of disability, were better for patients taking biologics than for those taking nbDMARD. Despite the statistically significant differences noted, the changes were very small and one might wish to consider whether statistical differences translate into clinically relevant ones.First, there are issues with the meaning of small changes in radiological progress. Second, there are more basic issues regarding the pathogenetic meaning when radiographs do not change.The minimal clinically important difference in radiographic progression is variable depending on the methods used, ranging from 2.3–5.5 units using the Larsen vs the Sharp/van der Heijde methods2. With changes of only 0.9 (adjusted data) in the biologic DMARD and 1.37 in the nbDMARD groups over 3 years in radiographic progression, it is clear that the differences are far below this number. Even if one assumes a linear change per year (not at all guaranteed), this means that using a difference in the rate of erosion of 0.4 units per year, one would need a minimum of 6–13 years of therapy to reach even a minimal clinically significant difference between treatments, radiographically. If not radiographically different, does this study posit a clinically significant … Address correspondence to Dr. Furst. E-mail: defurst{at}mednet.ucla.edu" @default.
- W2023079206 created "2016-06-24" @default.
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- W2023079206 date "2014-08-01" @default.
- W2023079206 modified "2023-09-23" @default.
- W2023079206 title "Rheumatoid Arthritis: Are Current Research-based Guidelines Clinically Relevant?" @default.
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- W2023079206 doi "https://doi.org/10.3899/jrheum.140352" @default.
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