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National Collaborating Centre for Chronic Conditions (UK). Rheumatoid Arthritis: National Clinical Guideline for Management and Treatment in Adults. London: Royal College of Physicians (UK); 2009 Feb. (NICE Clinical Guidelines, No. 79.)

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Rheumatoid Arthritis: National Clinical Guideline for Management and Treatment in Adults.

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Evidence Tables

4. Referral, diagnosis and investigations (REFER 1, INVEST, PROG)

REFER 1

INVEST

PROG

Footnotes

1

ASRA = Appraisal of Severity of RA, RAI = Ritchie Articular Index, HAQ = Health Assessment Questionnaire, GARS = Groningen Activity Restriction Scale, GHQ28 = 28-item General Health Questionaire, RSE = Rosenberg Self-Esteem scale, SSQS = Social Support Questionnaire for Transactions, ILRA = Independent Living with RA, OEH = Overall Evaluation of Health, GARA= Global Adjustment to RA

2

Coping refers to the cognitive, emotional and behavioural strategies used in day-to-day attempts to manage the consequences of a disease. Active and passive coping refers to the degree of internal and external control, respectively, that a patient relies on to manage pain. Passive coping strategies include praying, giving up social activities and relying on health professionals for pain relief.

3

10% of patients with poorest outcomes were compared with 10% of patients with best outcomes in univariate analyses in order to determine if the patient profiles obtained were different.

4

Phenobarbitone 2mg was encapsulated with each 125mg and 250mg of DPA in a standard capsule, resulting in a dose of 2mg daily for the first 4 weeks, and 4 mg thereafter. The ratio of phenobarbitone level in the blood to prescribed dose (LDR) was calculated for each patient for each visit.

5

Remission was defined as the absence of clinically active joint disease. Joints were considered active if they were tender to palpation or at extremes of motion, or if there were soft tissue swelling or effusion.

Conversely, we defined relapse as recurrence of active joint disease even if only one joint became involved.

6

Treatment failure was defined as withdrawal irrespective of cause, open treatment with a slow-acting drug, or increase in the dose of prednisolone.

7

Patients were randomly assigned to receive MTX or identical-appearing placebo tablets on the basis of the relative activity of their disease. They were placed into one of three categories of disease activity (mildly active, moderately active, or active) by a clinical investigator who had been following prospectively. Equal number of patients in each of the three categories were then placed in each of the two study groups (two with mildly active disease, tow with moderately active disease, and one with active disease in each group). However, a sub-analysis by category was not performed

8

According to the ARA criteria for clinical remission five of the following six requirements had to be fulfilled: (1) duration of morning stiffness not exceeding 15 min; (2) no fatigue; (3) no joint pain; (4) no joint tenderness or pain on motion; (5) no soft tissue swelling in joints or tendon sheaths; (6) ESR <30 mm/hr for a female or 20 mm/hr for a male.

9

A study flare was defined according to the following generally accepted criteria: firstly three or more swollen joints, secondly tow or more of the following three criteria (a) Ritchie articular index of >9 points, (b) duration of morning stiffness >45 min, (c) ESR > 28 mm/hr for men and >38 mm/hr for women.

10

Patients were randomized into two groups: one of them called the gold group, comprising patients given the same dosage schedule as before the study and the other, called the placebo group, comprising patients given the same dosage schedule as before the study and the other, called the placebo group, comprising patients who received gold in a suspension diluted 1/100

11

The corticosteroid withdrawal was covered, if necessary, by supplementary treatment with aspirin and other analgesics.

12

The clinically important improvement was a ≥40% improvement from baseline in the combined swollen and tender joint count.

13

Active RA was defined by the presence of ≥6 swollen joints, ≥12 tender joints, and one of the following: ESR ≥ 28mm/hr, CRP >20 mg/l, or morning stiffness ≥ 45 min.

Copyright © 2009, Royal College of Physicians of London.

All rights reserved. No part of this publication may be reproduced in any form (including photocopying or storing it in any medium by electronic means and whether or not transiently or incidentally to some other use of this publication) without the written permission of the copyright owner. Applications for the copyright owner’s written permission to reproduce any part of this publication should be addressed to the publisher.

Bookshelf ID: NBK51810

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